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Blood Transfusion
Titis Kurniawan
Transfusi Darah
Adalah; Tindakan memasukan produkdarah (whole blood, PRC, Trombosit,plasma, dll) melalui pembuluh darah venapasien
Tujuan: Memenuhi volume sirkulasi
Meningkatkan kadar Hb dan protein serum
Mengganti komponen darah
Diberikan pada pasien yang mengalamiperdarahan, anemia, kelainan darah
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Blood Components
Prepared from Whole bloodcollection or aphaeresis
Whole blood is separated bydifferential centrifugation Red Blood Cells (RBCs)
Platelets
Plasma
Cryoprecipitate Others include Plasma proteins
Coagulation Factors, albumin,Anti-D, Growth Factors, Colloidvolume expanders
Differential CentrifugationFirst Centrifugation
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2
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Differential Centrifugation
Second Centrifugation
Whole Blood
Storage
4for up to 35 days
Indications
Massive BloodLoss/Trauma/Exchange Transfusion
Considerations
Use filter as platelets and coagulation
factors will not be active after 3-5days
Donor and recipient must be ABOidentical
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RBC Concentrate Storage
4for up to 42 days, can be frozen
Indications Many indicationsie anemia, hypoxia, etc.
Considerations Recipient must not have antibodies to donor
RBCs (note: patients can develop
antibodies over time) Usual dose 10 cc/kg (will increase Hgb by
2.5 gm/dl)
Usually transfuse over 2-4 hours (slower forchronic anemia
Platelets Storage
Up to 5 days at 20-24
Indications Thrombocytopenia, Plt
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Plasma and FFP
ContentsCoagulation Factors (1 unit/ml)
Storage
FFP--12 months at 18 degrees or colder
Indications
Coagulation Factor deficiency, fibrinogenreplacement, DIC, liver disease, exchangetransfusion, massive transfusion
Considerations
Plasma should be recipient RBC ABOcompatible
In children, should also be Rh compatible
Account for time to thaw
Usual dose is 20 cc/kg to raise coagulationfactors approx 20%
Cryoprecipitate Description
Precipitate formed/collected when FFP isthawed at 4
Storage
After collection, refrozen and stored up to 1year at -18
Indication
Fibrinogen deficiency or dysfibrinogenemia
vonWillebrands Disease
Factor VIII or XIII deficiency
DIC (not used alone)
Considerations
ABO compatible preferred (but not limiting)
Usual dose is 1 unit/5-10 kg of recipient bodyweight
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Prosedur Transfusi
Hampir = Prosedur Pemasangan Infus
Persiapan Alat:Standar Infus Set TransfusiBotol berisi NaCl 0,9% PengalasTorniket Kapas alkoholPlester GuntingKassa steril BetadineProduk darah Sarung tanganIV Catheter no
Persiapan Pasien; Posisi, Informed consent,kesiapan, kerjasama yg diharapkan, Do & Dontselama transfusi dijalankan,
Persiapan Lingkungan; pencahayaan, privasi,keamanan
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Prosedur Transfusi
Pre transfusi; compatibility test/cross match
Crossmatch testing the patients plasma against a sample ofred cells from the actual unit that has been selected for transfusion.
Immediate spin: patients plasma is mixed with donor red cells andobserved for immediate agglutination and/or haemolysis (A,B,Ocheck) at room temperature ( 5 minutes)
Full crossmatch: (or Coombs Crossmatch): patients plasma ismixed with donor red cells and incubated at 37oC. Anti IgG isadded and a check is made for the presence of agglutination ( 40minutes)
Electronic crossmatch: a patient has an ABO, Rh, and antibodyscreen performed. If the antibody screen is negative, the computerassigns an ABO compatible unit to the patient from the Blood Bankinventory.
Results; Clothing (Incompatibility) or Not-Clothing (compatible )
..Prosedur TransfusiShort Review Sistem ABO
System ABO, 4 macam golongan darah berdasarkan senyawaAglutinogen dan Aglutinin dalam darah.
Aglutinogen; senyawa protein darah yang terdapat pada sel-sel darah merah dan berfungsi sebagai antigen aglutinogenA dan aglutinogen B.
Aglutinin; protein yang terdapat dalam plasma darahberfungsi antibody
Golongan darah Aglutinogen dalamSel darah merah
Aglutinin dalam Plasmadarah
A A (anti B)
B B (Anti A)
AB A & B -
O - dan
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..Prosedur TransfusiImportant Points;
Solution; NaCl 0,9% except intravenous immune Globuline(IVIG) must be delivered with 5% Dextrose in Water (D5W)
No medication infused in the line
Needle size;
The largest possible catheter should be used
Neonate, pediatric, chronically transfused patients RBCs canbe safely administered through 22, 24 or 26-gauge needle
Adult; 18 to 20-gauge catheter is recommended
Set changed (American Vascular Access Assoc); At least every 4-6 hours after completion of transfusion After 2 units of packed cell
Platelet must not be transfused after packed cell
PRC, Platelet, Cryoprecipitate bag must be invert several time to ensurere-suspension
Transfusion Flow Rate
Packed Cells: Initial rate of 50mL/hr for the first 15 minutes. If thepatient tolerates this "test dose", the rate may be increased so that theremainder of the unit is given within 2 hours.
Platelets and plasma products: Transfuse slowly (50mL/hour) for thefirst 15 minutes, monitor the patient closely and then platelets or 1 unit of
plasma is generally infused over 60 minutes.
25% albumin should NOT be infused faster than 2mL/minute as itdraws fluid from extravascular space into venous circulation, and maycause fluid overload.
IVIG should be infused at an initial rate of 0.01-0.02mL/ kg/minutewith a gradual increase to 0.06mL/kg/minute if tolerated well.
,
..Prosedur Transfusi
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.Prosedur Transfusi Pelaksanaan
Cuci tangan
Cek program transfusi (jumlah & jenis produk darah serta hasil cross match)
Siapkan transfusi set
Sambungkan transfusi set dengan botol NaCl 0,9%
Isi chamber dan alirkan NaCl ke dalam slang dan pastikan seluruh slang
terisi cairan NaCl (tidak ada gelembung udara)
Kaji area insersi IV catheter
Disinfeksi
Insersikan IV catheter dengan benar
Sambungkan IV catheter dengan slang transfusi set
Alirkan dan cek kelancaran aliran cairan NaCl
Fiksasi area insersi dan IV line dengan benar
Siapkan Produk darah yang akan ditransfusikan
Matikan aliran slang dan ganti botol NaCl dengan Kantong produk darah
Hitung tetesan sesuai kebutuhan dengan benar
.Prosedur Transfusi
Monitoring Vital Sign
Vital Signs include temperature, pulse, respiration rateand blood pressure.
Vital Signs must be taken before the transfusion ofall blood products.
Vital Signs should be repeated at minimum: 15 minutes after infusion has started
Following transfusion
The Vital Signs should also be repeated at intervals
during transfusion:
As per specific Clinical Service flowcharts/policiesor patient care order
If the transfusion is longer than 2 hours
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.Prosedur Transfusi
Evaluasi
Cek respon klien; nyeri, menggigil, gatal-gatal, dll
Cek kelancaran aliran IV line (darah)
Cek Kepatenan fiksasi
Dokumentasi
Jumlah dan jenis produk darah (termasuk golongan
darah) yang diprogramkan
Persediaan darah
Waktu pemasangan
Transfusion Complications
Acute Transfusion Reactions (ATRs)
Chronic Transfusion Reactions
Transfusion related infections
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Acute Transfusion Reactions Hemolytic Reactions (AHTR)
Febrile Reactions (FNHTR)
Allergic Reactions
Coagulopathy with Massive transfusions
Bacteremia
Acute Hemolytic Transfusion Reactions (AHTR)
Occurs when incompatible RBCs are transfused into a recipient whohas pre-formed antibodies (usually ABO or Rh) Antibodiesactivate the complement system, causing intravascularhemolysis
Symptoms (fever, chill, hypotension, oliguria, dark urine, abdominal/
back pain, dispnea, pallor) occur within minutes of starting thetransfusion
This hemolytic reaction can occur with as little as 1-2 cc of RBCs
Labeling error is most common problem
Can be fatal
Treatment; STOP, maintain IV fluid (RL/NS), maintain/monitorVS, give diuretic, send back the remaining blood to blood bank
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Febrile Nonhemolytic Transfusion Reactions
(FNHTR)
Definition--Rise in patient temperature >1C (associa ted withtransfusion without other fever precipitating factors)
Occurs with approx 1% of PRBC transfusions and approx20% of Plt transfusions
FNHTR caused by alloantibodies directed against HLAantigens
Need to evaluate for AHTR and infection
Treatment; STOP, antipyretic, steroid, narcotic (if severchilling)
Allergic Nonhemolytic Transfusion Reactions
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Bacterial Contamination
( )
(+) , /
,
( )
Chronic Transfusion Reactions
()
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Transfusion Associated Infections
,