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Managemen  Terapi

 Transfusi

Kuliah Anestesiologi

Dr.Bambang Suryono S.

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Indications for transfusion therapy

•A. Anemia•  Estimated allowable blood loss (EABL) :

• EABL=(Hct starting – Hct allowable)

•   xBV/Hct starting• Estimating te !ol"me o# blood to

trans#"se

•  Vol"me to trans#"se =(Hct desired –Hct

•   $resent) x BV/Hct trans#"sed blood

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Indications....

• B. %romboc&to$enia

• '. 'oag"lo$at&

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Managemen eilangan dara

• 1.Estimated blood !ol"me (EBV)•   *100-120 ml/kg premature

infant 

•  *90 ml/kg full-term infant •   *80 ml/kg infants 3 to 12 months

•   *70 ml/kg thereafter 

• .*e$lace !er& + ml blood loss wit, 

•   ml cr&stalloid or + cc -*B'

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Managemen......

• ,. -*B' : + "nit -*' increases Hct•   abo"t , and Hb abo"t + g/dl

, ml/g -*' increases Hb abo"t +

g/dl +0 ml/g -*B' increases Hct abo"t

+0

• 1. Max allowable blood loss =

•   2EBV x (Hct – target Hct)3/Hct 

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Managemen......

• 4. Fluid replacement equialents

• 'r&stalloid : , cc/+ cc estimated

blood•   loss (EBL)

• 'olloid : +cc/cc EBL

• 4ole blood : + cc/cc EBL• -aced red blood cells : 5 cc/cc

EBL

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'om$atibilit& testing

• +. %&$e s$eci6c :AB78* 99.• . %&$e and screen :AB78*

;<creen

•   99.91 com$atible

• ,.%&$e and crossmatc :AB78*

•   screen and crossmatc :99.9>

• 1. <creening donor blood

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Blood component therapy

• *Whole blood : 4! "ct

• *#ac$ed red blood cells %#&B'(: ) +

•   , ml "ct -/! incr. 0dult "b 1

gdl

• *#latelets

• *2resh fro3en plasma %22#( : ) mlbag

• *'ryoprecipitate : 1) mlbag

• *0lbumin

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'omplications of transfusions

• 0.&is$ factors• Minor allergic reactions

(#e!ercillsras)

•   +8 >:+00• ?on#atal emol&tic trans#.

*eactions

•   +:@.000

• AB7 incom$atibilit& +:,,.000

• Ana$&lactic soc +: >00.000

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'omplications.....

• *2atal hemolytic transf. &eactions :•   1:. to /.

• *"I infection : 1:4. to 55.

•"epatitis : "ep. 0 1:1 million•   "ep. B 1:,. to ).

•   "ep. ' 1:,. to 1.

• *Bacterial contamination

•   &ed cells 1:. #latelet 1:1).

• *0cute lung in6ury 1:.

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'omplications......

• ). Transfusions reactions• ebrile reactions

• Allergic reactions

• Ana$&laxis

• Ac"te emol&tic trans#"sion reactions

• ela&ed emol&tic trans#"sionreaction

• Cra#t !s ost disease• %rans#"sion related ac"te l"ng inD"r&

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 Treatment of hemolytic transfusionreactions

*7top the transfusion*Maintain urine output -1 mlhr by

  administer 8uids i.9

  possibly mannitol 1). + gram1 minutes

  If ineecti9e  furosemide )4 mg i9

*0l$alini3e the urine bicarbonate natr.

*0ssay urine and plasma "b concentration*&eturn unused blood antibody screen ;

direct antiglobulin test

*#re9ent hypotension

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'omplications....

• ,.Metabolic abnormalities

• ecreased $H

• ncrease $otassi"m• ecrease ., -C

• 'itrate toxicit&

• 1. Microaggregates• >.H&$otermia

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'omplications.....

• 5.'oagulopathy disorders

*A#ter massi!e trans#"sion (F+0

"nits)il"tional tromboc&to$enia

Low actors V and V

isseminated intra!asc"larcoag"lation

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<isseminated intra9ascularcoagulation

• ..is &$ercoag"lable stateca"sed b& acti!ation o# teclotting s&stem leading to

de$osition o# 6brin inmicro!asc"lat"re wic ca"sesa secondar& acti!ation o#6brinol&sis res"lting incons"m$tion o# #actors and$latelets

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Massi9e transfusions

• Massi!e trans#"sion is de!nedas the replacement of a patient"stotal #lood olume in less than 2$hours% or as the acuteadministration of more than halfthe patient"s estimated #loodolume per-hour 

•  **Thrombocytopenia

•  **'lotting factors

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'onser9ationsal9age techni=ues

• A. A"tologo"s donation• B. so!olemic emodil"tion

• '. 'ell sa!er/sca!enger

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7pecial considerations

• A. 'lassic emo$ilia oremo$ilia A

• B. Hemo$ilia B or 'ristmas

disease• '. Von 4illebrandGs disease

• .<icle cell anemia

• E. eo!aGs 4itness $atients