transfusi darah-kuliah s1.ppt
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Transfusi darahTRANSCRIPT
TRANSFUSI DARAH
Abdul Salam M. Sofro
Fakultas Kedokteran
Universitas YARSI Jakarta
Sejarah transfusi
Transfusi pertama kali tercatat pada th.1665, ketika Richard Lower di Oxford menstransfusikan darah dari anjing ke anjing lain. Dua tahun kemudian Dr. Jean Denis, dokternya raja Louis XIV di Paris melakukan transfusi pertama pada manusia ketika dia memberikan sejumlah darah domba ke anak muda yang demam.
The first recorded transfusion was in 1665, when Richard Lower transfused blood from one dog to another in Oxford. Two years later in Paris Louis XIV's physician, Jean Denis, performed the first transfusion involving a human when he gave some lamb’s blood to a feverish youth. (Denis thought lamb’s blood was healthy as the animal would not have done any evil deeds.) Amazingly, the boy recovered. Some months later, however, a man died in Paris after Denis gave him blood from a docile calf to cure his madness. Countries banned transfusions, and it was nearly 200 years before doctors risked the procedure again.
Herannya anak tadi sembuh Beberapa bulan kemudian Dr. Danis
memberi darah anak sapi ke pasien laki-lakinya yang gila (untuk mengobati gilanya), tetapi pasien tadi meninggal.
Selama hampir 200 th kemudian transfusi darah tidak dilakukan.
200 tahun kemudian: Transfusi darah pertama kali di Irlandia
Maret 1865, Mary Ann Dooley gadis umur 14 th kena tetanus. Pengobatan dengan tembakau, kloroform dll gagal.
Akhirnya Dr Robert McDonnell memutuskan untuk
memberikan darahnya pada 20 April di Dublin’s Jervis Street Infirmary. Dia ambil darah dari lengan kirinya, mengaduknya kemudian memasukkannya ke vena lengan kiri gadis tersebut dengan menggunakan syringe dan piston.
The Nobel Prize in Physiology or Medicine 1930
"for his discovery of human blood groups"
Karl Landsteiner
Austria
Rockefeller Institute for Medical Research New York, NY, USA
b. 1868d. 1943
Structure of RBC membrane
ISBT Human Blood Group Systems
ISBT Number Name Abbreviation
001 ABO ABO
002 MNS MNS
003 P P
004 Rh RH
005 Lutheran LU
006 Kell KEL
007 Lewis LE
008 Duffy FY
009 Kidd JK
010 Diego DI
011 Cartwright YT
012 XG XG
013 Scianna SC
014 Dombrock DO
015 Colton CO
016 Landsteiner-Wiener LW
017 Ch ido/
Rodgers CH/RG
018 Hh H
019 Kx XK
020 Gerbich GE
021 Cromer CROM
022 Knops KN
023 Indian IN
024 Ok OK
025 Raph RAPH
026 JMH JMH
Unassigned
027 IGNT
028 P
029 GIL
Apa itu transfusi darah?
Transfusi darah adalah pemindahan (transfer) darah atau komponen darah dari seseorang (donor) ke orang lain (resipien) lewat aliran darah.
Dapat dilakukan sebagai tindakan menyelamatkan nyawa untuk mengganti sel-sel darah atau komponen darah yang hilang lewat perdarahan
Yang paling aman?
Transfusi darah sendiri (autologous) adalah cara paling aman, tetapi memerlukan
perencanaan yang baik dan belum tentu dapat dilakukan pada semua pasien
Bahwa pada hakekatnya Transfusi Darah merupakan tindakan medis transplantasi yang dapat menjadi penyelamat jiwa dan melibatkan petugas medik, penyumbang darah dan penerima darah.
Blood collection
Quality and safety in Blood Transfusion Practice
In Blood Transfusion Practice
Blood = Medicine / Drug 1 unit of blood can save 1 – 3 Needs Professionalism, and the blood should be
Standardized Medical procedure considers risks (+) : - Donor: pain, hematoma, hemodynamic disturbance - Patient: blood transfusion complications
Sickness
Recovered
When we are sick
BLOOD TRANSFUSION COMPLICATIONS
ACUTE Blood Transfusion Reaction: - intravacular hemolysis (hemodynamic disturbance, respiration, acute renal failure, DIC) - fever, allergy - hypervolume, transfusion related acute lung injury (TRALI) - sepsis bacteria, etc LATE Blood Tranfusion Reaction: extra vascular
hemolysis, TTI (transfusion transmissible infection), etc
Can be PREVENTED
Can be FATAL
Transfusion Reactions
Immediate Delayed
Hemolytic Non-hemolytic
HemolyticTransfusion
Reaction
Febrile Allergic Hypo-calcemia
Hyper- Kalemia & Acidosis
Acute Lung Injury
Infections Allergic
Category 2: Reaksi sedang
Flushing Urticaria Rigors Fever
Restlessness Tachycardia
cemas gatal deg-degan dg sesak nafas ringan Sakit kepala)
Category 1: Mild Reactions
Urticaria/rash gatal-gatal
Category 3: Life threatening reactions
Rigors
Fever Restlessness Hypotension Tachycardia Dark Urine Unexplained bleeding
(DIC)
Bingung sakit dada sakit pada tempat
infus distress pernafasan sakit pinggang sakit kepala sesak nafas
Reaksi transfusi cepat
Reaksi demam Reaksi Urticarial (Allergic) Reaksi alergi berat (Anaphylactic) Reaksi haemolitik akut Kontaminasi Bakteri Kerusakan paru akut terkait transfusi Kelewat beban volume Hipothermia Toksisitas sitrat Efek Potasium
Reaksi Transfusi tertunda & jangka panjang
Haemolisis tertunda Alloimunisasi Penyakit Graft Versus Host terkait
transfusi Pengaruh immunomodulasi Penimbunan zat besi Transmisi penyakit infeksi
COMPLICATIONS of ALLOGENEIC BLOOD TRANSFUSION (USA)
Risks Prediction of risks / unit of transfused blood 1. INFECTIONS:Hepatitis B 1 in 63,000Hepatitis C 1 in 103,000HTLV I and II 1 in 641,000HIV1 1 in 1,100,000
2. TRANSFUSION REACTIONS:Febrile reactions 1 in 500Allergic cutaneous reactions 1 in 200Anaphylaxis 1 in 150,000Acute hemolytic reactions 1 in 250,000
Risk factor Estimated frequency per unit transfused Deaths per million units
Acute haemolytic reactions 1 in 250 000 to 1 in 1 000 000 0.67
Hepatitis B 1 in 100 000 to 1 in 400 000* <0.5
Hepatitis C 1 in 3 000 000 <0.5
HIV 1 in 4 000 000 <0.5
Bacterial contamination of red cell concentrates
1 in 500 000 <0.25
* Data from Kate Soldan, National Blood Service and Central Public Health Laboratory.
Data from Dr Pat Hewitt and Dr John Barbara, National Blood Service, North London.
Risks of red blood cell transfusion (adapted from British Committee for Standards in Haematology
(2001)
Virus and testing standard
Window Period (Days)
Point estimate of residual risk 'per unit'
HIV 1 and 2 antibody only 22 1 in 2,404,000
HIV antibody + NAT 9 1 in 7,299,000
HCV antibody only 66 1 in 300,000
HCV antibody + NAT 7 1 in 3,663,000
HBV 45 1 in 1,339,000
HTLV I & II 51 Considerably less than 1in 1,000,000
vCJD Possible, not yet reported in Australia
Taksiran IMLTD dari Medilink, ARCBS October 2004.
SERIOUS HAZARD of TRANSFUSION (SHOT): Overview of 618 cases: initial reports forms were received 1996 – 1999 (United Kingdom)
Incorrect blood/components transfused 335 (54,2 %) Acute transfusion reaction 89 (14,4 %) Delayed transfusion reaction 82 (13,3 %) Post transfusion purpura 32 (5,2 %) Transfusion related acute lung injury (TRALI) 43 (7%) Transfusion-associated graft versus host disease 11
(1,8%) Transfusion transmitted infection 19 (3 %) Unclassified 7 (1,1 %)
Jadi perlu:
Pemeriksaan laboratorium IMLTD
Pemeriksaan golongan darah
Uji silang serasi
EVOLUSI DALAM DETEKSI INFEKSI MENULAR LEWAT TRANSFUSI DARAH
Viral & BacterialRNA/DNADetection
Viral Antigen Detection
AntibodyTesting
SurrogateMarker
Serum ALT
T-cell count
Syphilis Reagin Test
Anti-HIV
Anti-HBCore
Anti-HCV
Anti-HTLV
HIV-1 p24 Ag
HBsAg
HCV Ag
NAT HIV-1 HCV WNV HBV Malaria Chagas Disease vCJD
Shorter window period to detection
Parvo B19
HAV
Bacterial RNA
Under Development
Plasma Industry Requirement
PELAKSANAAN UJI SARING
1975: Sifilis 1985: Hepatitis B (HBsAg) 1992: HIV (Anti-HIV) 1995: Hepatitis C (Anti-HCV)
Apa anjuran / rekomendasi dalam transfusi darah?
Gunakan Strategi
terintegrasi WHO
Strategi terintegrasi WHO
Didirikannya pelayanan transfusi yang terkoordinasi secara nasional dengan sistem yang setara di semua daerah.
Pengambilan darah hanya hanya dari donor darah sukarela bukan bayaran dari kelompok populasi berisiko rendah
Penapisan (screening) semua darah donasi terhadap penyakit infeksi menular lewat transfusi darah (IMLTD) termasuk Human Immunodeficiency Virus (HIV), virus hepatitis, syphilis and agen infeksi lain
dan praktik laboratorium yang bagus (good laboratory practice = GLP) dalam semua aspek penggolongan darah, uji kompatibilitas, preparasi komponen, penyimpanan dan transportasi darah serta produk darah.
Pengurangan transfusi yang tidak perlu lewat penggunaan klinis darah dan produk darah yang tepat, dan penggunaan alternatif transfusi yang sederhana, bila dimungkinkan.
APPROPRIATE USE of BLOOD / BLOOD PRODUCTS (COMPONENTS)
1. Transfusion of safe blood products only to treat a condition leading to significant morbidity or mortality that cannot be prevented or managed effectively by other means (It’s contraindicated if no strong indications of BT)
2. Transfusion carries the risk of adverse reactions and transfusion-transmissible infections (TTI)
Cont.
3. Blood donated by family/replacement
donors carries a higher risk of TTI
than blood donated by voluntary
non-remunerated donors
4. Blood should not be transfused unless
it has been obtained from
appropriately selected donors
Cont.
5. Need of transfusion can often be avoided by:
prevention / early diagnosis / treatment of
conditions that cause ANEMIA
6. Blood is often unnecessarily given:
- to raise a Hb level before surgery
- to allow earlier discharge from hospital
Correction of anemia
Replacement of depleted iron stores
before planned surgery
Cont.
7. WB, PRC or FFP:
- often given for ACUTE BLOOD LOSS
- other treatments (normal saline / IV
replacement fluids) would be safer,
less expensive & equally effective Simple alternatives to transfusions
(e.g. IV replacement fluids): safer, less expensive, may be equally effective
Factors Determining the Need for Transfusion
Blood loss Haemolysis Cardiorespiratory state and tissue
oxygenation Assessment of anemia Patient’s tolerance of blood loss and/or
anemia Anticipated need for blood
Prediction of Blood Loss based on Early Clinical Findings inPrediction of Blood Loss based on Early Clinical Findings in Male with Body weight of 70 KgMale with Body weight of 70 Kg(2)(2)
ParametersParameters Class I Class I Class II Class II Class III Class III Class IV Class IV
Blood loss (ml) to 750 750 – 1500 1500 – 2000 > 2000
Blood loss to 15 % 15 – 30 % 30 – 40 % > 40 %(% volume )
Pulse rate (minute) < 100 >100 > 120 > 140
Blood pressure (mmHg) normal normal decreased decreased
Resp. rate (minute) 14 – 20 20 – 30 30 – 40 > 35
Urine prod. (ml/hr) > 30 20 – 30 5 – 15 none
CNS/mental restless - restless - restless & restless &status mild moderate confused lethargic
Fluid replacement cristaloid cristaloid cristaloid & cristaloid & (based on 3:1 rule) blood blood
Based on: The American College of Surgeon Committee on Trauma(2)
TransfusionProvides guidelines on transfusion in gastrointestinal bleeding
SEVERITY OF BLEED
CLINICAL FEATURES
IV INFUSION / TRANSFUSION
END POINT
1. Mild bleed Pulse and haemog lobin normal
Maintain intravenous
access until diagnosis
is clear Ensure blood is available
2. Moderate bleed Resting of pulse > 100/min
and/or
Haemoglobin <10 g/dl
Replace fluid Order compatible red
cells (4 units)
Maintain Hb > 9 g/dl*
3. Severe bleed History of collapse
and/or
Shock Systolic BP <100
mmHg Pulse > 100/min
Replace fluid rapidly Ensure blood is available Transfuse red cells
according to clinical
assessment and Hb/Hct
Maintain urine
output > 0.5
ml/kg/hour Maintain systolic
BP > 100 mmHg Maintain Hb
> 9 g/dl*
* Until you are confident that the patients is not likely to have a further large bleed. The patient
may need to be referred for surgical intervention , once resuscitated
Tambahan informasi
KONGRES NASIONAL I KEDOKTERAN TRANSFUSI DAN
PEMBENTUKANPERHIMPUNAN DOKTER
TRANSFUSI DARAH INDONESIA (PDTDI)
Manado, 15-18 Juli 2003
KONGRES NASIONAL IIPERHIMPUNAN DOKTER
TRANSFUSI DARAH INDONESIA (PDTDI)
JAKARTA, 19 – 20 SEPTEMBER 2006
Teman-teman sepakat membentuk perhimpunan
PDTDI secara resmi dikukuhkan sebagai organisasi se-okupasi di bawah IDI dalamMuktamar IDI ke XXVI di Semarang 29 November – 2 Desember 2006
Dewan Penasehat
Prof.DR.Dr.S.Moeslichan, SpAKProf.DR.Dr.Ag. Sumantri, SpAKProf.DR.Dr.AA.Sudewa Jelantik, SpPK(k)Dr.Auda S Azis,Sp.KTDr.Masri Rustam, Sp.KTProf. DR.Dr.Suparyatmo, SpPK(k)
PENGURUS PUSAT
Ketua Umum
Prof.Dr.Abdul Salam M Sofro, PhD., Sp.KT
Ketua Bidang Kerjasama &
Pembinaan Masyarakat
Dr.Yuyun SM Soedarmono, MSc, Sp.KT
Ketua Bidang Pengembangan Organisasi
Dr.H.Titis Wahyuono
Ketua Bidang Pengembangan SDM
Dr. Sani Sanjaya
Sekretaris Umum Dr.Franckie RR Maramis, PKK, Sp.KT
Wakil Sekretaris Dr. Nova Surya Indah Hippy
Bendahara Umum Dr.Chairul Amri
Wakil Bendahara Dr.Erlina S.Kartabrata, Sp.KT
Departemen-Departemen
Penelitian & PengembanganDr.Ria Syafitri E.G, M.Bio, Sp.KT
Dr.Achmad Shiddiqi
Pendidikan & PelatihanDr.H.Udja Bahrusani
Dr.Banundari Rachmawati, SpPK
Kesejahteraan & Pemberdayaan AnggotaDr.WidyarmanDr.Peni Idiryati
Informasi & Pengabdian Masyarakat Dr.Samson E.Teron, SpPK Dr.Teguh Satriono. MARS
Kerjasama Luar Negeri Dr.Didik Sumarsidi
Dr.Mardiani Radjuni
Kerjasama Dalam Negeri Dr.J. Swanta
Dr.Nur Achmad Tjiptoprajitno, MSc