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BLOOD

TRANSFUSION
Indication & Reaction

Rahmawati Minhajat, A.Fachruddin Benyamin

Subdivision of Hematology and Medical


Oncology, Internal Medicine Dept,
UNHAS.

Sub Topics
I.
II.
III.
IV.

Introduction
Safety Blood Transfusion
Type & Indication
Transfusion Reaction

I. Introduction

Abad 17: Transfusi darah pertama

I. Introduction

(1)

Spectrum of patients who need


blood :
After blood loss (large volume)
trauma, accident, operation,
partus.
disease : hematemesis,
hemoptisis,
melaena, hematochezia,
hematuria.

I. Introduction

Tahun

1818,
James Blundell
transfusi darah
dengan syringe
donor ke resipien.

Reaksi

I. Introduction

(2)

Blood transfusion :
Transfer of blood or blood product

from donor to recipient


Chain of processes
must always follow safety
principles

Blood & Blood


Component
Donated blood :
a. Whole Blood
b. Blood Component i.e. :
- Packed Red Cells (PRC)
- Platelet Concentrate
- Frozen Plasma,
Cryoprecipitate,
- Granulocyte (WBC) etc.

II. Safety Blood


Transfusion
WHO Recommendation :
1. Healthy donor
2. Screened: Hept B, HIV, Lues
3. Component whenever
possible
4. Optimize voluntary donor
5. Avoid commercial donor

Why blood
component ?
1. Efficient (1 donor for 3
recipients)
2. Effective (give only recipients
need)
3. Safer (avoid unnecessary
component)
4. Prevention of longterm reaction

Examples :
To increase patients
hb/hematocrite
give only Packed Red Cells
To increase patients platelet
give only Platelet Concentrate
To restore patients coagulation
factors
give only Cryoprecipitate or
Fresh Frozen Plasma

Compatibility Test

abad 20
era transfusi
modern.

Awal

Tahun

1901, Karl
Landsteiner
identifikasi grup

Compatibility Test
Between donors blood and
recipient
Must be done before give the blood
!
Blood antigens : vary
What are must be tested ?
1. Blood Type Compatibility
(A,B,O,AB)
2. Rhesus factor Compatibility

DONOR

Cara aferesis

Cara
konvensional

III.

TYPE OF TRANSFUSION
& INDICATION

a. Whole Blood
Very limited indication:
1. Open heart surgery
2. Large volume blood loss
in relatively short time
3. Remote area (no facilities)

1. Fresh Whole Blood

Content all of unit blood from


donor :
RBC, WBC, platelet & plasma
No clear (strict) indication

Whole Blood
Darah Lengkap/ Whole Blood (WB)

Berisi sel darah merah, lekosit,


trombosit & plasma.
Satu kantung berisi 250ml & 350ml.
Suhu simpan 1-6 oC.
Lama simpan 21 hari (CPD: citrate
phosphat dextrose solution) & 35 hari
(CPDA: citrate phosphat dextrose
solution adenin).

2. Packed Red Cells


(PRC)

1 unit = 300 ml
2/3 ( 200 ml ) consist of RBC
Usually for patient with anemia
(to increase hematocrit )
1 unit PRC ht increased by 4 %
( Hb increased by 1,3 1,4 g% )

Packed Red Cells (PRC)


Sel Darah Merah Pekat/ Packed Red Blood Cell (PRC)

Berisi konsentrat eritrosit.


Nilai HCT berkisar antara 60 75%.
Volume sekitar 150 300ml.
Mengandung 60g hemoglobin atau
180ml sel darah merah dan 250mg
besi.

3. Frozen Blood

WBC (-), plasma (-)

Can be preserved until 3 yrs.


Difficult to be made & expensive.

Useful in :
1. Stock for very rare blood group
2. Severe Leukoaglutinin reaction
3. Anaphylactic rx to plasma
protein

4. Leuko-poor Blood
Made by centrifugation or washing
Leucocyte (-), platelet (-)
Useful in :
patient w/ severe Leuco-aglutinine
rx
to donors erythrocyte

5. Platelet
Concentrate

Each unit : 5 7 x 10 10 platelet


in 35 cc plasma
Each unit increase 10.000 / ul of
plt
Lasting for 2 3 days
Useful in : thrombocytopenia
(disorder of production)

Platelet Concentrate
Trombosit Pekat/ Platelet Concentrates (PC)

1 unit PC yang berasal dari 450ml WB


berisi kira-kira 5,5x1010 trombosit.
Volume sekitar 50ml.
1 unit PC dari tromboferesis berisi
sekitar 3x1011 trombosit setara
dengan 6 unit trombosit yang berasal
dari donor darah biasa.

Plasma Component
6. Fresh Frozen Plasma (FFP)
Volume : 200 cc
Contain all of coagulation factor
Useful in :
- correction of coagulation factor
deficiency
- Thrombotic Thrombocytopenic Purpura
(TTP)

Fresh Frozen Plasma


(FFP)
Plasma Segar Beku/ Fresh Frozen Plasma (FFP)

FFP diperoleh dari separasi plasma


WB atau melalui plasmaferesis.
Dibekukan dalam wktu 8 jam setelah
pengambilan, disimpan pada suhu
-18oC dengan masa simpan 1 tahun.
Volume sekitar 200 250ml.
FFP berisi plasma, semua faktor
pembekuan, komplemen dan protein
plasma.
Berguna untuk mengganti
kekurangan faktor koagulasi.

7. Cryoprecipitate

Made from fresh plasma


Volume : 20 cc
Contain :
- 250 mg of fibrinogen
- 80 - 100 unit of F VIII & Von Willebrand
factor

1 unit increase fibrinogen by 8 mg/dl


Useful in : - DIC
- Congenital fibrinogen
deficiency

Cryoprecipitate
Kriopresipitat/ Cryopresipitate (CRYO)

Dibuat dari plasma segar beku


dicairkan secara lambat pada suhu 46oC selama 12-14 jam atau pada
circulating waterbath 4oC selama 75
menit.
Suhu simpan minus 18oC dengan
lama simpan 1 tahun
volume sekitar 10-15 ml.
Setiap kantung berisi faktor VIII 80100 unit, fibrinogen 150-250 mg,
faktor von Willebrand 40-70 %, faktor
XIII 20-30 %

8. Granulocyte
Transfusion

Taken from ABO-matched donors


HLA-matching suggested

Radiated 1.500 gy to eradicate lymphocyte


(cause of GVHD: graft versus host disease),
without damaging the granulocyte

Indication :
- Severe Neutropenia (<100 /uL), with
sepsis
cause by gram negative bacteria
- Progressive Soft Tissue Infection

IV. Transfusion
Reaction
Based on time of onset
A. Acute Complication
(during or soon after
transfusion
/ within 24 hrs)
B. Late Complication

A. Acute Complication :
1. Mild reaction : fever, chills,
itchy
2. Moderate reaction:
- Moderate hypersensitivity
- Non-hemolytic fever
- Bacterial contamination
- Pyrogenic reaction

3. Severe / Live Threatening


Reaction
a. Acute Intravascular
Hemolytic
b. Septic Shock
c. Volume Overload
d. Anaphylactic reaction

Pyrogen Reaction/Fever

Occured during or after


transfusion
Pyrogen inside transfused
material
or instrument used in
transfusion
Pyrogen : product of bact.
metabolism

Transfusi Darah
Terkontaminasi Bakteri

Jika unit dibiarkan


mengendap, bakteri
hemolisis dapat dideteksi.
Unit yang tidak terinfeksi
memperlihatkan batas
yang jelas antara plasma
dan sel darah merah
(kanan), sebaliknya
terhadap unit yang
terhemolisis (kiri).

Pyrogen Reaction/Fever
- Chills, nervousness
- Stop transfusion symptoms
(-)

Hemolytic Reaction

1.

Often serious & fatal:


Intravascular hemolytic
- caused by anti A & anti B of the
ABO type system
- icterus/jaundice, haemoglobinemia,
fatal in DIC, Acute Renal
Failure

2.

Extravascular hemolytic (rarely


fatal)

B. LATE COMPLICATION
1. Transmission of disease :
( HIV, Hepatitis, Syphilis,
Malaria, Cytomegalovirus, etc)
2. Other Late Complication
Late hemolytic reaction
GVHD (graft versus host
disease)
Iron overload

Complication (based on
location) :
a. Local Complication
1. Failure in accessing the
vein
2. Poor vein fixation
3. On site infection

b. Systemic Complication
1.
2.
3.
4.

Transfusion Reactions
Transmission of diseases
Immunologic sensitivity
Hemochromatosis

Thank You