Managemen Terapi

Transfusi

Kuliah Anestesiologi

Dr.Bambang Suryono S.

Indications for transfusion therapy

A. Anemia
Estimated allowable blood loss (EABL) :
EABL=(Hct starting Hct allowable)

xBV/Hct starting
Estimating the volume of blood to
transfuse
Volume to transfuse =(Hct desired Hct

present) x BV/Hct transfused blood

Indications....
B. Thrombocytopenia
C. Coagulopathy

Managemen kehilangan darah

1.Estimated blood volume (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
2.Replace very 1 ml blood loss with
3

ml crystalloid or 1 cc PRBC

Managemen......
3. PRBC : 1 unit PRC increases Hct

about 3% and Hb about 1 g/dl

* 3 ml/kg PRC increases Hb about 1
g/dl
* 10 ml/kg PRBC increases Hct about
10%
4. Max allowable blood loss =

[EBV x (Hct target Hct)]/Hct

Managemen......
4. Fluid replacement equivalents
*Crystalloid : 3 cc/1 cc estimated
blood

loss (EBL)
*Colloid : 1cc/cc EBL
*Whole blood : 1 cc/cc EBL
*Packed red blood cells : cc/cc
EBL

Compatibility testing
1. Type specific :ABO-Rh 99.8%
2. Type and screen :ABO-Rh
+Screen

99.94% compatible
3.Type and crossmatch :ABO-Rh,

screen and crossmatch :

99.95%
4. Screening donor blood

Blood component therapy

*Whole blood : 40% Hct
*Packed red blood cells (PRBC): 250
300 ml Hct 70-80% incr. Adult Hb 1
g/dl
*Platelets
*Fresh frozen plasma (FFP) : 250 ml/bag
*Cryoprecipitate : 10-20 ml/bag
*Albumin

Complications of transfusions
A.Risk factors
*Minor allergic reactions
(fever,chills,rash)

1- 5:100
*Nonfatal hemolytic transf.
Reactions

1:6.000
*ABO incompatibility 1:33.000
*Anaphylactic shock 1: 500.000

Complications.....
*Fatal hemolytic transf. Reactions :

1:500.000 to 800.000
*HIV infection : 1:450.000 to 660.000
Hepatitis : Hep. A 1:1 million

Hep. B 1:30.0000 to 250.000

Hep. C 1:30.000 to 150.000

*Bacterial contamination

Red cells 1:500.000 Platelet 1:12.000

*Acute lung injury 1:5.000

Complications......

2. Transfusions reactions
*Febrile reactions
Allergic reactions
Anaphylaxis
Acute hemolytic transfusion reactions
*Delayed hemolytic transfusion
reaction
*Graft vs host disease
*Transfusion related acute lung injury

Treatment of hemolytic transfusion

reactions
*Stop the transfusion
*Maintain urine output 75-100 ml/hr by
-administer fluids i.v
-possibly mannitol 12.5 50 gram
5-15 minutes
If ineffective furosemide 20-40 mg iv
*Alkalinize the urine bicarbonate natr.
*Assay urine and plasma Hb concentration
*Return unused blood antibody screen &
direct antiglobulin test
*Prevent hypotension

Complications....
3.Metabolic abnormalities
*Decreased pH
*Increase potassium
*Decrease 2.3 DPG
*Citrate toxicity
4. Microaggregates
5.Hypothermia

Complications.....
6.Coagulopathy disorders
*After massive transfusion (>10
units)
*Dilutional thrombocytopenia
*Low Factors V and VIII
*Disseminated intravascular
coagulation

Disseminated intravascular
coagulation
..is hypercoagulable state
caused by activation of the
clotting system leading to
deposition of fibrin in
microvasculature which causes
a secondary activation of
fibrinolysis resulting in
consumption of factors and
platelets

Massive transfusions
*Massive transfusion is defined
as the replacement of a patients
total blood volume in less than 24
hours, or as the acute
administration of more than half
the patients estimated blood
volume per-hour

**Thrombocytopenia
**Clotting factors

Conservation/salvage techniques
A. Autologous donation
B. Isovolemic hemodilution
C. Cell saver/scavenger

Special considerations
A. Classic hemophilia or
hemophilia A
B. Hemophilia B or Christmas
disease
C. Von Willebrands disease
D.Sickle cell anemia
E. Jehovahs Witness patients