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