28. Pem Lab Pada Reaksi Transfusi

7/27/2019 28. Pem Lab Pada Reaksi Transfusi

1/21

PEMERIKSAAN

LABORATORIUM PADA

REAKSI TRANSFUSI DARAH

Efrida


2/21

REAKSI REAKSI

TRANSFUSI DARAH

Bila dilaksanakan pemeriksaan laboratorium pra-transfusi darah, mayoritas transfusi darah tidakmemberikan efek samping ke pada pasien

Namun, kadang kadang timbul reaksi pada pasien,walaupun pemeriksaan laboratorium pra-transfusidarah telah dilaksanakan dan hasilnyaCOMPATIBLE (= cocok antara darah resipien dandonor)

Reaksi: reaksi RINGAN (suhu meningkat, sakitkepala) s/d BERAT (reaksi hemolisis), bahkan dapatmeninggal


3/21

KOMPLIKASI TRANSFUSI DARAH

Komplikasi LOKAL:

- kegagalan memperoleh akses vena

- fiksasi vena tidak baik

- masalah ditempat tusukan

- vena pecah saat ditusuk, dll

Komplikasi UMUM:

- reaksi reaksi transfusi

- penularan/transmisi penyakit infeksi

- sensitisasi imunologis


4/21

CLERICAL ERROR

Kesalahan administrasi kesalahan manusia


5/21

REAKSI TRANSFUSI DARAH

Reaksi Tranfusi Darah AKUT:

hemolitik, panas, alergi, hipervolume,

sepsis bakteria, lung injury, dll Reaksi Transfusi Darah LAMBAT


6/21

REAKSI REAKSI

TRANSFUSI DARAH

Yang paling sering timbul:

- reaksi febris

- reaksi alergi- reaksi hemolitik


7/21


8/21

REAKSI ALERGI

Reaksi alergi berat (anafilaksis): jarang

Urtikaria kulit, bronkospasme moderat,edema larings: respon cepat terhadap

pengobatan


9/21

REAKSI HEMOLITIK

REAKSI YANG PALING BERAT

Diawali oleh reaksi:

- antibodi dalam serum pasien >< antigen

corresponding pada eritrosit donor

- antibodi dalam plasma donor >< antigen

corresponding pada eritrosit pasien

Reaksi hemolitik: - intravaskular

- ekstravaskular


10/21

REAKSI HEMOLITIK

REAKSI INTRAVASKULAR:

- hemolisis dalam sirkulasi darah

- jaundice dan hemoglobinemia

- antibodi IgM

- paling bahaya anti-A dan anti-B spesifik

dari sistem ABO

- fatal akibat perdarahan tidak terkontroldan gagal ginjal


11/21

REAKSI HEMOLITIK

REAKSI EKSTRAVASKULAR:

- jarang sehebat reaksi intravaskular

- reaksi fatal jarang

- disebabkan antibodi IgG destruksieritrosit via makrofag

- menimbulkan penurunan tiba- tiba kadar

Hb s/d 10 hari pascatransfusi


12/21

REAKSI REAKSI

TRANSFUSI DARAH

Bila dilaksanakan pemeriksaan laboratorium pra-transfusi darah, mayoritas transfusi darah tidakmemberikan efek samping ke pada pasien

Namun, kadang kadang timbul reaksi pada pasien,walaupun pemeriksaan laboratorium pra-transfusidarah telah dilaksanakan dan hasilnyaCOMPATIBLE (= cocok antara darah resipien dandonor)

Reaksi: reaksi RINGAN (suhu meningkat, sakitkepala) s/d BERAT (reaksi hemolisis), bahkan dapatmeninggal


13/21

GOLONGAN DARAH

A,B, AB, O

Rhesus + / - Golongan darah jarang


14/21

Sistem golongan darah eritrosit utama pada manusia

Tahun

ditemukan

1901

1926

1926

19401945

1946

1946

1950

1951

19551956

1962

1965

1967

1974

Sistem

ABO

MNSs

P

Rh

Lutheran (Lu)

Kell

Lewis (Le)

Duffy (Fy)

Kidd (Jk)

Diego (Di)Cartwright (Yt)

Xg

Dombrock (Do)

Colton (Co)

Scianna (Sc)

Antigen utama

pada eritrosit

H,A,B

M,N,S,s

P1,p

D,C,E,c,e

Lua.Lub

K,k,Kpa,Kpb,Kpc,Jsa,Jsb

Lea,Leb

Fya,Fyb

Jka,Jkb

Dia,Dib

Yta,Ytb

Xga

Doa,Dob

Coa,Cob

Sc1,Sc2

Antibodi timbul

secara alamiah

Selalu

Tak

Kadang kadang

Tak

TakTak

Kadang kadang

Tak

Tak

Tak

Tak

Tak

Tak

Tak

Tak


15/21

Golongan darah ABO

Fenotip

O

A1

A2

B

A1B

A2B

Genotip

OO

A1A1

A1OA1A2

A2A2A2O

BBBO

A1B

A2B

Antigen

eritrosit

H

A + A1

A + H

B + (H)

A + A1 + B

A + B + (H)

Antibodi

serum

Anti-A

Anti-B

Anti-B

Anti-B

(Anti A1)

Anti-A

tidak ada

(Anti A1)

Frekuensi

Kaukasia Oriental

45 30

41 38

11 22

3 10


16/21

PEMERIKSAAN SEROLOGI GOLONGAN

DARAH PRA TRANSFUSI

PEMERIKSAAN GOLONGAN DARAH ABO dan Rhesus pada

PASIEN DAN DONOR

Pemeriksaan CROSSMATCHING (reaksi kecocokan silang)

PEMERIKSAAN GOLONGAN DARAH ABO, dari 2 arah:- Cell grouping: ada/tidaknya antigen A atau B

pada permukaan eritrosit

- Serum grouping (back typing): ada/tidaknya

antibodi A, B, AB dalam serum/plasma

PEMERIKSAAN GOLONGAN DARAH RHESUS:

- hanya antigen-D atau Du yang diperiksa pada eritrosit


17/21


18/21

Table 1. Acute Transfusion Reactions (1)

Type Sign and Symptoms Usual Cause Treatment Prevention

Intravascular Hemoglobinemia and ABO incompatibility Stop transfusion; Avoid clerical

hemolytic hemoglobinuria, fever, (clerical error) or other hydrate, support errors; ensure

(immune) chills, anxiety, shock, DIC, complement fixing blood pressure & proper sample

dyspnea, chest pain, antibody causing respiration; induce & recipient

flank pain, oliguria antigen antibody diuresis; treat shock

identification incompatibility and DIC, if present

Extravascular Fever, malaise, indirect IgG Monitor Ht, Avoid clerical

Hemolytic hiperbilirubinemia, non-complement- renal & hepatic error : ensure(immune) increased urine urobili- fixing antibody often function, coagulati proper sample

nogen, falling hematocrit assoclated with on profile, no acute & recipient

delayed hemolysis treatment generally identification

required

Febrile Fever, chill, rarely Antibodies to Stop transfusion; Pre transfusion

hypotension leukocytes or plasma give antipyretic; antipyretic;

protein; hemolysis; eg, acetaminophen leukocyte-passive cytokines ; for rigors reduced blood

infusion; sepsis. Use meperidine 25- if recurrent

Commonly due to 50 mg IV or IM

patients underlying

condition

(continued)


19/21

Table 5. Acute Transfusion Reactions (2)

Type Sign and Symptoms Usual Cause Treatment Prevention

Allergic (mild Urticaria (hives), rarely Antibodies to plasma Stop transfusion; Pre-transfusion

To severe) hypotension or anaphy- proteins; rarely anti- give; antihistamine antihitamine;

laxis bodies to IgA (PO or IM); if severe, washed RBC

epinephrine and/or components, if

steroids recurrent or

severe check pre-

transfusion IgA

levels in patients

with a history ofof anaphylaxis

to transfusion

Hypervolemic Dyspnea, hypertension Too rapid and/or Induced diuresis; Avoid rapid or

pulmonary edema, excessive blood phlebotomy; excessive

cardiac arrhytmias transfusion support cardio- transfusion

respiratory systemas needed

(continued)


20/21


21/21

Table 4. Workup of an Acute Transfusion Reaction

If an acute transfusion reaction occurs :

1. Stop blood component transfusion immediately

2. Verify the correct unit was given to the correct patient

3. Maintain IV access and ensure adequate urine output with an appropriate crystalloid or colloid solution4. Maintain blood pressure, pulse

5. Maintain adequate ventilation

6. Notify attending physician and blood bank

7. Obtain blood / urine for transfusion reaction workup

8. Send blood bag and administration set to blood transfusion service immediately

9. Blood bank performs workup of suspected transfusion reaction at follows :

a. Check paper work to ensure correct blood component was transfused to the right patient

b. Evaluate plasma for hemoglobinemiac. Perform direct antiglobulin set

d. Repeat other serologic testing as needed (ABO/RH)

If intravascular hemolytic reaction in confirmed

10. Monitor renal status (BUN, creatinine)

11. Initiate a diuresis12. Analyze urine for hemoglobinuria

13. Monitor coagulation status (prothrombin time, partial tromboplastin time, fibrinogen, platelet count)

14. Monitor for sign of hemolysis (lactate dehydrogenase, bilirubin, haptoglobin, plasma hemoglobin)

15. Repeat compatibility testing (cross match)

16. If sepsis is suspected, culture unit and patients, and treat as appropiate

Adapted from snyder EL. Transfusion reaction. In : Hoffman R, Benz. EF Jr, Shattil SJ, et al. Hematology : Basic

Principle and practice, 2nd ed. Ney York : Chruchill Livingstone, 1995 ; 2045-53

28. Pem Lab Pada Reaksi Transfusi

Documents

Transcript of 28. Pem Lab Pada Reaksi Transfusi