Blood Transfusion 5 Des 2013

7/24/2019 Blood Transfusion 5 Des 2013

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Blood Transfusion

Titis Kurniawan

Transfusi Darah

Adalah; Tindakan memasukan produkdarah (whole blood, PRC, Trombosit,plasma, dll) melalui pembuluh darah venapasien

Tujuan: Memenuhi volume sirkulasi

Meningkatkan kadar Hb dan protein serum

Mengganti komponen darah

Diberikan pada pasien yang mengalamiperdarahan, anemia, kelainan darah


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Blood Components

Prepared from Whole bloodcollection or aphaeresis

Whole blood is separated bydifferential centrifugation Red Blood Cells (RBCs)

Platelets

Plasma

Cryoprecipitate Others include Plasma proteins

Coagulation Factors, albumin,Anti-D, Growth Factors, Colloidvolume expanders

Differential CentrifugationFirst Centrifugation

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Differential Centrifugation

Second Centrifugation

Whole Blood

Storage

4for up to 35 days

Indications

Massive BloodLoss/Trauma/Exchange Transfusion

Considerations

Use filter as platelets and coagulation

factors will not be active after 3-5days

Donor and recipient must be ABOidentical


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RBC Concentrate Storage

4for up to 42 days, can be frozen

Indications Many indicationsie anemia, hypoxia, etc.

Considerations Recipient must not have antibodies to donor

RBCs (note: patients can develop

antibodies over time) Usual dose 10 cc/kg (will increase Hgb by

2.5 gm/dl)

Usually transfuse over 2-4 hours (slower forchronic anemia

Platelets Storage

Up to 5 days at 20-24

Indications Thrombocytopenia, Plt


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Plasma and FFP

ContentsCoagulation Factors (1 unit/ml)

Storage

FFP--12 months at 18 degrees or colder

Indications

Coagulation Factor deficiency, fibrinogenreplacement, DIC, liver disease, exchangetransfusion, massive transfusion

Considerations

Plasma should be recipient RBC ABOcompatible

In children, should also be Rh compatible

Account for time to thaw

Usual dose is 20 cc/kg to raise coagulationfactors approx 20%

Cryoprecipitate Description

Precipitate formed/collected when FFP isthawed at 4

Storage

After collection, refrozen and stored up to 1year at -18

Indication

Fibrinogen deficiency or dysfibrinogenemia

vonWillebrands Disease

Factor VIII or XIII deficiency

DIC (not used alone)

Considerations

ABO compatible preferred (but not limiting)

Usual dose is 1 unit/5-10 kg of recipient bodyweight


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Prosedur Transfusi

Hampir = Prosedur Pemasangan Infus

Persiapan Alat:Standar Infus Set TransfusiBotol berisi NaCl 0,9% PengalasTorniket Kapas alkoholPlester GuntingKassa steril BetadineProduk darah Sarung tanganIV Catheter no

Persiapan Pasien; Posisi, Informed consent,kesiapan, kerjasama yg diharapkan, Do & Dontselama transfusi dijalankan,

Persiapan Lingkungan; pencahayaan, privasi,keamanan


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Prosedur Transfusi

Pre transfusi; compatibility test/cross match

Crossmatch testing the patients plasma against a sample ofred cells from the actual unit that has been selected for transfusion.

Immediate spin: patients plasma is mixed with donor red cells andobserved for immediate agglutination and/or haemolysis (A,B,Ocheck) at room temperature ( 5 minutes)

Full crossmatch: (or Coombs Crossmatch): patients plasma ismixed with donor red cells and incubated at 37oC. Anti IgG isadded and a check is made for the presence of agglutination ( 40minutes)

Electronic crossmatch: a patient has an ABO, Rh, and antibodyscreen performed. If the antibody screen is negative, the computerassigns an ABO compatible unit to the patient from the Blood Bankinventory.

Results; Clothing (Incompatibility) or Not-Clothing (compatible )

..Prosedur TransfusiShort Review Sistem ABO

System ABO, 4 macam golongan darah berdasarkan senyawaAglutinogen dan Aglutinin dalam darah.

Aglutinogen; senyawa protein darah yang terdapat pada sel-sel darah merah dan berfungsi sebagai antigen aglutinogenA dan aglutinogen B.

Aglutinin; protein yang terdapat dalam plasma darahberfungsi antibody

Golongan darah Aglutinogen dalamSel darah merah

Aglutinin dalam Plasmadarah

A A (anti B)

B B (Anti A)

AB A & B -

O - dan


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..Prosedur TransfusiImportant Points;

Solution; NaCl 0,9% except intravenous immune Globuline(IVIG) must be delivered with 5% Dextrose in Water (D5W)

No medication infused in the line

Needle size;

The largest possible catheter should be used

Neonate, pediatric, chronically transfused patients RBCs canbe safely administered through 22, 24 or 26-gauge needle

Adult; 18 to 20-gauge catheter is recommended

Set changed (American Vascular Access Assoc); At least every 4-6 hours after completion of transfusion After 2 units of packed cell

Platelet must not be transfused after packed cell

PRC, Platelet, Cryoprecipitate bag must be invert several time to ensurere-suspension

Transfusion Flow Rate

Packed Cells: Initial rate of 50mL/hr for the first 15 minutes. If thepatient tolerates this "test dose", the rate may be increased so that theremainder of the unit is given within 2 hours.

Platelets and plasma products: Transfuse slowly (50mL/hour) for thefirst 15 minutes, monitor the patient closely and then platelets or 1 unit of

plasma is generally infused over 60 minutes.

25% albumin should NOT be infused faster than 2mL/minute as itdraws fluid from extravascular space into venous circulation, and maycause fluid overload.

IVIG should be infused at an initial rate of 0.01-0.02mL/ kg/minutewith a gradual increase to 0.06mL/kg/minute if tolerated well.

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..Prosedur Transfusi


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.Prosedur Transfusi Pelaksanaan

Cuci tangan

Cek program transfusi (jumlah & jenis produk darah serta hasil cross match)

Siapkan transfusi set

Sambungkan transfusi set dengan botol NaCl 0,9%

Isi chamber dan alirkan NaCl ke dalam slang dan pastikan seluruh slang

terisi cairan NaCl (tidak ada gelembung udara)

Kaji area insersi IV catheter

Disinfeksi

Insersikan IV catheter dengan benar

Sambungkan IV catheter dengan slang transfusi set

Alirkan dan cek kelancaran aliran cairan NaCl

Fiksasi area insersi dan IV line dengan benar

Siapkan Produk darah yang akan ditransfusikan

Matikan aliran slang dan ganti botol NaCl dengan Kantong produk darah

Hitung tetesan sesuai kebutuhan dengan benar

.Prosedur Transfusi

Monitoring Vital Sign

Vital Signs include temperature, pulse, respiration rateand blood pressure.

Vital Signs must be taken before the transfusion ofall blood products.

Vital Signs should be repeated at minimum: 15 minutes after infusion has started

Following transfusion

The Vital Signs should also be repeated at intervals

during transfusion:

As per specific Clinical Service flowcharts/policiesor patient care order

If the transfusion is longer than 2 hours


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.Prosedur Transfusi

Evaluasi

Cek respon klien; nyeri, menggigil, gatal-gatal, dll

Cek kelancaran aliran IV line (darah)

Cek Kepatenan fiksasi

Dokumentasi

Jumlah dan jenis produk darah (termasuk golongan

darah) yang diprogramkan

Persediaan darah

Waktu pemasangan

Transfusion Complications

Acute Transfusion Reactions (ATRs)

Chronic Transfusion Reactions

Transfusion related infections


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Acute Transfusion Reactions Hemolytic Reactions (AHTR)

Febrile Reactions (FNHTR)

Allergic Reactions

Coagulopathy with Massive transfusions

Bacteremia

Acute Hemolytic Transfusion Reactions (AHTR)

Occurs when incompatible RBCs are transfused into a recipient whohas pre-formed antibodies (usually ABO or Rh) Antibodiesactivate the complement system, causing intravascularhemolysis

Symptoms (fever, chill, hypotension, oliguria, dark urine, abdominal/

back pain, dispnea, pallor) occur within minutes of starting thetransfusion

This hemolytic reaction can occur with as little as 1-2 cc of RBCs

Labeling error is most common problem

Can be fatal

Treatment; STOP, maintain IV fluid (RL/NS), maintain/monitorVS, give diuretic, send back the remaining blood to blood bank


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Febrile Nonhemolytic Transfusion Reactions

(FNHTR)

Definition--Rise in patient temperature >1C (associa ted withtransfusion without other fever precipitating factors)

Occurs with approx 1% of PRBC transfusions and approx20% of Plt transfusions

FNHTR caused by alloantibodies directed against HLAantigens

Need to evaluate for AHTR and infection

Treatment; STOP, antipyretic, steroid, narcotic (if severchilling)

Allergic Nonhemolytic Transfusion Reactions

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Bacterial Contamination

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Chronic Transfusion Reactions

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Transfusion Associated Infections

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Blood Transfusion 5 Des 2013

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