179176287 Jurnal Hiperbilirubinemia Pada Inkompatibilitas ABO
Inkompatibilitas Abo
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Transcript of Inkompatibilitas Abo
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INKOMPATIBILITAS ABO/RHESUSINKOMPATIBILITAS ABO/RHESUS
Dr Dora Darussalam SpADr Dora Darussalam SpA
Sub Neonatologi Bag Anak Sub Neonatologi Bag Anak RSUZARSUZA
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PatogenesisPatogenesis
Golongan darah ibu O/Rh negatifGolongan darah ibu O/Rh negatif Golongan darah bayi A/B/Rh positifGolongan darah bayi A/B/Rh positif Eritrosit janin masuk kedalam sirkulasi Eritrosit janin masuk kedalam sirkulasi
maternalmaternal Sensitisasi maternal oleh antigen A atau B Sensitisasi maternal oleh antigen A atau B
eritrosit janin/antigen D eritrosit janineritrosit janin/antigen D eritrosit janin Produksi anti A atau anti B /anti D maternal Produksi anti A atau anti B /anti D maternal
yang bersifat imunyang bersifat imun
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PatogenesisPatogenesis
Masuknya anti A atau anti B imun /anti Masuknya anti A atau anti B imun /anti D imun secara transplansental D imun secara transplansental kedalam sirkulasi janin kedalam sirkulasi janin
Melekatnya anti A atau anti B imun / Melekatnya anti A atau anti B imun / antibodi D pada eritrosit janin/bayiantibodi D pada eritrosit janin/bayi
Aglutinasi dan lisis eritrosit janin/bayiAglutinasi dan lisis eritrosit janin/bayi
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Patogenesis RhesusPatogenesis Rhesus
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Gambaran KlinisGambaran Klinis
Ikterus pada 24 jam pertama kelahiranIkterus pada 24 jam pertama kelahiran AnemiaAnemia Hydrops foetalis (Rhesus Hydrops foetalis (Rhesus
inkompatibilitas)inkompatibilitas)
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Pemeriksaan PenunjangPemeriksaan Penunjang
HiperbilirubinemiaHiperbilirubinemia Anemia,retikulosit ,normoblastemiaAnemia,retikulosit ,normoblastemia Uji coombs direk positifUji coombs direk positif Ditemukan anti A atau Anti B bebas Ditemukan anti A atau Anti B bebas
tipe Ig G dalam serum bayitipe Ig G dalam serum bayi
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TATALAKSANATATALAKSANA
Transfusi tukar dengan golongan Transfusi tukar dengan golongan darah O/Rh negatifdarah O/Rh negatif
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ANEMIA ANEMIA PREMATURITASPREMATURITASDr Dora Darussalam SpADr Dora Darussalam SpA
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DefinisiDefinisi
Suatu keadaan berkurangnya Suatu keadaan berkurangnya sejumlah sel darah merah pada bayi sejumlah sel darah merah pada bayi prematur. Sel darah merah berisi Hb.prematur. Sel darah merah berisi Hb.
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EtiologiEtiologi
Umur eritrosit yang Umur eritrosit yang pendekpendek
Produksi Produksi eritropoetin eritropoetin
Perdarahan Perdarahan iatrogenikiatrogenik
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Gambaran KlinisGambaran Klinis
PucatPucat TakipneaTakipnea TakikardiaTakikardia Kenaikan berat badan yang lambatKenaikan berat badan yang lambat Aktifitas menurunAktifitas menurun
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Pemeriksaan penunjangPemeriksaan penunjang
Hb Hb RetikulositRetikulosit Normositik normokromNormositik normokrom
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TatalaksanaTatalaksana
Transfusi sel darah merahTransfusi sel darah merah
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PENYAKIT PERDARAHAN PENYAKIT PERDARAHAN PADA NEONATUS (PPN)PADA NEONATUS (PPN)
Dr Dora Darussalam SpADr Dora Darussalam SpA
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DefinisiDefinisi
Penyakit perdarahan akibat Penyakit perdarahan akibat kekurangan vitamin Kkekurangan vitamin K
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InsidensInsidens
4-170 per 100.000 kelahiran 4-170 per 100.000 kelahiran negara berkembangnegara berkembang
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Vitamin K DeficiencyVitamin K Deficiency
Incomplete carboxylation of coagulationIncomplete carboxylation of coagulation
proteins that do not form appropriate proteins that do not form appropriate complexes with Ca&phospholipcomplexes with Ca&phospholip
Qualitative deficiency of Factors II,VII,IX,X
BLEEDING
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Type Type OnsetOnset DetailsDetails
EarlyEarly Within 24 Within 24 hrshrs
h/o drug intake in motherh/o drug intake in mother
Anticonv;antiTB,coumarins,Anticonv;antiTB,coumarins,salicylates , Poor nutrition:: salicylates , Poor nutrition:: Scalp,GI,ICHScalp,GI,ICH
ClassicalClassical
2-72-7
daysdays Usually in breast fed Usually in breast fed babies::GI,Skin,nasalbabies::GI,Skin,nasal
LateLate
1-61-6
monthsmonths
Common in breast fed -Common in breast fed -rare in top fed and vit K rcd at rare in top fed and vit K rcd at birth..50%ICH,GIbirth..50%ICH,GI
VKDB CharacteristicsVKDB Characteristics
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EtiologiEtiologi
Chronic diarrhoeas & malabsorptionChronic diarrhoeas & malabsorption Liver disorders-hepatitisLiver disorders-hepatitis Warfarin and other drugsWarfarin and other drugs Prolonged antibioticsProlonged antibiotics
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Gambaran klinisGambaran klinis
Bayi tampak letargisBayi tampak letargis PerdarahanPerdarahan PucatPucat IkterusIkterus
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Pemeriksaan penunjangPemeriksaan penunjang
Manifestasi perdarahanManifestasi perdarahan PT ,PTT memanjangPT ,PTT memanjang Trombosit normalTrombosit normal
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TatalaksanaTatalaksana
SuportifSuportif OksigenasiOksigenasi Pemberian cairan parenteralPemberian cairan parenteral Jaga suhu tubuh dalam batas normalJaga suhu tubuh dalam batas normal Pertahankan kadar gula darah dalam batas Pertahankan kadar gula darah dalam batas
normalnormalUmumUmum Berikan vitamin KBerikan vitamin K Transfusi darah FFPTransfusi darah FFP
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PerdarahanPerdarahan IntrakranialIntrakranialDr Dora Darussalam SpADr Dora Darussalam SpA
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EtiologiEtiologi
Chronic diarrhoeas & malabsorptionChronic diarrhoeas & malabsorption Liver disorders-hepatitisLiver disorders-hepatitis Warfarin and other drugsWarfarin and other drugs Prolonged antibioticsProlonged antibiotics
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Gambaran klinisGambaran klinis
HipotonikHipotonik KejangKejang PucatPucat Ubun-ubun membonjolUbun-ubun membonjol
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Pemeriksaan penunjangPemeriksaan penunjang
Bleeding time normalBleeding time normal PT ,PTT memanjangPT ,PTT memanjang Trombosit normalTrombosit normal USG kepala; CT Scan kepalaUSG kepala; CT Scan kepala