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Hj.Banundari Rachmawati
Bagian Patologi FK Klinik
UNDIP
ReaKsi Transfusi
Angka 2% (selama 24 jam stl pemberian)
Biasanya ringan
2kategori:
InfeKsi
i.e HIV dan HCV 1 penularan /2 juta transfusi
Non infeksi
Reaksi transfusi Non-infeksi
Pedoman
Acut (< 24jam)
Immunologik
Non-immunologik
Iron overload
Akut (< 24°)
Immunologi
Hemolitik
Panas , non-hemolitik
Urticarial/Allergic
Anafilaktik
Hemolitik
Paling berat , terjadi pada transfusi PRC
bereaksi terhadap Antibodi
Bisa terjadi walau baru mendapat 10-15 mL
ABO-incompatible blood
Penyebab
Kejadian: 1:38,000 sampai 1:70,000
Clerical and other human error pada compatible
transfusion
Mortalitas 1:1,000,000 transfusi
Hemolytic
Highly variable in acuity and severity
Severe
Fevers and/or chills
Hypotension
Dyspnea
Tachycardia
Pain
DIC
ARF
Shock
Hemolytic
Pathophysiology
Intravascular hemolysis, opsonization,
generation of anaphylotoxins
Complement activation classical
pathway
Cytokines activation
TNF, IL-1, IL-6, IL-8
Coagulation activation
Bradykinin
Hemolytic
Laboratory findings
Hemoglobinemia
Hemoglobinuria
LDH
Hyperbilirubinemia
Haptoglobin
BUN, creatinine in ARF
DAT +
Hemolytic
Treatment/Prevention
Stoptransfusion
Supportive care to maintain renal function
Goal of urine O/P 100 mL/hr. in adults for at least 18-
24 hours
Low dose dopamine
Treatment of DIC
? Heparin – direct anticomplement effect
Prevention of clerical/human errors
Akut (< 24°)
Immunologik
Hemolytic
Panas, non-hemolytic
Urticarial/Allergi
Anafilaktik
Panas, non-hemolitik
Suhu tubuh naik 1°C atau lebih .
Insidens
43-75% of semua reaksi transfusi.
SDMP /PRC 0.5-6%
Trombosit 1-38%
Signs/Symptoms
Panas, menggigil
Mual, Muntah
Cont....
Etiologiy
Reaksi
Antara WBC antibodies resipien (HLA, WBC antigens) dengan
WBC donor
Sitokin yang terakumulasi selama penyimpanan
Differential Diagnosis:
Semua kasus panas ok hemolitik atau bakteri/sepsis
Pengobatan/pencegahan
Hentikantransfusi?
Obat penurun panas
Leukoreduced blood component
Akut (< 24°)
Immunologik
Hemolytic
Fever/chills, non-hemolytic
Urticaria/Allergic
Anafilaktik
Urtikaria/Allergi
Derajat
Urtikaria ringan
Anafilaktoid
Berat : anafilaktik
Insidens
1-3% dari semua reaksi transfusi.
Signs/Symptoms
Uriticaria pada badan dan leher
Panas
Tanda kelainan paru
Gastro Intestinal : abdominal pain, diarrhea
Sirkulasi – takikardia, hipotensi
Urtikaria/Allergi
Etiologi
Antibodi pada sirkulasi resipien terhadap material dalam darah donor
(Protein pada plasma donor)
Ikatan IgE antibody pada mast cells
Release of histamine
Vasoactive substances
C3a, C5a, leukotrienes
Differential Diagnosis:
Hemolytic
Bacterial
Injuri paru karena Reaksi Transfusi akut
Pengobatan/Pencegahan
Hentikan transfusi
Antihistamine/steroids
Washing of blood products, pretreatment,leukoreduction?
Akut (< 24°)
Immunologik
Hemolytic
Fever/chills, non-hemolytic
Urticarial/Allergic
Anafilaktik
Anafilaktik
jarang
Insidens
1:18,000
- 170,000
Plt 1:1598-9630
FFP 1:28,831
RBCs 1:23,148-57,869
Signs/Symptoms
cardiovascular instability
Cardiac arrhythmia
Shock
Cardiac arrest
Gangguan respirasi
Anafilaktik
Etiology
Antibodi IgA (IgE, IgG, IgM) pada defisiensi IgA
Serum IgA < 5 mg/dL
1 diantara 342 darah donor
Ab C4
Defisiensi Haptoglobin (IgG / IgE anti-haptoglobin)
?
Differential Diagnosis:
Hemolitik
Bakteri
Injuri paru karena Reaksi transfusi akut I
overload
Anfiilactik
Pengobatan/pencegahan
Hentikan transfusi
Terapi Supportif
Epinephrine
Antihistamine/steroids
Pada pasien defisiensi IgA IgA-deficient product, wash
blood product
Akut (< 24°) Non-
Immunologik
Hipotensi
Injuri paru akut karena Transfusi
overload
Hemolisis non imun
Emboli udara
Hipokalsemia
Hipotermia
Hipotensi
Treatment/Prevention
Terapisupportatif
Jangan berikan albumin
Akut (< 24°) Non-
Immunologik
Hipotensi
Injuri paru akut karena transfusi
Overload
Hemolisis non imun
Emboli udara
Hipokalsemia
Hipotermia
Injuri paru akut karena transfusi darah
Definisi
Transfusiyang berhubungan dengan oedem paru non
kardiogenik
Deferensialal Diagnosis
overload
Allergic/Anafilaktik
Bacterial
Acute hemolytic reaction
Tanda klinik( pada keadaan berat)
Acute respiratory distress
Oedem paru
Hipoksia
Hipotensi
Blood warmer
Delayed (> 24°)
Immunologik
Allo-immunization
Hemolitik
Graft-versus-host disease (GVHD)
Post-transfusion purpura
Immuno-modulation
Allo-immunization
Dijumpai bbrp minggu sampai bulan
postransfusi
Insidens
1-1.6% karena Ag SDM
10% to HLA
Delayed (> 24°)
Immunologik
Allo-immunization
Hemolytik
Graft-versus-host disease (GVHD)
Post-transfusion purpura
Immuno-modulation
Hemolytic
Terjadi beberapa jam sampai 6 minggu disebabkan karena
Antibodi IgG bereaksi dengan SDM
Insidens
1 in 2082 recipients
1 in 11,328 units
Delayed (> 24°)
Immunologik
Allo-immunization
Hemolytic
Graft-versus-host disease (GVHD)
Post-transfusion purpura
Immuno-modulation
Graft-versus-host disease
(GVHD)
Komplikasi fatal
Attackrecipient tissues
Pada pasien imunokompromise
Keganasan yang mendapat terapi radiasi
Stem cell transplant dll
Insidens
Jarang
Male:Female 1:5
Usia 16-83
Tanda klinik
self-limited, recovery dalam 21 hari
10-15% mortality
PTP
Signs/Symptoms
Profound thrombocytopenia
Purpura
Bleeding
Fever (reported)
Delayed (> 24°)
Immunologic
Allo-immunization
Hemolytic
Graft-versus-host disease (GVHD)
Post-transfusion purpura
Immuno-modulation
Immuno-modulation
? Risiko recurrent cancer dan infeksi
bakteri
Delayed (> 24°)
Non-Immunologik
Iron overload
Iron overload
Tiap unit PRC 200-225 mg Fe
Transfusi kronik
> 50-100 units of PRC
Fe disimpan di RE sites saturasi
disimpan ditempat lain
Heart, liver, endocrine glands (pancreas)
Removal of Fe
Desferoxamine – Fe-chelating agent
Transfusi kronik pada hemoglobinopati
Transfusion transmissible
Viruses
Plasma-borne Cell-associated
hepatitis C and viruses
variants CMV
hepatitis A (rarely) EBV(95% adults
hepatitis B immune)
parvo B19 HTLV
HIV-1 and HIV-2
Transfusion transmissible
Bacteria and Parasites
Bacteria Parasites
occasional plasmodium
bacterial trypanosoma cruzi
contaminants (Chagas disease)-endemic in
Latin America
(pseudomonas,
serretia) Toxoplasma gondii - only
a risk in pregnant and
treponema immunosuppressed recipients
pallidum Babesia microti - potential
brucellosis
risk in certain areas of N.
America
Highlight Case from SHOT 2003
True / False
Question 2 of 4
True / False
Module 10 quiz answers
Question 1: True
Question 2: C
Question 3: All are correct
Question 4: True