TRANSFUSI DARAH

Transfusi darah

Transfusi darah

History and Significance

First blood transfusion
Richard lower  (1665)
Animal to animal



Jean Denis (1667)                               
Animal to human


Lewisohn (1914) -  
used citrate

Human to human                   - James Blundell – 1818                                               

                                               - Philip (1825) First human blood transfusion
Landsteiner (1900) 
The elucidation of the ABO   blood group system
                                 

(1940) Landsteiner
and Wiener, in describe Rh typing


World war I
                                                            How to store blood longer ?
                                                                       


World war II

Is there any suitable Blood Substitutes


Blood Transfusion
Successful blood transfusion is relatively recent

•         Crossmatching

•         Anticoagulation

•         Plastic storage container

Transfusi darah

ž     Autolog = darah pasien sendiri

ž     Allogenik = darah orang lain

ž     Tujuan transfusi:

•         Meningkatkan oxygen carrying capacity/delivery

•         Koreksi defisit faktor” koagulasi

•         Additional intravascular fluid volume

NILAI – NILAI NORMAL DARAH

ž     pH                                                                        : 7.4

ž     Volume Darah                                                      : 70-80 CC/KGbb

ž     Hemoglobin                                                            : Pria  = 14-16 gr%

                                                                                          Wanita    = 12-14 gr%

ž     Hematokrit                                                            : Pria          = 42-50%

                                                                                          Wanita        = 40-48%

ž     Eritrosit                                                                 : 5.000.000/mm3

ž     Leukosit                                                                 : 8.000/mm3

ž     Trombosit                                                               : 200.000-350.000/mm3

KOMPONEN – KOMPONEN DARAH

ž     Darah Lengkap

ž     Packed Red Cells

ž     Fresh Plasma

ž     Fresh-frozen Plasma

ž     Platelet Rich Plasma

ž     Platelet Concentrate

ž     Cryoprecipitate

BLOOD THERAPHY

ž     Langkah awal : tentukan gol darah donor dan resipien

ž     Penggolongan rutin berdasarkan antigen pada membran eritrosit (A, B, Rh)

CROSS – MATCH

ž     Mayor: eritrosit donor di inkubasi dengan plasma resipien

ž     Minor: eritrosit resipien diinkubasi dengan plasma donor

ž     Terjadi Aglutinasi incompatible pada mayor dan minor

TRANSFUSI EMERGENCY

ž     Diperlukan transfusi segera sebelum tes compatibility selesai

•         Opsi pertama: dilakukan partial cross-match (eritrosit donor dicampur dengan plasma resipien, sentrifuse dan observasi makroskopik aglutinasi) [waktu <5 menit]

•         Opsi kedua: pemberian type-specific, non-cross matched

•         Opsi terakhir: diberikan PRC O-negatif

BLOD STORAGE

ž     Media mengandung phospat, dextrose, adenin

ž     Temperatur penyimpanan 1-6 oC

ž     Waktu penyimpanan 21-35 hari (tergantung media yg dipakai)

ž     Delivery oksigen tergantung 2,3-DPG

KEPUTUSAN MELAKUKAN TRANSFUSI
Berdasarkan :
1.  Monitoring for blood loose
                         - estimasi dengan kasa, drapes, suction apparatus

2.  Monitoring for inadequate perfusion and oxygenation of vital organ

- arterial BP, HR, output urin, ECG, saturasi oksimetri, arterial blood gas, mixed vein saturation

3.  Monitoring for transfusion indikator (Hb)
                         - Hb < 6 gr% almost require t