blood transfusion

CHAPTER I

INTRODUCTION

I.1. Background

. Techniques of blood transfusion was found on June 3, 1667, for the first time in the history of medicine and surgery, doctors Frenchman, Jean Baptist Denis managed to perform blood transfusions. The first successful operation of blood transfusion is a big leap in medical science because previously, many patients who have lost their lives due to lack of blood

. Treatment with transfusions is recognized and accepted in the medical world, after Karel Landsteiner discovered blood groups A, B, AB and O in 1940 and this is the benchmark used until now in the world. 

. Blood plasma separation technique was found June 3, 1904, Charles Richard Drew, a physician finder separation techniques and preservation of blood plasma, was born into the world in the city of Washington DC He is studying medicine at McGill University in Montreal, Canada. In 1938, Drew received a scholarship to continue her education at Columbia Univesity, New York, where he did research on the various problems that are found in blood transfusion. During the study, he found that blood plasma or liquid that contains no blood cells, can be dried and stored for a long time without experiencing damage.. Charles Drew's great discovery was received from the world inetrnasional and in 1939, Drew received funding from the Association of Blood Transfusion and blood storage bank he opened at Columbia Presbyterian Hospital.. In 1940, Charles Drew received his doctorate and became the first black U.S. citizens who receive this title Charles Drew died in a car accident in 1950. 

I.2.goal

objective of writing is to know about the definition of blood transfusion, blood dosage forms as well as blood components, indications of blood transfusion, complications and blood transfusion reactions.

 CHAPTER II

DISCUSSION

II.1.  Definition

Blood transfusion is the transfer of blood from a donor into the recipient's bloodstream (recipient).  Another definition is a pile of work processes to move blood from healthy people to sick people..

Blood is composed of the components of erythrocyte, leukocyte, thrombocyte and plasma that contains clotting factors.. Providing the necessary blood components can only be justified rather than giving a complete whole-blood, this principle is emphasized again the importance in the field of pediatrics because of the baby or growing child need not be disturbed imunologisnya system by antigens that are not needed. Giving whole blood only performed on indication of anemia after acute bleeding and transfusion rates.

II.2. Various kinds of dosage forms of blood and blood components

a.  Complete blood (whole blood)

Complete blood has a main component of erythrocytes, also have a complete blood thrombocyte content and labile clotting factors (V, VIII). Blood volume according to the blood bag that is used among other things, 250 ml, 350 ml, 450 ml. Complete blood count is useful for increasing the number of erythrocytes and plasma simultaneously. Hb increased 0.9 ± 0.12 g / dl and Ht increased by 3-4% post-transfusion of 450 ml of full blood.

b.  Red blood cells

. .Packed red cell

Packed red cells obtained from separation or expenditure in a closed or septic plasma such that the hematocrit to 70-80%.. Depending on the volume of blood bags would be used of 150-300 ml. Keep the temperature 4 ° ± 2 ° C. Old blood stored 24 hours with an open system. 

Packed cells is a component consisting of erythrocytes which have been concentrated by separating the other components.. Packed cells are used in the treatment of anemia, especially thalassemia, aplastic anemia, leukemia and anemia due to other malignancies.. The provision aims to improve the oxygenation of transfusion tissue and organs. Usually achieved when Hb level was above 8 g%.

Dosage is based on getting a blood transfusion recipient anemis person, the less amount of blood given per et mal in a series of blood transfusions and more slow given the amount of droplets.. This is done to avoid the complications of heart failure.: Doses used to raise hemoglobin is by using the empirical formula:

. Supplies of blood (ml) = 6 x BW (kg) x desired increase in Hb.

Decrease in Hb level 1-2 days after transfusion, it should be thought of auto-immune hemolytic anemia. This can be proved by the Coombs test against erythrocytes from the serum of a recipient or recipients themselves against donor erythrocytes. Granting such circumstances is washed packed red cells in addition to the option component of immuno supressive (prednisone, imuran) on the recipient.

·         Red cell suspension

Made by mixing the packed red cells with a liquid solvent in the same  amount.

·         Washed red cells

. Washed red cells obtained by washing the packed red cells 2-3 times with saline, the remaining waste discharged plasma.. Useful for patients who can not be given human plasma. Weaknesses washed red cells is the danger of secondary infections that occur during the process and save a short period (4-6 hours). Washed red cells used in the treatment of hemolytic anemia aquired and exchange transfusion. 

·         Poor concentrated red blood leukocytes

The main content of erythrocytes, keep the temperature 4 ° ± 2 ° C, useful to increase the number of erythrocytes in patients who often require transfusions. Benefits of these blood components to reduce heat and allergic reactions.

c. A suspension of granulocytes / leukocytes concentrated

The main content of granulocytes with a volume of 50-80 ml. Keep the temperature of 20 ° ± 2 ° C. Old store must be transfused within 24 hours.

Granulocyte transfusions given when patients with high heat nutropenia had failed were treated with appropriate antibiotics for more than 48 hours.. Granulocyte transfusions given to patients with leukemia, other malignant diseases and aplastic anemia in which the number leukositnya 2000/mm3 or less with a temperature of 39 ° C or more.

Donors from the next of kin will minimize the possibility of a transfusion reaction.. If not found a suitable donor was ABO type can be selected then the donor group O.. Granulocyte suspension components should be administered immediately after preparation and directly administered intravenously or by droplets quickly.. The effect of granulocyte transfusions will be seen from the decrease in temperature, not from patients with leukocyte count. Drop in temperature occurs about 1-3 days post-transfusion. 

d. Platelet suspension

Platelet gift is often necessary in cases of bleeding caused by a lack of thrombocyte. Provision of platelet repeatedly can cause the formation of thrombocyte antibodies in patients. 

Platelet transfusions prove useful to stop bleeding because of thrombocytopenia.. Platelet component is an indication of any spontaneous bleeding or a major operation with a total platelet count less than 50.000/mm3.. such as bleeding on trombocytopenic purpura, leukemia, aplastic anemia, dengue fever, DIC, and bone marrow aplasia because of cytostatica against malignant tumors.. Splenectomy in patients with thalassemia hipersplenisme and portal hypertension will also require giving prabedah thrombocyte suspension. Platelet components have the store up to three days. ⁽²⁾

: Kinds of stocks:

·         Platelets Rich Plasma (Platelet-rich plasma)

Platelets Rich Plasma is prepared by separating plasma from fresh blood.. Storage 34 ° C should be 24 hours.

·          Concentrate platelet (thrombocyte concentrated)

.The main content of platelets, the volume of 50 ml with store temperature 20 ° ± 2 ° C.. Useful to increase platelet count.. Improved post-transfusion on the average adult 5.000-10.000/ul. Side effects such as urticaria, chills, fever, alloimunisasi Platelet donor antigen.

.Created by means of centrifugation (centrifugasi) again on Platelets Rich Plasma, so that the sediment is obtained pletelet concentrate and then separates them from above in the form of plasma Platelets Poor Plasma. Period ± save 48-72 hours.

e. Plasma

Useful for improving blood plasma volume of circulating blood (hypovolemia, burns), replace the wasted proteins like albumin in the nephrotic syndrome and cirhosis hepatis, replace and fix the amount of certain factors such as globulin from the plasma.

Plasma is needed for patients with hyperbilirubinemia. Albumin in the plasma component necessary to bind free bilirubin is toxic to the fetal brain tissue. This action usually precedes an act of exchange transfusion. The dose needed is 35 ml / kg. Use as a plasma expander in shock, protein substitution oral feedback on the difficulties are rarely carried out.

Kinds of preparations of plasma are:

·         Liquid Plasma

Obtained by separating plasma from whole blood in the manufacture of packed red cells.

·         Dried plasma (plasma lyoplylized)

Frozen plasma was obtained by drying and more durable (three years).

·          Fresh Frozen Plasma

Made by the separation of plasma from fresh blood and immediately frozen at a temperature of -60 ° C. Use the best to stop bleeding (hemostasis).

The main content of labile plasma and clotting factors, with a volume of 150-220 ml. Store temperature -18 ° C or lower to save one year old.. Useful to increase if the labile clotting factors clotting factors concentrated / kriopresipitat not exist. . Transfused within 6 hours after thawed. Side effects such as urticaria, chills, fever, hipervolemia.

·         Cryopresipitate

The main components contained in it is the factor VIII or anti-hemophilic globulin (AHG), coagulation factor XIII, factor Von Willbrand, fibrinogen.. Its use is to stop the bleeding because of the lack of AHG in the blood of patients hemofili A.. AHG is not a genetic marker antigens such as granulocyte, thrombocyte or eitrosit, but repeated administration may lead to the formation of antibodies that are inhibitors to factor VIII. Because of that gift is not advisable until the maximum dose, but according to the optimal dose for a given clinical situation. 

Manufacture of fresh frozen plasma manner at a temperature of -60 ° C, then thawed at a temperature of 4-6 ° C. As a result of liquefaction process precipitates which is then separated immediately from cryoprecipitate supernatant plasma.

Each bag contains 100-150 kriopresipitat U factor VIII..  Mode of administration is by intravenous injected directly, not through an IV drip, given immediately after the components to melt, because this component can not stand at room temperature.

Store temperature -18 ° C or lower to save one year old, transfused within 6 hours after thawed.. Side effects include fever, allergies.

·         Heated plasma

Plasma is heated at a temperature of 60 ° C for 10 hours. Reduced danger of hepatitis. Heated plasma containing 88% albumin, globulin 12%, NaCl 0.06%, 0.02% Na coprylic acid, acetyl tuphtophen Na 0.02%, sodium cone 50 mEq / L

·         Albumin

Made from plasma, after gamma globulin, AHF and fibrinogen are separated from the plasma. 96-98%. 96-98% purity. In the use of diluted until it becomes liquid 5% or 20%, 100 ml of albumin 20% have an osmotic pressure equal to 400 ml of normal plasma

II.3. Benefits of blood components

Given via a transfusion of blood components intended for transfusion, appropriate, patients received only blood components required, reduces transfusion reactions, reduced volume of transfusion, increasing the efficiency of blood usage, and enables storage of blood components stored at a temperature optimum.

II.4. Indication 

a.  Red blood cells. The only indication for red blood cell transfusion is the need to improve the oxygen supply to the network in a short time frame.

·         acute blood loss, if blood is lost due to trauma or surgery, then either the replacement of red blood cells and blood volume needed.

·         Prabedah given a blood transfusion if Hb 80 g / L or less.. Anemia associated with chronic disorders, such as patients with malignant disease, rheumatoid arthritis, or chronic inflammatory processes that do not respond to hematinik necessary transfusions.

·         Renal failure, severe anemia associated with renal failure treated with transfusions of red blood cells or with recombinant human eritropoetin.. Bone marrow fail because of leukemia, cytotoxic treatment, or infiltrates malignancy requiring transfusions of red blood cells and other components.

·         Transfusion-dependent patients such as severe thalassemia, aplastic anemia and anemia requiring transfusion sideroblastik regularly.. Crescent cell disease, some patients also require transfusions regularly, especially after the stroke.

·         Other indications for replacement transfusion in neonatal hemolytic disease, plasmodium falciparum malaria and heavy because of meningococcal septicemia.

b. Indications for Platelet transfusions are:. Failed to bone marrow caused by disease or treatment mielotoksik.

·         Platelet function abnormalities, namely in the form of reduced platelet function disorders such as Glanzmann disease, Bernard-Soulier syndrome, and storage of thrombocyte deficiency. Patients with acquired defects of platelet function, secondary to myeloma, paraproteinemia and uremia. Thrombocytopenia due to dilution secondary to massive transfusion or transfusion substitute, and the patient was bleeding.. Cardiopulmonary bypass, either during or after hemorrhage may occur because of thrombocytopenia due to dilution, as well as disorders of thrombocyte functions.

·         Autoimmune thrombocytopenia purpura, although probably not effective because the transfused platelet autoantibodi destroyed by the circulation.

c. Indications of granulocyte transfusions is limited to certain cases only. Granulocyte transfusions should be considered only for reasons such as:. Persistent neutropenia and severe infections that there is clear evidence of bacterial or fungal infections that can not be controlled with proper treatment with antibiotics for 48-72 hours.

·         Neutrophil functions such as abnormal and persistent infections in chronic granulomatous disease and most cases mielodisplasia.

·         Neonatal sepsis, especially in premature infants with sepsis can experience the benefits of granulocyte transfusions, although their effectiveness is not proven.

d. Fresh Frozen Plasma

- To correct the deficiency of clotting factor / coagulation in the (in) a deficit of bleeding patients with various clotting or coagulation factors (liver disease, DIC, transfusion masive)

   - Warfarin or excessive vitamin K deficiency, coagulopathy which required the repair process within 12-24 hours

patients with bleeding or patients with high risk of bleeding

   - Replacement of a deficiency in Factor V and XI

e. Cryoprecipitate

 - Hypofibrinogenemia - Fibrinogen <>

· · Massive transfusion (masive)

·  · Congenital deficiency

·  · Acquired deficiency (eg DIC)

 - Factor XIII deficiency

- Uremia, with bleeding that did not react with non-transfusion therapy (eg, dialysis, desmopressin)

-  Dysfibrinogenemia (fibrinogen dysfunction)

II.5 Complications of transfusion ⁽⁶⁾

Transfusion complications are divided into local and general.

 Local complications are:

·         Failure to select a vein.

·         Fixation veins that are not good.

·         Problem puncture site.

·         Venous rupture during the stabbing.

 Common complications are:

·          Transfusion reactions.

·          Transmission or transmission of infectious diseases.

·          Immunological sensitization

·          Transfusion haemochromatosis.

In a Research Show Danger In Blood Transfusion

1)Patients given transfusions of blood stored for 29 days or more - still good in the U.S. standards - two times more likely to have a contagious infection in the hospital than those who get newer blood, researchers said on Tuesday.

Regulation of U.S. Food and Drug Agency to allow the blood is stored until 42 days before having to be discarded. But researchers at Cooper University Hospital in Camden, New Jersey, found that blood stored nearly two weeks of the deadline it still may be problematic. The researchers are tracking 422 patients hospitalized in an intensive care and given blood transfusions from July 2003 until September 2006.

If they received blood stored 29 days or more, their blood stream infections, pneumonia, urinary tract infections, heart valve infections, sepsis (a serious medical condition in which inflammation occurs throughout the body caused by infection) and other infections with a possible two-fold compared with patients who received blood stored 28 days at the latest.

These infections were not caused by contaminated blood donated at the time, but due to deterioration over time, the researchers said.  Red blood cells stored amended so encouraging tersiarnya biochemical substances called "cytokines", which can lower the immune function of patients and makes them more susceptible to infection, the researchers said.

"There are important policy implications for this. Transfusions remain an important medical practice.," Said Gerber, whose findings were presented at the meeting of the American College of Chest Physisians. The average age of blood used in transfusions in the U.S. is around 17 days, the researchers said. Gerber did not recommend diperpendeknya 42-day policy, but says it can reduce the amount of available blood supply.

Richard Benjamin, head of medical staff for the American Red Cross, said the study shows the need for further data on the effects of age on the results obtained by the blood of patients.  "However, the use of blood transfusions legally possible medical procedures and operations that actually would not be performed due to blood loss. Many doctors and patients need to consider the potential benefits against the small risk of harm caused by transfusion," Benjamin said in a statement.

Is not the first study found that health problems in people who received blood transfusions are relatively longer. Researchers at the Cleveland Clinis in Ohio reported in March that heart surgery patients who received blood stored for more than 14 days were more likely to experience complications including periods shorter survival.

2).Blood transfusions from incompatible groups can cause an immunological transfusion reactions that result in hemolytic anemia, kidney failure, shock, and death. Hemolysis is the breakdown of red blood cells which will separate hemoglobin from erythrocytes. Owners should not be rhesus negative rhesus positive blood transfusion. If these two types of blood groups meet each other, would certainly be war. Recipient immune system (donor recipient) would regard it as a donor rhesus from foreign objects that need to be resisted. In the world, owner of rhesus negative blood are in a minority.

II.6. Transfusion reactions 

 Pyrogenik reactions may occur during or after the transfusion, a typical reaction by increasing temperature between 38 ° C-40 ° C.. May be accompanied by chills, redness, anxiety and tension, if the transfusion was stopped reaction and anxiety will disappear

1.   Pyrogen may be contained in the transfused material or from a     tool used for transfusion. Pyrogen is a product of bacterial metabolism.

2.      Allergic reactions consist of two mechanisms of antigen from the donor and the antibody in the serum of sick people react, antibodies in the serum of donors who are passively transferred antigen in patients with existing circulation in patients. Antigen may be found on white blood cells or on plasma or thrombocyte donors.

  allergic reactions:

- Anaphylaxis with symptoms of shock with or without pireksia, primers can occur with acute circulatory failure, fast pulse, blood pressure falls, breathing heavily.

- Urticaria are common, severe reactions can occur with asthma, increased temperature, chills, headache, nausea, vomiting and breathing heavy.

- Pireksia difficult to distinguish from pyrogen reaction.

3.      Circulatory overload occurs because after a fast and a lot especially since colloidal and extra cellular fluid, occurring primarily in patients with anemia, heart problems or blood vessel degeneration.. Reaction fever can precede excessive circulatory load reaction.

4.       Hemolytic reaction occurred after incompatible blood transfusion reaction caused by blood transfusion has vitro hemolysis. Mechanism of red blood cell damage, non-immunological / damage in vitro.

5.      Reaction of blood contaminated with bacteria typical sign of the temperature rise to 42 ° C, peripheral circulatory disturbances, hypotension and rapid pulse.

6.      Citrat intoxication due citrat in blood collection and reduction of calcium ions, citrat excreted by the kidneys and metabolized in the liver, can accumulate in blood for transfusion in patients with liver and kidney disease and severe heart failure can occur.

CHAPTER III

CONCLUSION

1.      Blood transfusion is the transfer of blood from a donor into the recipient circulation.

2.      Various kinds of dosage forms of blood and blood components is a complete blood (whole blood), red blood cells, suspension of granulocytes / leukocytes concentrated, Platelet and plasma suspension.

3.      Benefits of blood components to patients obtaining only the blood components needed.

4.      Transfusion complications are divided into local and general.

5.      Transfusion reactions consisted of pyrogenik reactions, allergic reactions, circulatory overload, hemolytic reactions, reactions and reactions of blood contaminated citrat intoxication.

REFERENCES

1.      Contreras, M., Penerjemah Oswari, J., Petunjuk Penting Transfusi, Ed.. 2, Jakarta EGC 1995. .

2.      Hassan, R., dkk. Hassan, R., et al. Buku Kuliah Ilmu Kesehatan Anak, Bagian Ilmu Kesehatan Anak FKUI, Jakarta 2002 hal : 483-490.

3.      Rustam, M., Almanak Transfusi Darah, Lembaga Pusat Transfusi Darah Palang Merah Indonesia, Jakarta 1977 Hal : 65- 69.

4.      Sejarah Transfusi dalam www.google.com

5.      Transfusion Guidelines dalam www.google.com

6.      Pelatihan Teknologi Transfusi Darah Bagi Dokter Unit Transfusi Darah, Angkatan XX, Jakarta 2005.