Kuliah Bleeding and Transfusion 2010
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Transcript of Kuliah Bleeding and Transfusion 2010
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BLEEDING
AND
TRANSFUSION
SUBDVISON OF HEMATOLOGY-ONCOLOGY
Department of Pedatr!"# Fa!$%t& of Med!ne# Gad'a(Mada Un)er"t& Yo*&a+arta
, .an$ar& /0,0
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Bleeding and Transfusion
Objectives:
1. To know the cause of bleeding :
angiophaty, thrombophaty and
coagulopathy
2. To diagnose the bleeding
. !ow to treat the bleeding
". #lood componen transfusion, apheresis,indication and side effect
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• Suatu mekanisme• mempertahankandarah:
selalu di dalam vasa &
dalam bentuk cairan
1. Vaskular
2. Trombosit3. Faktorkoagulasi
‘Dynamic walls’
MultilayersElasticInteractio
n
Ti
$b
TmT
%
&&
&
HEMOSTASIS
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HEMOSTASIS
Interaksi dinding vasa – trombosit – faktor
koagulasi – mekanisme penyeimbangnya
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Trombosi
t
oagulasi23
V a s o k o n s t r i k
s i
‘Menambal’ lobang
1
HEMOSTASIS
'ibrinolisis
(antifibrinolisi
s
!
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The cause of bleeding
a. )s this local bleeding* or systemic
bleeding*b. )f systemic bleeding : angiopathy,
thrombopathy, or coagulopathy*
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Screening of bleeding
1.+umple eede
2.&latelet count
#leeding time
". -lotting time
. -lot retraction
ocal : all normal
/ystemic : 1 or more abnormal
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Local bleeding
In'$r 1 traff! a!!dent
Operat)e pro!ed$re
Et!
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Why the systemic bleeding can
happen ? D"order" of Hemo"ta""1
0ascular disorders Ea"& 2r$"n*
&latelet disorders Lo3 N$m2er or a2norma% f$n!ton
-oagulation disorders
Fa!tor def!en!&
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Systemic bleeding
,45$mp%e Leede po"tf 1 An*opat(&6
/4 P%ate%et !o$nt de!rea"e 1
T(rom2o!&topena6
4 B%eedn* tme pro%on*ed 1T(rom2o!&topena6 An*opat(&6
74 C%ottn* tme pro%on*ed4 Fa!tor !oa*$%aton
defe!en!& 8 Hemop(%a et!96 :4 C%ot retra!ton a2norma% 4 T(rom2o!&te
F$n!ton d"ea"e4
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Where the bleeding occur ?
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Bleeding
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Bleeding
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Treatment
Depend on an $nder%&n* d"ea"e"
Tran"f$"on1 2%ood !omponent
8P5C# P%a"ma# P%ate%et9
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TRANSFUS!N
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Preparation Child and Family
Inform !(%d ; fam%& of t(e fo%%o3n* 1
T(at a 2%ood prod$!t tran"f$"on " ne!e""ar&
T(e rea"on for t(e tran"f$"on
T(e rea!ton of tran"f$"on
Informed !on"ent
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-O$&O%T ))-3T)O/ &+%-34T)O/
5BC 0/ !arr&n* !apa!t& n"&mptomat! nd)d$a%"
Compat2%t& te"ted
P%ate%et" 8F poo%ed 8ABO!ompat2%e9
P%ate%et" 8Ap(9 ≈ a2o)e# refra!tor& to randomdonor p%ate%et"
, !o%%e!ton-,tran"f$"on
Cr&opre!ptated AHF
)
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Fresh Frozen Plasma (FFP)
Komponen plasma yang dipisahkan dari
komponen darah lengkap dibekukan dalam waktu
6-8 jam lalu disimpan sampai 1 tahun
FFP mengandung 1!!" semua konstituenplasma normal termasuk #aktor koagulasi labil dan
stabil (#a$tor %& %%& '& '%%& '%%%& %& & %& %%%& 'on
illebrand)
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Red cell transfusion
Pa!+ed 5ed Ce%%
rare%& nd!ated for H2 *=d%4 and " a%mo"ta%3a&" nd!ated for H2 @ *=d%# 8part!$%ar%&
3(en t(e anaema " a!$te94 T(e "pe!f! rea"on" for tran"f$"on "(o$%d
2e do!$mented
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Aferesis
Gree+ 1 to ta+e a3a&
S$at$ !ara med"# dara( donor dam2% ata$
pa"en# me%a%$ "$at$ a%at# dam2% &an*
dper%$+an# ""an&a dma"$++an +em2a% +edonor=pa"en4
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ndi'asi pemberian 'omponen
omponen Conto( +e*$naan
,4 Ertro"t - ma$ opera"
anema ap%a"t+
anema perdara(an tra$ma
/4 P%a"ma - DHF# DIC
4 Trom2o"t - ITP8 %fe "a)n*9# DHF# DIC
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Apheresis
http://upload.wikimedia.org/wikipedia/en/b/bc/Apheresis.PNG
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"latelet blood bag
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O()$$4% $%)3T%
-3T%5O+6 T6&% O' +%3-T)O
D"ea"etran"m""on
Hepatt" B# C 8non-A# non-B9#CMV# Ma%ara# AIDS# S&p(%"
Sept!ema Ba!tera% "ep"" d$e to nfe!ted 2%ood
Em2o%"m Ar em2o%"m
M!roem2o%"m
O)er%oad F%$d# ron# !trate
E%e!tro%&te m2a%an!e
Hemorr(a*!dat(e""
T(rom2o!&topena
Coa*$%aton fa!tor def!en!e"
Follo%&u" o# bloo$ trans#usion
Transfusion reactions
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Transfusion reactions
)$$4% $%)3T%
-O/T)T4%T T6&% O' +%3-T)O
5BC" A!$te=de%a&ed (emo%&t!#
A%%om$naton to 5BC ant*en"
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!bser(e child for ma)or reactions to
blood product
5*or
La2o$red 2reat(n*=3(een*
C(e"t pan
Ba!+ or 'ont pan=dar+ened $rne
Lo"" of !on"!o$"ne""
S$dden !o%%ap"e
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!bser(e child for minor reactions to
blood product
S3eatn*
Dne""
5a"(
5edne"" on !(e"t F%$"(n*
Fe)er
Ta!(&!arda Na$"ea
C(%%"
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f a se(ere reaction occurs*
Stop tran"f$"on mmedate%&
Inf$"e 04 "od$m !(%orde for nf$"on
See+ $r*ent med!a% a"""tan!e4
G)e "terod and ant-("tamne f pre"!r2ed 5e!ord )ta% "*n" 8temperat$re# p$%"e# re"praton ;
BP9
5e!ord n!dent n !(%dJ" re!ord"
o not recommence transfusion Inform B%ood Tran"f$"on La2orator
Comp%ete an n!dent report form
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Malignancy
Leukemia (ALL A!L" solid tumor
Impacts of malignancy side e#ects ofmedicines
$% $ ''$ ot al)ays emergency*
Some e'"eriences #rom "e$iatric
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T(alassemia
$% +b > ,- gr.
,/0 monthly life long
Some e'"eriences #rom "e$iatric
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IT) (Immune Thrombocytopenia Purpura)
$ bleeding1life saving prophyla2is forinvasive maneuvers may re3uire hugeamounts
Some e'"eriences #rom "e$iatric
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"+NUTU"
B%eedn*6 Lo+a% ata$ "&"tem+
S!reenn*6 5L# B%eedn* tme# Coa*$%aton tme#T(rom2o!&te# C%ot retra!ton
S&"tem+6 An*opat( T(rom2opat( Coa*$%opat(&
Pem2eran +omponen dara( (an&a pada +eadaantertent$ 8P5C P%a"ma Trom2o"t d%%9
omponen dara( %e2( 2a+
Afere"" %e2( ra"ona% men*$ran* r"+o a+2attran"f$"
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