Kuliah Bleeding and Transfusion 2010

8/16/2019 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



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IT) (Immune Thrombocytopenia Purpura)

$ bleeding1life saving prophyla2is forinvasive maneuvers may re3uire hugeamounts



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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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Kuliah Bleeding and Transfusion 2010

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