PK 1.1 1.2-Kuliah FKG Usu KBK Skreening Hemostasis
PK 1.1 1.2-Kuliah FKG Usu KBK Skreening Hemostasis
PK 1.1 1.2-Kuliah FKG Usu KBK Skreening Hemostasis
(VIRCHOWS TRIAD)
Blood vessel (vasoconstriction) Platelets (adhesion and aggregation) Coagulation and Fibrinolysis
Prof. Dr. Adi Koesoema Aman, SpPK (KH)
BLOOD VESSEL
Pressure midway between systole and diastole For 5 minutes (Hess test)
Interpretation
(+): small red dots difficult to be seen (++): bigger dots and easily seen (+++): not only easily seen but also quite prominent and sometimes confluent (++++): true bruising
Bleeding Time
As a global test to measure roughly Platelets function Platelets number
First blood drop is wiped Next, blood is tipped off by filter paper every 30 sec
PLATELET
PLATELET
Bleeding Time
As a global test to measure roughly Platelets function Platelets number
CELL COUNTER
PLATELETS
PLATELET ADHESION PLATELET AGGREGATION
Platelet Aggregation
Platelet adhesion is mediated by vWF. This activates platelets causing release of TxA2 During activation, a receptor for fibrinogen becomes exposed on the platelet membrane. Activated platelets release by ADP, Epinephrin, serotonin: Fibrinogen ADP/ATP vWF Serotonin dense core granules Factor V Ca2+ Factor VIII Platelet derived growth factor (PDGF) ~ promotes healing Platelet factor IV prevents formation of active thrombin inhibitor from heparin and anti-thrombin III.
a-granules
AGGREGATION OF PLATELET
IS MEASURED AFTER ADDING THE PLATELET AGONISTS SUH AS ATP EPINEPHRIN SEROTONIN RISTOCETIN
Intrinsic pathway
XIIa
Extrinsic Pathway XIa
TF Prothrombin
VIII IXa VIIIa VIIa Xa Va Thrombin V
Soft clot
Fibrinogen
Fibrin
XIIIa
Hard clot
Fibrin
FIBRINOGEN ASSAYS
Radial immunodifussion Clauss method (pure clotting-based) Blomback and Blomback (+thrombin Ca++) soluble and unstabilized. The tyrosine content is measured after adding urea. Ratnoff and Menzies: Fibrinogen is clotted into Fibrin in glass beads, washed and bolied +NaOH, tyrosine measured with Fiolin CalcateuPhenol reagent
Intrinsic pathway
Extrinsic pathway
Intrinsic pathway
Extrinsic pathway
Intrinsic pathway
Extrinsic pathway
Intrinsic pathway
Extrinsic pathway
PENGERTIAN TRANSFUSI .
TRANSFUSI DARAH = HEMOTERAPI .
Yang dimaksud hemoterapi adalah pemberian komponen darah serta derivat 2 nya utk terapi dengan cara transfusi . - Komponen Darah : RBC , Trombosit , Lekosit , Plasma , Kriopresipitat . - Derivat : Albumin , F VIII , F IX , Fraksi Protein Plasma .
PEMBAHASAN MELIPUTI :
1. SELEKSI DONOR
2. PEMERIKSAAN PRA TRANSFUSI
3. PENYIMPANAN DARAH
4. KOMPONEN DARAH 5. INDIKASI TRANSFUSI DARAH 6. REAKSI TRANSFUSI DARAH 7. IMMUNO HEMATOLOGI .
1. SELEKSI DONOR .
65 thn .
1.2. KADAR HB DAN HT . Darah diambil dari : Ujung jari , daun telinga dan vena
- Wanita : Hb. > 12 ; Ht. > 36% - Pria : Hb. > 13 gr% pria : > 39% . ujung jari & vena .
- Sampel dr earlobe : - Wanita : Hb. > 12,5 gr% , Ht.38% - Pria. : Hb. > 13,5 gr% ,Ht. > 40%
BERAT BADAN .
- Nadi : 50 100 /mnt , reguler , tdk patologis . - TD : tdk. > 180 / 100 mmHg , TD > 180/100 mmHg harus dengan seizin dokter . - Wanita hamil diajurkan tdk donor , bila sangat dibutuhkan , dilarang < 6 minggu - BB sebaiknya > 50 kg .
Components
Whole blood
Cellular components
Fresh plasma
Cryoprecipitate
1.
2. 3.
WHOLE BLOOD .
R.B.C RBC + Adenin Saline .
500 ML
25O ML 330 ML
4.
200 ML
5. 6.
180 ML 220 ML .
7.
8.
PLATELETS ( PLT. > 5,5 X 1010 / UNIT ; SEDIKIT WBC , PLASMA DAN RBC . PLATELETS ( > 3 X 1011 / UNIT ) ; SEDIKIT SKL WBC PLASMA DAN RBC .
50 ML .
300 ML
9.
220 ML
10.
220 ML .
11.
200 ML
12.
15 ML .
13. 14.
25 ML 25 ML
15.
30 ML
17.
5 % ; 25%
18.
IgG ANTIBODI
VARIASI
19.
IgG anti D
1 ML
- 450 ml Darah + 63 ml Pengawet , Ht : 36 40 % - Pada Suhu 16 C = 21 36 hari . CPD = 21 hari . CPD-A = 35 hari . - CPD : Ph. DARAH , 2,3-DPG tetap . - Kadar 2,3-DPG yg rendah Affinitas Hb. thd 02 . - Adenin CPD agar ATP RBC tetap .
ISTILAH PD WHOLE BLOOD: 1.1. Fresh WB . < 24 jam . - Tidak tersedia di UTD . - Ok pemeriksaan penyaring Lama .
INDIKASI :
- SEBAGAI O2-CARRYING CAPACITY & BLOOD VOLUME EXPANSION . - KEHILANGAN DARAH AKUT & BANYAK .
KONTRA INDIKASI :
- Tdk diberikan pada anemi kronik . DOSIS : - Pada dewasa 1 bag 1 gr% , Ht. 3 4 % - Pada anak 8 ml/kg.BB 1 gr% . - Pemberian harus selesai dalam 4 jam .
Contraindications
Anemias that can be corrected with specific medications such as iron, vitamin B12, folic acid, or erythropoietin Coagulation deficiency Volume expansion To improve oncotic pressure, wound healing and sense of well being
INDIKASI :
ANEMI DEFF. BERAT . ANEMI CHRONIK DISEASE . ANEMI GGK . ANEMI GAGAL SUMSUM TULNG . PASIEN DGN REGULER TRANSFUSI . HDN . AIHA .
3. PLATELET CONCENTRATES .
3.1. RANDOM DONOR . - DARI BERBAGAI INDIVIDU .
Platelet Incubator
INDIKASI :
1. ANEMIA APLASTIK . 2. KELAINAN FUNGSI TROMBOSIT . - PENY. GLANZMANN . - PENY. BERNARD-SOULIER . 3. SEK. TROMBOPATI . - MM , PARAPROTEINEMIA . - UREMIA . 4. DILUTION TROMBOSITOPENIA OK TRANSFUSI MASIF ( PLT. < 50 X 103/MM3 . ) . 5. PENGGUNAAN ALAT KARDIPULMONAIR ( HEART LUNG MACHINE ) . TROMBOSITOPENIA 6. PENDERITA ITP . - TERUTAMA TROMBOSITOPENIA BERAT .
7. DILUTION TROMBOSITOPENIA OK TRANSFUSI MASIF ( PLT.< 50 x103/mm3 ) 8. PENGGUNAAN ALAT KARDIO-PULMONAIR ( HEART LUNG MACHINE ) . TROMBOSITOPENIA . 9. PENDERITA ITP . TERUTAMA TROMBOSITOPENIA BERAT
KONTRA INDIKASI .
PEMBERIAN TDK EFFEKTIP PADA KEADAAN : 1. Ps. DGN RAPID PLATELETS DESTRUCTION . 2. IDIOPATIK AUTOIMMUN TROMBOSITOPENIA PURPURA ( ITP ) . 3. DIC . 4. SEPTIKEMIA . 5. HYPERSPLENISME .
4. GRANULACYTES.
- CENTRIFUGATION LEUKOPHRESIS - 1 BAG = >1,0 X 1010 GRANULACYTES . - JUMLAH LIMFOSIT ,TROMBOSIT,RBC BERVARIASI . - SUSPENSI 200 300 PLASMA .
INDIKASI .
1. BONE MARROW HYPOPLASIA . 2. NETROPENIA < 500 PMN / MM3 . 3. FEVER 24 48 JAM , TDK RESPONS THD ANTI BIOTIK TERAPI .
Frozen Plasma 24
6. LIQUID PLASMA .
- Dibuat pemisahan plasma dari wholeblood . - Volume 200 250 ml ( bag 450 ) atau 100 125 ml ( bag 250 ml ) . - Mengandung stabil faktor yang cukup , labil faktor sedikit kurang ( FV dan F VIII ) . - Penyimpan < ( -18oC ) tahan 5 tahun
INDIKASI .
MULTIPLE F.KOAGULASI DEFFISIENSI SEK.
- LIVER DISEASE .
- DIC . - DILUTION COAGULOPATHY OK MASSIVE BLOOD REPLACEMENT .
- MILD HEMOFILIA B .
INDIKASI .
1. DEFFISIENSI STABIL FAKTOR .
Cryoprecipitate
7. CRYOPRECIPITATED AHF .
- FFP THAWING 40C SUPERNATANT + PRICIPITATE .
- SUPERNATANT DIKELUARKAN COLD PRECIPTATE PROTEIN + 10 15 ML PLASMA = CRYOPRECIPITATE REFROZEN PADA ( 180C ) TAHAN 1 TAHUN .
-MENGANDUNG : F.VIII:C ( PROKOAGULANT ACTIVITY ) F.VIII , Vwf , FIBRINOGEN , F.XIII FIBRONECTIN . - 1 BAG = 80 120 UNIT F.VIII ; C , 250 mg FIBRINOGEN , 20-30% F.XIII .
Cryoprecipitate is prepared by thawing fresh frozen plasma at a temperature between 1C and 6C. After centrifugation, the supernatant plasma is removed and the insoluble cryoprecipitate is refrozen. On average, each unit of cryoprecipitate contains 80 IU or more Factor VIII (FVIII:C) and at least 150 mg of fibrinogen in 5-15 mL of plasma. Cryoprecipitate provides a source of coagulation factors. Factor VIII, Factor XIII and von Willebrand Factor. Fibrinogen and fibronectin are present.
INDIKASI .
1. HEMOFILIA A .
2. Von WILLIBRAND DISEASE . 3. DEFF. FIBRINOGEN CONGENITAL / AQUIRED . 4. DIC .
6. PENDERITA ITP . - TERUTAMA TROMBOSITOPENIA BERAT . - SELALU TDK EFFEKTIP OK AKAN LISIS OLEH PROSES IMMUN .
CARA PEMBERIANNYA :
- 1 UNIT KONSTR. / 10 KGBB RESIPIEN . - SINGLE DONOR = 6 UNIT KONSTR. PLT.
- GUNAKAN PERANGKAT PEMBERIAN TROMBOSIT - GUNAKAN KONSTR. TROMB. SPESIFIK ABO & Rh.
KOMPLIKASI . 1. TROMBOSITOPENI REFRAKTER TRANSF. TROMB. BERULANG . ANTIBODI HLA . 2. GRAFT VERSUS HOST DISEASE ( GVHD ) . - JARANG TERJADI .
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