Strategi, Indikasi,

Target, dan
Pemantauan Tranfusi

Dr. Adam
Dr. Abdurachman
 KARAKTERISTIK
BEBERAPA
KOMPONEN DARAH

Harrison’s Principles of Internal medicine

20th Ed. (2018)
 WHOLE BLOOD
Whole blood provides both oxygen-carrying capacity and volume
expansion. It is the ideal component for patients who have sustained
acute hemorrhage of ≥25% total blood volume loss. Whole blood is
stored at 4°C to maintain erythrocyte viability, but platelet
dysfunction and degradation of some coagulation factors occur.
In addition, 2,3- bisphosphoglycerate levels fall over time, leading
to an increase in the oxygen affinity of the hemoglobin and a
decreased capacity to deliver oxygen to the tissues, a problem with
all red cell storage. Fresh whole blood avoids these problems, but it
is typically used only in emergency settings (i.e., military). Whole
blood is not readily available, since it is routinely processed into
components.

Harrison’s Principles of Internal medicine 20th Ed. (2018)

 Whole Blood
Darah yang langsung berasal dari donor + antikoagulan pada kantung darah

Komponen = Eritrosit, trombosit, faktor pembekuan labil (V dan VIII)

Di Indonesia, 1 kantung whole blood = 250 ml / 350 ml

• Antikoagulan 15 ml per 100 ml darah

Suhu penyimpanan 2-6°C

Masa penyimpanan
• Fresh blood < 6 jam
• Stored blood > 6 jam (max shelf-life 35 hari)
Perhatian
• Dilarang memasukan obat-obatan ke kantung darah
• Golongan darah harus sesuai ABO dan RhD compatible
• Waktu transfusi maksimal 4 jam

Taroeno-Hariadi KW. BLOOD TRANSFUSION GUIDELINES. :55.

 Whole Blood
Tujuan
• Meningkatkan eritrosit + plasma
• Peningkatan Hb paska transfusi 450 ml whole blood ~0.9-1.2 g/dl dan
peningkatan hematokrit 3-4%

Indikasi
• Pendarahan massif atau aktif >25-30% volume darah total
• Transfusi tukar
• Bila belum sempat dicocokkan  tipe O (-)

Kontraindikasi
• Anemia kronis normovolemik yang tujuannya untuk meningkatkan RBC

Dosis dan cara pemberian

• 250 ml pada dewasa meningkatkan Hb 0.5-0.6 g/dl
• Pada anak 8 ml/kg meningkatkan Hb ~1 g/dl

Taroeno-Hariadi KW. BLOOD TRANSFUSION GUIDELINES. :55.

 PACKED RBC
 This product increases oxygen-carrying capacity in the anemic
patient. 
 PRBC are stored in additive solution up to 35–42 days at 4°C.
Adequate oxygenation can be maintained with a hemoglobin
content of 70 g/L in the normovolemic patient without cardiac
disease; however, comorbid factors may necessitate transfusion
at a higher threshold. The decision to transfuse should be
guided by the clinical situation and not by an arbitrary
laboratory value. In the critical care setting, liberal use of
transfusions to maintain near-normal levels of hemoglobin has
not proven advantageous.
Harrison’s Principles of Internal medicine 20th Ed. (2018)
 PACKED RBC
PRBCs may be modified to prevent certain adverse reactions. The
majority of cellular blood products are now leukocyte-reduced and
universal prestorage leukocyte reduction has been recommended. 
Prestorage filtration appears superior to bedside filtration as
smaller amounts of cytokines are generated in the stored product.
These PRBC units contain <1 to 5.106 donor leukocytes, and their
use lowers the incidence of posttransfusion fever and chills,
cytomegalovirus (CMV) infections, and alloimmunization. Other
theoretical benefits include less immunosuppression in the
recipient and lower risk of infections with intracellular pathogens
(in addition to CMV). Plasma, which may cause allergic reactions,
can be removed from cellular blood compo-nents by washing.
Harrison’s Principles of Internal medicine 20th Ed. (2018)
 Packed Red Cell (PRC)

Definisi
• Terdiri dari eritrosit (RBC) yang telah dipisahkan dari komponen lain sehingga
mencapai hematokrit 65-70%
Setiap unit PRC = volume ~150-250 ml; Hb 20gr/100dl; Hct 55-75%

Tujuan
• Meningkatkan Hb tanpa meningkatkan volume darah secara signifikan
• 4 ml/kg (ekuivalen 1 unit / 70 kg) umumnya meningkatkan Hb 10 g/L

Keuntungan
• Kenaikan Hb dapat disesuaikan
• Mengurangi kemungkinan penularan penyakit dan reaksi imunologis
• Kemungkinan overload cairan berkurang

Taroeno-Hariadi KW. BLOOD TRANSFUSION GUIDELINES. :55.

 Packed Red Cell (PRC)
• Rutin = umumnya 1 unit dalam 90-120 menit (max 4 jam)
• Kurang toleran terhadap volume darah  lebih lambat
Kecepatan dengan monitor hemodinamik. Diuretik (furosemide 20-40
pemberian mg) dapat diberikan
• Pendarahan mayor = infus cepat (1 unit dalam 5-10 menit)
dengan monitoring

• Anemia tanpa penurunan volume darah (cth: anemia

Indikasi hemolitik, leukemia, talasemia, CKD, pendarahan kronis)
• Tidak dilakukan bila Hb 10 g/dl atau lebih

• Hb <7 g/dl pada 2 pemeriksaan jeda >2 minggu (eksklusi

Kriteria sebab lain) atau
laboratorium • Hb > 7 g/dl dengan perubahan wajah, pertumbuhan
buruk, fraktur, tanda klinis hematopoiesis ekstramedula

Taroeno-Hariadi KW. BLOOD TRANSFUSION GUIDELINES. :55.

 Packed Red Cell (PRC)

 Dosis
 Jumlah PRC = selisih Hb x 3 x BB

Target peningkatan Hb =

Trompeter S, Cohen A, Porter J. BLOOD TRANSFUSION [Internet]. Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT) [Internet]. 3rd edition.
Thalassaemia International Federation; 2014 [cited 2022 Jul 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK269390/
 PLATELET
Thrombocytopenia is a risk factor for hemorrhage, and
platelet transfusion reduces the incidence of bleeding.
Platelets are stored in plasma or in additive solution up to
5–7 days at 20–24°C and under permanent motion.
The threshold for prophylactic platelet transfusion is
10,000/μL. In patients without fever or infections, a
threshold of 5000/μL may be sufficient to prevent
spontaneous hemorrhage. For invasive procedures,
50,000/μL platelets is the usual target level. 

Harrison’s Principles of Internal medicine 20th Ed. (2018)

 PLATELET
Platelets are given either as pools of 4 to 6 prepared RDs
or as SDAPs from a single donor. In an unsensitized patient
without increased platelet consumption (splenomegaly, fever,
disseminated intravascu- lar coagulation [DIC]), two units of
transfused RD per square-meter body surface area (BSA) is
anticipated to increase the platelet count by ~10,000/uL.
Patients who have received multiple transfusions may be
alloimmunized to many HLA- and platelet-specific antigens
and have little or no increase in their posttransfusion platelet
counts. Patients who may require multiple transfusions are
best served by receiving leukocyte-reduced components to
lower the risk of alloimmunization. 
Harrison’s Principles of Internal medicine 20th Ed. (2018)
 Platelet / Thrombocyte Concentrate

Penyimpanan pada Tidak disimpan dalam

Shelf life 5 hari
suhu 22±2°C kulkas

Dosis
• 1 unit TC / 10 kgBB
• 1 unit meningkatkan TC harus diberikan Pemberian umumnya
PLT 20-40x109/L segera setelah sampai selama 30-60 menit.

Schwartz J, Padmanabhan,Aet al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Writing Committee of the American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31:149-338.
 Platelet
• Pendarahan akibat trombositopenia & disfungsi
Indikasi
platelet

<10x109/L • Pasien stabil tanpa pendarahan serius

<15-20x109/L • Kelainan sumsum tulang, sepsis, pasien tidak stabil

• Pendarahan mengancam nyawa di thorak atau

<30-50x109/L
kepala

Profilaksis
pembedahan

Schwartz J, Padmanabhan,Aet al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Writing Committee of the American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31:149-338.
 Platelet

DIC
• Tidak ada indikasi pada DIC kronis tanpa pendarahan aktif
• DIC akut  pertahankan PLT >50x109/L

ITP
• Transfusi platelet hanya pada kondisi pendarahan mengancam
nyawa dari GIT, saluran kemih, dan SSP
• Terapi lain juga perlu diberikan (contoh IVIG)

Komplikasi
• Febrile non hemolytic dan reaksi urtikaria jarang terjadi

Schwartz J, Padmanabhan,Aet al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Writing Committee of the American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31:149-338.
 FFP (Fresh Frozen Plasma)
FFP contains stable coagulation factors and plasma proteins:
fibrinogen, antithrombin, albumin, as well as proteins C and S.
Indications for FFP include correction of coagulopathies,
including the rapid reversal of warfarin effects; supplying deficient
plasma proteins; and treatment of auto-antibody-mediated
thrombotic thrombocytopenic purpura (TTP).
In the latter case, therapeutic plasma exchange allows both the
removal of the autoantibody and the supplementation of the
depleted enzyme (ADAMTS13). Other auto-immune diseases such as
Guillain-Barré syndrome and myasthenia gravis may benefit from
plasma exchange.
Harrison’s Principles of Internal medicine 20th Ed. (2018)
 FFP (Fresh Frozen Plasma)

FFP should not be routinely used to expand blood

volume. FFP is an acellular component and does not
transmit intracellular infections, e.g., CMV. In addition to
FFP, pre-thawed or never frozen plasma as well as freeze-
dried plasma are increasingly used to insure immediate
availability when required. Patients who are IgA-deficient
and require plasma support should receive FFP from IgA-
deficient donors to prevent anaphylaxis. 

Harrison’s Principles of Internal medicine 20th Ed. (2018)

 Fresh Frozen Plasma

Terdiri dari faktor

Plasma dipisahkan dari
pembekuan stabil,
1 kantong whole blood
albumin, Ig; F VIII Volume 60-180 ml
(max 6 jam) dibekukan
minimal 70% dari fresh
pada -25oC
plasma

1 unit FFP mengandung Dosis awal 10-15 ml/kg

seluruh faktor koagulan per dosis

Szczepiorkowski ZM, Dunbar NM. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638–44.
 Fresh Frozen Plasma

Perhatian

• Reaksi alergi akut dapat terjadi dengan pemberian cepat

• Reaksi anafilaksis jarang terjadi
• Harus ABO compatible untuk mengurangi risiko hemolisis
• Diberikan segera setelah thawing dalam air 30-37oC dengan alat
transfusi darah standard

Penyimpanan

• Pada -25oC atau lebih bertahan 1 tahun

• Setelah thawing harus di transfusi dalam waktu 24 jam atau
disimpan pada suhu 2-6oC selama 5 hari

Szczepiorkowski ZM, Dunbar NM. Transfusion guidelines: when to transfuse. Hematology Am Soc Hematol Educ Program. 2013;2013:638–44.
 Fresh Frozen Plasma
Indikasi Pendarahan aktif atau risiko pendarahan akibat defisiensi faktor
koagulan
Overdosis warfarin

Transfusi massif dengan pendarahan koagulopati

Kontraindikasi Untuk meningkatkan volume atau kadar albumin untuk nutrisi

Koagulopati yang dapat dikoreksi dengan penyesuaian dosis warfaring

dan/atau vit K

Normalisasi hasil skrining koagulasi abnormal tanpa pendarahan

Schwartz J, Padmanabhan,Aet al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Writing Committee of the
American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31:149-338.
 Fresh Frozen Plasma
Risiko Reaksi alergi
Overload sirkulasi akibat transfusi
Acute lung injury (ALI) akibat transfusi
Infeksi akibat transfusi
Respon Abnormalitas koagulasi  aPTT, PT, INR dalam rentang
homeostasis
Pada TTP  ↑PLT & ↓LDH

INR Salah satu tujuan = untuk normalisasi INR sebelum

pembedahan atau prosedur invasif
Pasien dengan INR ≥2.0 (atau ≥1.5 untuk pasien bedah
syaraf) dianggap kandidat untuk transfusi plasma

Tinmouth A. Evidence for a rational use of frozen plasma for the treatment and prevention of bleeding. Transfus Apher Sci 2012;46:293-8
Harrison’s Principles of Internal medicine 20th Ed. (2018)