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Intravenous Fluid Therapyand Blood Component
MUHAMMAD ALAMSYAH
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Fluid Compartments
Total body consists of60% water byweight in adults
Body fluids divided into: Intracellular compartment Extracellular compartment, further
divided into:
Interstitial compartmentIntravascular compartment
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Intracellular Fluid
Intracellular Fluid 2/3
Extracellular Fluid1/3
InterstitialFluid=75%
IntravascularFluid=25%
Fluid Compartments
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Consists of: Cellular components of blood Proteins Ions mainly sodium, chloride andbicarbonates Potassium only a small portion in plasma
Normal blood volume is about 72 mL/kg of bodyweight
Intravascular compartement
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Larger than intravascular compartment Water and electrolytes pass freely between blood
and interstitial spaces, which have similar ioniccomposition
Plasma proteins are not free to pass out of theintravascular space unless there is damage tocapillaries, e.g., septic shock or burns
With fluid loss or fall in blood pressure, water andelectrolytes pass from interstitial compartmentinto blood (intravascular) to maintain volume(physiologic priority)
Interstitial compartement
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Water within cells: Largest reservoir of body water Ionic composition different from extracellular fluid Contains high concentration of potassium ions and
low sodium and chloride ions Normal saline given IV: Tends to remain inextracellular compartment
Glucose solution gets distributed throughout allbody compartments Pure water given IV: Causes massive hemolysis(dangerous)
Intracellular Compartement
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Fluid replacement should be as close as possiblein volume and composition to those fluids lost
Acute losses should be replaced quickly
Chronic lossesreplace with caution; rapidinfusion may cause fluid overload and heartfailure Better replaced by oral or rectal rehydration
Mostly deficient in water: Do not overload withsodium
Principles of Fluid Therapy
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Use salt solution Normal saline or Ringerslactate
Preload 1 L before spinal anesthesia
Ketamine anesthesia does not need preloading Maintenance fluid 4mL/kg/hour
Fluid Therapy DuringOperation
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Replacement for the loss of fluid Blood loss replace with crystalloid 3 times the
volume of blood loss Blood loss more than 1 L consider giving
blood Desirable to have a hemoglobin minimum
89 mg after surgery
Intravenous FluidTherapy
Fluid Therapy DuringOperation
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Subjective Fully soaked and dripping mop approximately
100 mL
Monitor heart rate, blood pressure throughout theoperation
Urine output 0.5 mL/kg/hr considered adequatefluid replacement
Estimation of Blood Loss
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Crystolloids 5% dextrose in aqua 5% dextrose in NaCl Normal saline (NaCl) Hartmans solution Ringers lactate solution Cholera saline
Colloids Dextran 40, 70 Gelatin preparations e.g., Haemacel Hetastarch, Pentastarch
Intravenous FluidTherapy
Types of IV Fluids
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TRANSFUSI DARAH
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Nilai ulang:- check list pelaksanaan transfusi darah- golongan darah pasien = donor ?(tanyakan/peneng)
- identitas pasien tepat ?- identitas donor dan golongan darah donor- awasi selama dan setelah transfusi(tanggung jawab dokter)
- awasi reaksi transfusi darah
Pemberian Transfusi DarahPada Pasien
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Table 1. Blood Components and Plasma Derivatives (1)
Component/Product Composition Volume Indications
Whole Blood RBCs (approx. Hct 40%); plasma; 500 ml Increase both cell mass & plasma
WBCs; platelets volume (WBCs & platelets not
functional; plasma deficient in labileclotting Factors V and VIII)
Red Blood Cells RBC (approx. Hct 75%); reduced 250 ml Increase red cell mass in symptom
plasma, WBCs, and platelets atic anemia (WBCs & platelets not
functional)
RBCs Leukocytes > 85% original volume of RBC; 225 ml Increased red cell mass; < 5 x 106 WBCs
Reduced (prepa- < 5 x 106 WBC; few platelets; to decrease the likelihood of febrile reac-
red by filtration) minimal plasma tions, immunization to leukocytes (HLA)
antigens) of CMV transmission
RBCs Washed RBCs (approx, Hct 75%); 180 ml Increase red cell mass; reduced risk of
< 5 x 108 WBCs; no plasma allergic reactions to plasma proteins
(Continued)
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Component/Product Composition Volume Indications
Platelets Platelets (> 5.5 x 1010/unit); 300 ml Bleeding due to thrombocytopenia or
RBC; WBCs; plasma thrombocytopathy
Platelets Pheresis Platelets (> 3 x 1011); 300 ml Same as platelets;l sometimes HLARBCs; WBCs; plasma matched
FFP; FFP Donor Plasma; anticoagulation factors; 220 ml Treatment of some coagulatioRetested plasma; complement (no platelets)
Solvent/detergent-
Treated plasma
Cryoprecipitated Fibrinogen; Factors VIII and XIII; 15 ml Deficiency of fibrinogen; Factor XIII;AHF von Willebrand factor second choice in treatment of
hemophilia A, von Willebrands disease
(Continued)
Table 1. Blood Components and Plasma Derivatives (1)
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Trombosit disimpan dalam kondisi digoyang terus(Reciprocal agitator), pada suhu kamar (20C)
Harus segera diberikan (tidak boleh disimpan dikulkas/ di ruangan)
Kecepatan cepat Gunakan infus set khusus (jangan menggunakan
set transfusi darah merah)
Transfusi Trombosit
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Trombosit:- dosis umumnya: 1 unit per 10 kg BB(5-7 unit untuk orang dewasa)
- 1 unit meningkatkan 5000/mm3(dewasa 70 kg)- ABO-Rh typing saja, tak perlu cross
match, kecuali pada keadaan tertentu
Kebutuhan Trombosit
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KEBUTUHAN PLASMA/FFP
Dosis bergantung kondisi klinis dan penyakitdasarnya
Coagulation factor replacement:10 20 ml/kg BB (= 4-6 unit pd dewasa)
Dosis ini diharapkan dapat meningkatkan faktorkoagulasi 20 % segera setelah transfusi
Plasma yang dicairkan (suhu 30 - 37 C) harussegera ditransfusikan
ABO-Rh typing saja (tak perlu cross match)
Transfusi Plasma / FFP
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KEBUTUHAN KRIOPRESIPITAT
Diencerkan pada suhu 30 37 C 1 unit akan meningkatkan fibrinogen 5
mg/dl pada dewasa
Target hemostasis level: fibrinogen> 100 mg %
Segera transfusikan dalam 4 jam
Transfusi Kriopresipitat
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REAKSI REAKSITRANSFUSI DARAH
Bila dilaksanakan pemeriksaan laboratoriumsebelum pemberian transfusi darah, mayoritastransfusi darah tidak memberikan efek sampingkepada pasien
Namun, kadang-kadang timbul reaksi padapasien, walaupun pemeriksaan laboratorium pra-transfusi darah telah dilaksanakan dan hasilnyaCOMPATIBLE(= cocok antara darah resipien dan donor)
Reaksi: reaksi RINGAN (suhu meningkat, sakitkepala) s/d BERAT (reaksi hemolisis), bahkandapat meninggal
Reaksi Transfusi Darah
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KOMPLIKASI TRANSFUSIDARAH
Komplikasi LOKAL:- kegagalan memperoleh akses vena- fiksasi vena tidak baik- masalah ditempat tusukan
- vena pecah saat ditusuk, dll
Komplikasi UMUM:- reaksi reaksi transfusi
- penularan/transmisi penyakit infeksi- sensitisasi imunologis- kemokromatosis
Komplikasi Transfusi Darah
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REAKSI TRANSFUSI DARAH
Reaksi Tranfusi Darah AKUT:hemolitik, panas, alergi, hipervolume,
sepsis bakteria, lung injury, dll
Reaksi Transfusi Darah LAMBAT
REAKSI TRANSFUSI DARAH
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REAKSI REAKSITRANSFUSI DARAH
Yang paling sering timbul:- reaksi febris
- reaksi alergi- reaksi hemolitik
REAKSI TRANSFUSI DARAH
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REAKSI FEBRIS
Nyeri kepala menggigil dan gemetartiba tiba suhu meningkat
Reaksi jarang berat Berespon terhadap pengobatan
REAKSI FEBRIS
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REAKSI ALERGI
Reaksi alergi berat (anafilaksis): jarang
Urtikaria kulit, bronkospasme moderat,edema larings: respon cepat terhadappengobatan
REAKSI ALERGI
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REAKSI HEMOLITIK
REAKSI YANG PALING BERAT Diawali oleh reaksi:
- antibodi dalam serum pasien >< antigen
corresponding pada eritrosit donor- antibodi dalam plasma donor >< antigen
corresponding pada eritrosit pasien Reaksi hemolitik: - intravaskular
- ekstravaskular
REAKSI HEMOLITIK
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REAKSI HEMOLITIK
REAKSI INTRAVASKULAR:- hemolisis dalam sirkulasi darah- jaundice dan hemogolobinemia
- antibodi IgM- paling bahaya anti-A dan anti-B spesifikdari sistem ABO
- fatal akibat perdarahan tidak terkontrol
dan gagal ginjal
REAKSI HEMOLITIK
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REAKSI HEMOLITIK
REAKSI EKSTRAVASKULAR:- jarang sehebat reaksi intravaskular- reaksi fatal jarang
- disebabkan antibodi IgG destruksieritrosit via makrofag
- menimbulkan penurunan tiba triba
kadarHb s/d 10 hari pasca transfusi
REAKSI HEMOLITIK
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