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"Transfusi darah autologous (TDA) adalah jenis transfusi darah paling aman baik untuk operator maupun pasien. Sedangkan teknik donasi pre operatif merupakan salah satu teknik TDA yang telah berhasil menurunkan permintaan darah homologous dengan sukses. Transfusi darah homologous (TDH) lebih banyak mempunyai risiko terjadinya komplikasi seperti penularan penyakit, reaksi anafilaktik, reaksi hemolitik dsb. Penelitian ini merupakan suatu uji paralel, membandingkan kelompok yang memperoleh TDA dengan kelompok yang memperoleh TDH pada operasi tulang belakang. Parameter yang digunakan adalah nilai hemoglobin(Hb) dan hematokrit(Ht) pre operasi (pasca donasi pada TDA), nilai Hb dan Ht pasca transfusi dan jumlah hari perawatan pasca operasi. Penelitian ini juga untuk mengetahui keberhasilan penggunaan TDA dilihat dari jumlah pasien yang akhirnya menggunakan TDH tambahan. Sampel adalah 74 pasien orthopaedi yang akan menjalani operasi tulang belakang dengan diagnosis fraktur, spondilitis TB, scoliosis, spinal stenosis dan spondilolisthesis. Pada kelompok TDA usia pasien 33,9 ± 14 tahun, sedangkan pada TDH 29,1 ± 11,5 tahun. Berat badan pemakai TDA 55,3 ± 11,1 kg dan pemakai TDH 52,8 ± 9,7 kg. Jumlah donasi pre operatif pada pemakai TDA 798,6 ± 170 cc. Ada 12 pasien (32,4%) yang jumlah donasi pre operatifnya tidak sesuai dengan permintaan. Pada kelompok pemakai TDA, ada delapan pasien (21,6%) yang akhirnya memerlukan tambahan TDH rata-rata 550 cc. Ada tiga pasien (8,1%) dari pemakai TDA mendapatkan transfusi yang tidak sesuai dengan indikasi (perdarahan < 15% dari total blood volume). Nilai Hb dan Ht pre operasi (pasca donasi) pada pemakai TDA secara bermakna (p=0,001) lebih rendah daripada pemakai TDH. Nilai Hb pasca transfusi pada pemakai TDA secara tidak bermakna (p=0,30) lebih rendah daripada pemakai TDH. Jumlah hari perawatan pasca operasi secara bermakna (p=0,000) lebih tinggi pada pemakai TDH dibanding pemakai TDA. Dapat disimpulkan bahwa : ada 21,6% dari pemakai TDA dengan teknik donasi pre operatif yang akhirnya memrlukan TDH tambahan; tidak ada perbedaan yang bermakna Hb, Ht pre operasi dan pasca transfusi pada pemakai TDA dan TDH; jumlah hari perawatan pasca operasi secara bermakna lebih tinggi pada pemakai TDH dibanding pemakai TDA. (Med J Indones 2004; 13: 17-23)

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Autologous Blood Transfusion (ABT) is the safest type of blood transfusion for the operator and the patient. The preoperative donation technique had already been reduced the homologous blood requirements successfully. Homologous Blood Transfusion (HBT) brings more risks in complications such as transmission of diseases, anaphylactic reactions, haemolitic reactions etc. This was a parallel study, comparing one group receiving ABT and a second group receiving HBT where in both groups were performed spine surgery. The parameter used was the hemoglobin(Hb) and hematocrit(Ht) content preoperatively (after donation of ABT) and after transfusion, total days in hospitalization after surgery. Another purpose of this study was also to achieve understandings in using ABT by considering the total patients who finally required additional HBT. There were 74 patients with diagnosis of spine fracture, tuberculous spondylitis, scoliosis, spinal stenosis and spondylolisthesis. In the ABT group the average age was 33,9 ± 14 years old and the HBT group was 29,1 ± 11,5 years old. Both groups consisted of 21 males and 16 females. Body weight of the ABT group was 55,3 ± 11,1 kg and the HBT group 52,8 ± 9,7 kg. Amount of donations preoperatively in ABT was 798,6 ± 170 cc. There were 12 patients (32,4%) where the donated blood amount preoperatively did not match up the requests. There were eight patients (21,6%) in the ABT group that required additional HBT of about 550 cc. Three patients (8,1%) of the ABT group received transfusion that did not match the indications (blood loss < 15% of the total blood volume). The Hb and Ht content preoperatively (after donation) of the ABT group significantly was less than the HBT group (p= 0,001). Hb content after transfusion in the ABT group was not significantly less than the HBT group (p = 0,30). Hospitalization days after surgery were significantly higher in the HBT group (p = 0,000). In conclusions : there was 21,6% of the ABT group with the preoperative donation technique that finally required additional HBT. Also there was no difference in the Hb and Ht content preoperatively and post transfusion in the ABT and HBT group, whereas hospitalization days after surgery were higher in the group receiving HBT than in the group receiving ABT. (Med J Indones 2004; 13: 17-23)"

"ABSTRAKDeteksi antibodi bertujuan untuk mendeteksi adanya antibodi ireguler terhadap sel darah merah di dalam plasma pasien. Sampai saat ini, kegiatan pelayanan transfusi darah di Indonesia masih bergantung pada uji silang serasi yang masih kemungkinan adanya antibodi ireguler yang tidak terdeteksi. Antibodi tersebut dapat menyebabkan terjadinya reaksi transfusi tipe lambat yang ditandai dengan penurunan hemoglobin dan peningkatan kadar bilirubin. Upaya keamanan pada pasien transfusi perlu ditingkatkan dengan diterapkan uji saring antibodi secara rutin pada pemeriksaan pra-transfusi. Tujuh ratus sampel pasien yang meminta darah ke laboratorium pelayanan pasien di UTD PMI DKI Jakarta dilakukan uji saring antibodi dan uji silang serasi secara otomatis dengan alat Ortho AutoVue Innova dengan Column Agglutination Technology. Untuk membuktikan kompatibel palsu dipilih 10 plasma pasien yang mengandung antibodi untuk dilakukan uji silang serasi mayor dengan 70 sampel darah donor. Hasil kompatibel dilakukan konfirmasi dengan antigen typing pada donor. Semua sampel pasien yang tidak memiliki antibodi 100 kompatibel pada uji silang serasi mayor. Dari 70 sampel dengan hasil kompatibel pada uji silang serasi mayor ditemukan 14 20 hasil negatif palsu. Dari penelitian ini disimpulkan uji saring antibodi lebih mampu mendeteksi antibodi pada plasma pasien dan aman digunakan dalam pemeriksaan pra-transfusi.

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ABSTRACTDetection of antibody aims to detection of irregular antibody on the blood cell in patient plasma. Until now, blood transfusion in Indonesia in terms still depending on the crossmatch is still risking on undetected irregular antibody. The irregular antibody may cause a delayed hemolytic transfusion with hemoglobin reduction and bilirubin increase as the symptoms. Patient with blood transfusion 39 s safety needs to be improved by routine antibody screening on pre transfusiontest. 700 samples of patients who requested blood to the patient care laboratory in UTD PMI DKI Jakarta were antibody screening and major crossmatch automatically with Ortho tool AutoVue Innova with Column Agglutination Technology. To prove false compatible, 10 patient 39 s plasma containing antibodies have been selected to be tested by major of crossmatch with 70 blood donor samples. Compatible Results were confirmed with antigen typing. All samples of patients who did not have antibodies 100 compatible on crossmatch test. from 70 samples which compatible on major crossmatch test was found 14 20 of false negative results. This study suggests the antibody screening which capable of detecting antibodies in the patient 39 s plasma and safely used in the pre transfusion test. "

"ABSTRAKDarah merupakan sumber daya yang tidak tergantikan. Menurut Hall (2013), diUniversity Hospitals of Leicester UK, dari 507 unit darah yang di-crossmatchhanya 283 unit darah yang ditransfusikan. Terdapat 25% darah terbuang padaRumah Sakit Publik Guyana (Kurup, 2016). Penelitian ini merupakan penelitiandeskriptif dengan metode kualitatif. Berdasarkan analisis diperoleh hasil, yaitu35.79% unit darah yang tidak ditransfusikan, capaian CT Ratio 2.12 (dari 3536unit darah yang dicrossmatch, hanya 1670 unit darah yang ditransfusikan),Penyebab darah terbuang adalah kadaluarsa 98.4%, selang habis, kantong bocor,darah rusak dll. Penggunaan MSBOS dapat menurunkan angka ketidakterpakaiandarah pada pasien operasi elektif sebesar 35.64%.

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ABSTRACTBlood is an irreplaceable resource. According to Hall (2013), at UniversityHospitals of Leicester UK, from 507 units of crossmatched blood, only 283 unitswere used. There is 25% discharge blood at Guyana Public Hospital (Kurup,2016). This research is a descriptive case study with qualitative method. Based onthe analysis, 35.79% of the blood units were not transfused, the CT ratio was 2.12(from 3536 unit of crossmatched blood, only 1670 unit were transfused). Thecause of blood wastage is expired 98.4%, blood tube runs out, blood bag leak,blood damaged and unidentified causes. The use of MSBOS may decrease the rateof blood units wastage in elective surgery patients by 35.64%."

"[ABSTRAKLatar belakang. Komponen darah washed erythrocyte (WE) mempunyai fungsi yang sama dengan leukodepleted PRC (LD-PRC) yaitu untuk mencegah atau mengurangi reaksi transfusi. Namun banyak kekhawatiran para klinisi tentang cara pembuatan komponen darah WE dan bahan yang terkandung pada filter leukosit untuk menangkap leukosit. Tujuan utama dari penelitian ini adalah memberikan bukti secara ilmiah akan keamanan dalam pemakaian komponen darah PRC yang telah dimodifikasi ini dan juga memberikan pemahaman tentang pemakaian yang benar untuk komponen darah ini. Metoda. Penelitian ini menggunakan desain potong lintang pada 52 sampel darah. Pemeriksaan darah dilakukan pada 26 sampel WE sebelum dan sesudah menjadi komponen darah WE dan 26 sampel LD-PRC sebelum dan sesudah menjadi komponen darah LD-PRC. Pemeriksaan hematologi diperiksa secara otomatis menggunakan Sysmex Xn-2000, total protein diperkirakan menggunakan ADVIA 1650/1800, sedangkan hemolisis darah diamati menggunakan uji Osmotic Fragility Test (OFT). Hasil. Menunjukan kadar hemoglobin pada kelompok WE berkurang 15,4%, volume hematokrit menurun 8,55%, kadar protein menurun 98,4 %, dan jumlah leukosit menurun 87,31% dibandingkan dengan kelompok PRC sebelum dicuci. Selain itu, kadar hemoglobin dari komponen darah leukodepleted menurun 29,1%, volume hematokrit meningkat 21%, kadar protein menurun 79,1% dan jumlah leukosit menurun 99,9% dibandingkan dengan kelompok WB sebelum dijadikan komponen leukodepleted PRC. Persentase hemolisis pada komponen darah WE dan LD-PRC adalah < 0,8% Perbedaan bermakna komponen darah WE dan LD-PRC dapat diamati pada parameter penilaian protein sisa dan leukosit sisa (p<0,05). Simpulan. Dalam pembuatan komponen darah WE protein plasma berkurang sebanyak 98,4%, sedangkan dalam pembuatan leukodepleted PRC, jumlah leukosit berkurang sebanyak 99,97%. Terjadinya hemolisis dapat diabaikan karena pada kedua komponen darah, hemolisis terjadi < 0,8%. Jika diperlukan komponen darah dengan kandungan protein plasma yang sedikit dapat digunakan komponen darah WE, sementara itu jika diperlukan komponen darah dengan jumlah leukositnya sedikit dapat digunakan/dipilih komponen darah leukodepleted.

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ABSTRACTBackground. Washed erythrocyte (WE) and leukodepleted erythrocyte (LD-PRC) are normally used in clinical transfusion to prevent transfusion reaction. However, clinicians are wondering on the safety of those two blood components. The open system with saline for erythrocyte washing and the use of filter for blood leukodepletion still leave quiries on the possibility of hemolysis and their effectiveness for clinical transfusion. This study aims to provide scientific reasoning and the appropriate use of WE and leukodepleted blood respectively. Methods. A cross sectional approach was employed in this study on two groups of blood component consisting of 52 blood samples each , i.e. WE and LD-PRC respectively. Blood examinations were carried out on 26 WE samples prior to and after washing and on 26 LD-PRC samples prior to and after leukodepletion. Blood indices were examined automatically using Sysmex Xn-2000, total protein was estimated using ADVIA 1650/1800, while blood hemolysis was observed employing Osmotic Fragility Test (OFT). Results. It was shown that hemoglobin concentration of WE group decreased by 15.4%, hematocrit volume decreased by 8.55%, protein concentration decreased by 98.4%, and leukocyte count decreased by 87.3% compared to those the original Packed Red Cells. In addition, it was shown that the hemoglobin concentration of the leucodepleted blood component decreased by 29.1%, hematocrit volume increased by 21%, protein concentrations decreased 79.1% and the leukocyte count decreased by 99.9%. All the sampel of the WE blood products and all the LD-PRC blood sampel has hemolysis level <0,8% However, a significant difference in protein concentration and leukocyte count was observed betwen WE and LD-PRC (p<0.05). Conclusion. The process of erythrocytes? washing decreased the plasma protein concentration by 98.4%, whilst the process of leucodepletion decreased the leucocyte count by 99.97%. Hemolysis during the preparation of both blood components could be negligible. It is concluded that WE blood component is preferable for transfusion when low plasma protein is required. On the other hand, leukodepleted PRC is preferable when blood component with low in leucocyte count is required.;Background. Washed erythrocyte (WE) and leukodepleted erythrocyte (LD-PRC) are normally used in clinical transfusion to prevent transfusion reaction. However, clinicians are wondering on the safety of those two blood components. The open system with saline for erythrocyte washing and the use of filter for blood leukodepletion still leave quiries on the possibility of hemolysis and their effectiveness for clinical transfusion. This study aims to provide scientific reasoning and the appropriate use of WE and leukodepleted blood respectively. Methods. A cross sectional approach was employed in this study on two groups of blood component consisting of 52 blood samples each , i.e. WE and LD-PRC respectively. Blood examinations were carried out on 26 WE samples prior to and after washing and on 26 LD-PRC samples prior to and after leukodepletion. Blood indices were examined automatically using Sysmex Xn-2000, total protein was estimated using ADVIA 1650/1800, while blood hemolysis was observed employing Osmotic Fragility Test (OFT). Results. It was shown that hemoglobin concentration of WE group decreased by 15.4%, hematocrit volume decreased by 8.55%, protein concentration decreased by 98.4%, and leukocyte count decreased by 87.3% compared to those the original Packed Red Cells. In addition, it was shown that the hemoglobin concentration of the leucodepleted blood component decreased by 29.1%, hematocrit volume increased by 21%, protein concentrations decreased 79.1% and the leukocyte count decreased by 99.9%. All the sampel of the WE blood products and all the LD-PRC blood sampel has hemolysis level <0,8% However, a significant difference in protein concentration and leukocyte count was observed betwen WE and LD-PRC (p<0.05). Conclusion. The process of erythrocytes’ washing decreased the plasma protein concentration by 98.4%, whilst the process of leucodepletion decreased the leucocyte count by 99.97%. Hemolysis during the preparation of both blood components could be negligible. It is concluded that WE blood component is preferable for transfusion when low plasma protein is required. On the other hand, leukodepleted PRC is preferable when blood component with low in leucocyte count is required., Background. Washed erythrocyte (WE) and leukodepleted erythrocyte (LD-PRC) are normally used in clinical transfusion to prevent transfusion reaction. However, clinicians are wondering on the safety of those two blood components. The open system with saline for erythrocyte washing and the use of filter for blood leukodepletion still leave quiries on the possibility of hemolysis and their effectiveness for clinical transfusion. This study aims to provide scientific reasoning and the appropriate use of WE and leukodepleted blood respectively. Methods. A cross sectional approach was employed in this study on two groups of blood component consisting of 52 blood samples each , i.e. WE and LD-PRC respectively. Blood examinations were carried out on 26 WE samples prior to and after washing and on 26 LD-PRC samples prior to and after leukodepletion. Blood indices were examined automatically using Sysmex Xn-2000, total protein was estimated using ADVIA 1650/1800, while blood hemolysis was observed employing Osmotic Fragility Test (OFT). Results. It was shown that hemoglobin concentration of WE group decreased by 15.4%, hematocrit volume decreased by 8.55%, protein concentration decreased by 98.4%, and leukocyte count decreased by 87.3% compared to those the original Packed Red Cells. In addition, it was shown that the hemoglobin concentration of the leucodepleted blood component decreased by 29.1%, hematocrit volume increased by 21%, protein concentrations decreased 79.1% and the leukocyte count decreased by 99.9%. All the sampel of the WE blood products and all the LD-PRC blood sampel has hemolysis level <0,8% However, a significant difference in protein concentration and leukocyte count was observed betwen WE and LD-PRC (p<0.05). Conclusion. The process of erythrocytes’ washing decreased the plasma protein concentration by 98.4%, whilst the process of leucodepletion decreased the leucocyte count by 99.97%. Hemolysis during the preparation of both blood components could be negligible. It is concluded that WE blood component is preferable for transfusion when low plasma protein is required. On the other hand, leukodepleted PRC is preferable when blood component with low in leucocyte count is required.]"

"Latar belakang: Perdarahan pada operasi OPCAB dapat terjadi didasari oleh mekanisme aktivasi jalur fibrinolisis akibat trauma bedah. Asam traneksamat yang diberikan secara topikal bekerja sebagai antifibrinolitik secara lokal dengan efek samping sistemik minimal. Penelitian ini bertujuan untuk mengetahui keunggulan penggunaan asam traneksamat topikal dibandingkan plasebo pada pasien yang menjalani operasi OPCAB pada perdarahan pascaoperasi.Metode: Randomisasi 44 sampel menjadi kelompok asam traneksamat topikal (n = 22) dan kelompok plasebo (n = 22). Pengukuran volume perdarahan dilakukan empat kesempatan, pada perdarahan inisial, enam jam, 24 jam dan 48 jam pascaoperasi. Transfusi komponen darah (PRBC, TC, FFP, kriopresipitat) dicatat selama masa perawatan. Variabel dengan sebaran normal menggunakan statistik independent t-test, sedangkan data dengan sebaran tidak normal menggunakan statistik nonparametrik uji Mann-Whitney.Hasil: Perdarahan inisial (72,50 (15-210) vs. 62,5 (10-180), p = 0,878), perdarahan enam jam (145 (55-640) vs. 220 (90-810), p = 0,006), perdarahan 24 jam (327,5 (120-770) vs. 437,5 (250-1620), p = 0,045), perdarahan 48 jam (462,5 (175-1680) vs. 572,5 (311-2060), p = 0,177), tidak ada perbedaan bermakna pada kebutuhan transfusi komponen darah pada kedua kelompok. Efek samping lebih rendah pada kelompok asam traneksamat.Simpulan: Pemberian asam traneksamat topikal secara klinis lebih unggul dibandingkan plasebo dalam menurunkan volume perdarahan pada 6 jam dan 24 jam pascaoperasi namun tidak lebih unggul dalam menurunkan kebutuhan transfusi darah pada pasien yang menjalani operasi jantung dengan teknik OPCAB.

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Background: Bleeding during OPCAB surgery can occur based on the activation mechanism of the fibrinolysis pathway due to surgical trauma. Topically administered tranexamic acid acts as a local antifibrinolytic with minimal systemic side effects. This study aims to determine the advantages of using topical tranexamic acid compared to placebo in patients undergoing OPCAB surgery for postoperative bleeding.

Method: A total of 44 samples were randomized into topical tranexamic acid group (n =22) and placebo group (n = 22). Bleeding volume measurements were carried out four times, at the initial bleeding, six hours, 24 hours, and 48 hours postoperatively. Transfusions of blood components (PRBC, TC, FFP, cryoprecipitate) were recorded throughout the treatment period. Variables with normal distribution were carried out with independent t-test statistical analysis, whereas data with abnormal distribution were analyzed using nonparametric statistics Mann-Whitney test.

Result: Initial bleeding (72.50 (15-210) vs. 62.5 (10-180), p = 0.878), six-hour bleeding (145 (55-640) vs. 220 (90-810), p = 0.006), 24-hour bleeding (327.5 (120-770) vs. 437.5 (250-1620), p = 0.045), 48-hour bleeding (462.5 (175-1680) vs. 572.5 (311) -2060), p = 0.177), there was no significant difference in the need for blood component transfusions in the two groups. The side effects were lower in the tranexamic acid group.

Conclusion: Topical tranexamic acid administration is clinically superior to placebo in reducing bleeding volume at 6 hours and 24 hours postoperatively but not superior in reducing the need for blood transfusions in patients undergoing cardiac surgery using the OPCAB technique.

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"Pendahuluan: Perdarahan intraoperatif menjadi penyebab utama terjadi henti jantung di ruang operasi. Perdarahan dapat ditangani dengan pemberian transfusi. Pemberian transfusi berisiko menyebabkan infeksi dan reaksi alergi sehingga tidak semua pasien dengan perdarahan diberikan transfusi. Jumlah transfusi dapat dipengaruhi oleh berbagai faktor seperti kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik serta perkiraan allowable blood loss. Berdasarkan hal tersebut, penelitian ini dilakukan untuk membuktikan hipotesis terdapat hubungan antara faktor-faktor tersebut terhadap jumlah transfusi pada pasien perdarahan intraoperatif Metode: Penelitian ini bersifat analitik observasional dengan desain potong-lintang. Data diperoleh dari 84 rekam medis pasien di Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dianalisa adalah kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik, perkiraan allowable blood loss dan jumlah transfusi intraoperatif. Uji yang dilakukan adalah uji bivariat pada masing-masing faktor dengan uji korelasi Pearson, Spearman dan uji komparatif Mann Whitney menggunakan perangkat lunak SPSS versi 20. Hasil: Didapatkan bahwa jumlah perdarahan (p=0,000) mempengaruhi jumlah transfusi. Pada kelompok dengan gangguan hemodinamik didapatkan perbedaan jumlah transfusi dibandingkan dengan kelompok tanpa gangguan hemodinamik (p=0,009). Hb praoperasi dan perkiraan allowable blood loss tidak mempengaruhi jumlah transfusi (p=0,794, p=0,250). Kesimpulan: Jumlah perdarahan berhubungan dengan jumlah transfusi. Nilai Hb praoperasi dan perkiraan allowable blood loss tidak berhubungan dengan jumlah transfusi intraoperatif.

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Introduction: Intraoperative haemorrhage is the leading cause of cardiac arrest in surgery. Transfusion can be given to replace intraoperative blood loss. Transfusion can trigger infection and allergy reactions. Hence it must be given cautiously. Blood transfusion volume can be related to many factors, ie, preoperative hemoglobin value, blood loss volume, the presence or absence of hemodynamic instability, and allowable blood loss value. This study aimed to know the relationship between those factors and the blood transfusion volume. Method: This was an observational analytic study with a cross-sectional design that included 84 patients who had received an intraoperative blood transfusion in Ciptomangunkusumo Hospital, Jakarta. Preoperative hemoglobin, blood loss volume, estimated allowable blood loss, hemodynamic instability, and intraoperative blood transfusion volume data were obtained from medical records and analyzed. Bivariate test (Pearson, Spearman correlation test, and the Mann Whitney comparative test, was performed using SPSS ver. 20.0. Results: Blood loss volume (p=0,000) was significantly associated with the blood transfusion volume. Blood transfusion volume was significantly different in patients with hemodynamic instability than patients with stable hemodynamic (p=0.009). Preoperative hemoglobin level and estimated allowable blood loss value were not significantly associated with blood transfusion volume (p=0.794 and p=0.250, respectively). Conclusion: Blood loss volume was significantly related to blood transfusion volume. Preoperative hemoglobin level and estimated allowable blood loss were not significantly associated with blood transfusion volume."