BLEEDING

AND
TRANSFUSION
SUBDVISON OF HEMATOLOGY-ONCOLOGY
Department of Pediatrics, Faculty of Medicine, Gadjah
Mada University Yogyakarta
13 January 2010

Bleeding and Transfusion

Objectives:
1. To know the cause of bleeding :
angiophaty, thrombophaty and
coagulopathy
2. To diagnose the bleeding
3. How to treat the bleeding
4. Blood componen transfusion, apheresis,
indication and side effect

HEMOSTASIS
Suatu mekanisme
mempertahankan
darah:
selalu di dalam vasa &
dalam bentuk cairan

1. Vaskular
2. Trombosit
3. Faktor
koagulasi

Tm
Multi
layers
Elastic
Interactio
n
P
P

E
Mb
Ti
P

Dynamic walls

Ta

HEMOSTASIS
Interaksi dinding vasa trombosit faktor
koagulasi mekanisme penyeimbangnya

HEMOSTASIS
Menambal lobang

Vasokonstrik
si

1
2

3
Trombosi
t

Koagulasi

Fibrinolisis
4
-antifibrinolisi
s

The cause of bleeding

a. Is this local bleeding? or systemic

bleeding?
b. If systemic bleeding : angiopathy,
thrombopathy, or coagulopathy?

Screening of bleeding
1.Rumple Leede
2.Platelet count
3 Bleeding time
4. Clotting time
5. Clot retraction
Local
: all normal
Systemic : 1 or more abnormal

Local bleeding
Injuri : traffic accident
Operative procedure
Etc

Why the systemic bleeding can

happen
? of Hemostasis:
Disorders

Vascular disorders

Platelet disorders

Easy bruising
Low Number or abnormal function

Coagulation disorders

Factor deficiency

Systemic bleeding
1.Rumple Leede positif : Angiopathy?
2. Platelet count decrease :

Thrombocytopenia?
3. Bleeding time prolonged :
Thrombocytopenia? Angiopathy?
4. Clotting time prolonged. Factor coagulation
defeciency ( Hemophilia etc)?
5. Clot retraction abnormal . Thrombocyte
Function disease.

Where the bleeding occur ?

Bleeding

Bleeding

Treatment
Depend on an underlying diseases
Transfusion: blood component

(PRC, Plasma, Platelet)

TRANSFUSION

Preparation Child and Family

Inform child & family of the following :

That a blood product transfusion is necessary

The reason for the transfusion
The reaction of transfusion
Informed consent

Appropriate use of blood products

COMPONENT

INDICATIONS

PRECAUTIONS

RBC

02 carrying capacity in
symptomatic individuals

Compatibility tested

Platelets (FWB)

Control/prevent bleeding in
thrombocyto-penia/pathy

5-8 pooled (ABO

compatible)

Platelets (Aph)

above, refractory to random

donor platelets

1 collection-1
transfusion

Cryoprecipitated
AHF

vWf, Fibrinogen, FVIII

Pooled before adms

(ABO comp)

Plasma

Multiple coagulation factors

Plasma exchange

ABO comp

FFP

above, F V

Mainly for fractination

WBC (Aph)

ANC<500x106/L with antibiotic Unproven efficacy

resistant infection

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 100% semua konstituen
plasma normal termasuk faktor koagulasi labil dan
stabil (factor I, II, V, VII, VIII, IX, X, XI, XIII, Von
Willebrand)

Red cell transfusion

Packed Red Cell
rarely indicated for Hb > 9g/dl. and is almost
always indicated for Hb < 6g/dl, (particularly
when the anaemia is acute).
The specific reasons for transfusion should
be documented

Aferesis
Greek : to take away
Suatu cara medis, darah donor diambil atau

pasien, melalui suatu alat, diambil yang

diperlukan, sisanya dimasukkan kembali ke
donor/pasien.

APA YANG DIAMBIL?

Type aferesis
1.Plasmaferesis
2.Plateletferesis
3.Leukaferesis
4. Sel Stem
5. LDL feresis
6. Fotoferesis
7. Eritrositaferesis
8. Imunoadsorbsi

Yang diambil
plasma
trombosit
lekosit
sel stem untuk trnasplantasi
Low Density Lipoprotein

eritrosit
alo atau autoantobodi

Indikasi pemberian komponen

Komponen
1. Eritrosit

2. Plasma
3. Trombosit

Contoh kegunaan
- mau operasi
anemia aplastik
anemia perdarahan trauma
- DHF, DIC
- ITP( life saving), DHF, DIC

Apheresis

Platelet blood bag

Follow-up of blood transfusion

Transfusion reactions
NON-IMMUNE MEDIATED
CATEGORY

TYPE OF REACTION

Disease
transmission

Hepatitis B, C (non-A, non-B),

CMV, Malaria, AIDS, Syphilis

Septicemia

Bacterial sepsis due to infected blood

Embolism

Air embolism
Microembolism

Overload

Fluid, iron, citrate

Electrolyte imbalance

Hemorrhagic
diathesis

Thrombocytopenia
Coagulation factor deficiencies

Follow-up of blood transfusion

Transfusion reactions
IMMUNE MEDIATED
CONSTITUENT

TYPE OF REACTION

RBCs

Acute/delayed hemolytic,
Alloimunization to RBC antigens

WBCs

Febrile, pulmonary edema

Alloimunization to WBC antigens

Platelets

Alloimunization to Platelet antigens

Post transfusion purpura

Plasma protein

Urticaria
Anaphylaxis

Observe child for major reactions to

blood product
Rigor
Laboured breathing/wheezing
Chest pain
Back or joint pain/darkened urine
Loss of consciousness
Sudden collapse

Observe child for minor reactions to

blood product

Sweating
Dizziness
Rash
Redness on chest
Flushing
Fever
Tachycardia
Nausea
Chills

If a severe reaction occurs:

Stop transfusion immediately
Infuse 0.9% sodium chloride for infusion
Seek urgent medical assistance.
Give steroid and anti-histamine if prescribed
Record vital signs (temperature, pulse, respiration &

BP)
Record incident in childs records
Do not recommence transfusion
Inform Blood Transfusion Laboratory,
Complete an incident report form

Some experiences from pediatric

Malignancy
Leukemia (ALL, AML), solid tumor
Impacts of malignancy, side effects of
medicines
PRC, PC, FFP, Not always emergency!

Some experiences from pediatric

Thalassemia
PRC, Hb 10 gr%,
1-2 monthly, life long

Some experiences from pediatric

ITP

(Immune Thrombocytopenia Purpura)

PC, bleeding/life saving, prophylaxis for

invasive maneuvers, may require huge
amounts

PENUTUP
Bleeding? Lokal atau systemik
Screening? RL, Bleeding time, Coagulation time,

Thrombocyte, Clot retraction

Systemik? Angiopathy, Thrombopathy, Coagulopathy
Pemberian komponen darah hanya pada keadaan
tertentu (PRC Plasma Trombosit dll)
Komponen darah lebih baik
Aferesis lebih rasional mengurangi risiko akibat
transfusi