PENGARUH LEUKOREDUKSI PADA TRANSFUSI PLATELET TERHADAP REAKSI TRANSFUSI DEMAM NON-HEMOLITIK DAN KENAIKAN ANGKA PLATELET

ASTARI ANGGARA DEWI, dr. Johan Kurnianda, SpPD-KHOM.; dr. Mardiah Suci Hardianti, PhD, SpPD-KHOM

2020 | Tesis-Spesialis | ILMU PENYAKIT DALAM

Latar belakang: Sekitar 75% transfusi platelet diberikan kepada pasien hematoonkologi, tidak jarang membutuhkan transfusi berulang. Insidensi FNHTR terjadi pada 30% pada transfusi platelet. Transfusi platelet berulang dapat menimbulkan gagal respon (refraktori platelet). Leukoreduksi diketahui menurunkan kejadian FNHTR dan refraktori platelet. Tujuan: Mengetahui pengaruh pemberian transfusi platelet leukoreduksi terhadap kejadian FNHTR serta angka kenaikan platelet paska transfusi platelet dengan leukoreduksi di RSUP Dr. Sardjito. Metode: Penelitian ini merupakan studi observasional kohort prospektif yang dilakukan di RSUP Dr. Sardjito periode Desember 2019-April 2020. Subyek penelitian adalah pasien usia > 18 tahun yang menderita kelainan hematologi, keganasan hematologi maupun onkologi yang telah menjalani transfusi berulang dalam >2 bulan dan memenuhi indikasi diberikan transfusi platelet. Pasien kemudian dibagi dalam kelompok non-leukoreduksi (transfusi TC standar), dan kelompok leukoreduksi (transfusi TA atau TC dengan filter bedside). Dilakukan pemantauan efek samping transfusi hingga 4 jam paska transfusi. Respon kenaikan platelet paska transfusi dinilai 24 jam paska transfusi dengan rumus platelet increment. Data dianalisa menggunakan SPSS. Perbedaan dianggap bermakna jika nilai p<0,05. Hasil Penelitian: Didapatkan total 167 subyek, dimana 51 subyek mendapat transfusi TC non-leukoreduksi dan 116 subyek mendapat transfusi trombosit leukoreduksi (70 subyek mendapat TA, 46 subyek mendapat TC dengan filter bedside). Pasien dengan leukoreduksi memiliki angka kejadian FNHTR yang lebih rendah dibanding pasien non-leukoreduksi (2,58% vs 13,7%; p = 0,01) dan proporsi platelet increment baik yang lebih tinggi (58,6% vs 41,2%; p = 0,04). Transfusi TA secara signifikan memperbaiki kejadian FNHTR dan platelet increment dibanding TC non-leukoreduksi (1,4% vs 13,7%; p = 0,01 dan 64,2% vs 41,2%; p = 0,02). Kesimpulan: Transfusi platelet dengan leukoreduksi menurunkan kejadian FNHTR dan menghasilkan respon kenaikan platelet paska transfusi yang lebih baik.

Background: About 75% of platelet transfusions are given to hematooncologic patients, in which multiple transfusions are frequently required. FNHTR approximately occurred in 30% of platelet transfusion. Multiple transfusion could lead to post-transfusion response failure (platelet refractoriness). Leukoreduction has been known to reduce the rate of FNHTR and platelet refractoriness. Objective: To evaluate the effect of leukoreduction on platelet transfusion in the rate of FNHTR and post-transfusion platelet response at Sardjito General Hospital. Method: This prospective cohort observational study was conducted at Dr. Sardjito General Hospital from December 2019 - April 2020. Subjects were patients aged > 18 years with hematological disorders, hematology or oncology malignancies who had multiple transfusions for > 2 months and met the indications for platelet transfusion. Subjects were divided into non-leukoreduction groups ( standard TC transfusions), and leukoreduction group (TA or TC with bedside filter transfusions). Transfusion reactions were monitored for up to 4 hours after transfusions. Post-transfusion platelet responses were evaluated 24 hours post-transfusion using platelet increment formula. Data was analyzed using SPSS. P value of <0.05 was considered significant. Results: A total of 167 subjects were included, in which 51 subjects received non-leukoreduced TC transfusions and 116 subjects received leukoreduced platelet transfusion (70 subjects received TA, 46 subjects received TC with bedside filter). Subjects with leukoreduction had lower FNHTR rate than non-leukoreduction subjects (2,58% vs 13,7%; p = 0,01) and higher improved platelet increment rate (58,6% vs 41,2%; p = 0,04). TA transfusions significantly improved FNHTR and platelet increment compared to standard TC transfusions (1,4% vs 13,7%; p = 0,01 and 64,2% vs 41,2%; p = 0,02). Conclusion: Leukoreduction in platelet transfusion improved rate of FNHTR and platelet response.

Kata Kunci : leukoreduksi, platelet, FNHTR, platelet increment, leukoreduction, platelet, FNHTR, platelet response