Korelasi Masa Simpan Packed Red Cell (PRC) dengan Delta Interleukin-1 beta (IL- 1 beta) Pasien Keganasan Dewasa Pascatransfusi PRC

ARDIAN SATISFYA S, Dr. dr. Teguh Triyono, M.Kes, Sp.PK(K)

2020 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang: Transfusi menggunakan Packed Red Cell (PRC) sering dibutuhkan pasien keganasan yang mengalami kondisi anemia akibat dari perjalanan penyakit, efek samping terapi, defisiensi nutrisi, dan proses inflamasi kronis. Masa simpan suatu produk PRC memiliki pengaruh terhadap perubahan biokimiawi maupun biomekanik yang dikenal dengan istilah red cell storage lesion. Salah satu perubahan yang terjadi adalah peningkatan kadar sitokin proinflamasi yang dihasilkan oleh lekosit kontaminan selama PRC disimpan, salah satunya adalah interleukin-1 beta (IL-1 beta). Adanya sitokin proinflamasi berkaitan dengan risiko kejadian reaksi transfusi. Tujuan: Untuk mengetahui hubungan antara masa simpan PRC dengan delta IL-1 beta pada pasien keganasan dewasa pascatransfusi PRC. Metode: Penelitian ini merupakan penelitian cross sectional. Subjek penelitian adalah pasien keganasan dewasa di Instalasi Kanker Terpadu TULIP RSUP dr Sardjito Yogyakarta yang mendapatkan transfusi 1 kantong PRC dan memenuhi kriteria inklusi. Sampel plasma EDTA diambil dua kali sebanyak 3 mL. Sampel pratransfusi diambil tepat sebelum transfusi dan sampel pascatransfusi diambil dalam dua jam setelah transfusi. Dari sampel tersebut dilakukan pemeriksaan darah lengkap menggunakan alat hematologi otomatis dan pemeriksaan IL-1 beta menggunakan metode sandwich ELISA. Delta IL-1 beta diukur dari selisih kadar IL-1 beta pra dan pascatransfusi. Uji korelasi dilakukan antara masa simpan PRC dengan delta kadar IL-1 beta. Hasil: Subjek penelitian berjumlah 32 orang dengan rerata umur subjek adalah 54,2 kurang lebig 11,3 tahun. Terdapat peningkatan Hb yang bermakna pascatransfusi (p < 0,05) namun tidak demikian halnya dengan parameter angka lekosit dan trombosit (p = 0,72 dan 0,66). Masa simpan PRC yang digunakan dalam penelitian ini bervariasi antara 1 hingga 9 hari, dengan jumlah terbanyak adalah PRC berumur 2 hari (12 kantong; 37,5%). Tidak terdapat perbedaan bermakna antar kelompok masa simpan PRC berdasarkan volume PRC yang digunakan (p = 0,19). Kadar IL-1 beta mengalami peningkatan dari 1,7 (1,2-23,4) pg/mL pada saat pratransfusi menjadi 2,65 (1,3-24,4) pg/mL pascatransfusi. Median delta IL-1 beta adalah sebesar 0,75 (1,5-12,8) pg/mL. Masa simpan PRC berkorelasi terhadap delta kadar IL-1 beta dengan nilai r = 0,52 (p < 0,05). Simpulan: Masa simpan PRC berhubungan sedang dengan delta IL-1 beta pada pasien keganasan dewasa pascatransfusi PRC

Background: Blood transfusion using a packed red cell (PRC) often required in malignancy patients undergo anemia condition as a result of course of the disease, therapeutic side effect, nutritional deficiency, and also chronic inflammation process. Storage time of PRC have an influence to biochemical and biomechanical changes which known as red cell storage lesion. Proinflammatory cytokines increment which produced by leukocyte in blood product during storage is one of that lesion. Interleukin-1 beta (IL-1 beta) is one of proinflammatory cytokine which can be increased during blood storage. Proinflammatory cytokines are related with risk of transfusion reaction. Objectives: The aim of this study was to measure the association between storage time of PRC and IL-1 beta delta in adult malignancy patients after PRC transfusion. Method: This was a cross sectional study. Subject were adult malignancy patients at "TULIP" Integrated Cancer Center of Sardjito Hospital Yogyakarta, who received one bag PRC transfusion and fulfilled inclusion criteria. Three mililiter of plasma EDTA sample were taken twice. First was pretransfusion sample which taken right before transfusion given and the second was posttransfusion sample which taken in two hours after transfusion. Those sample then examined for complete blood count using automatic hematology analyzer and IL-1 beta level using ELISA sandwich method. Delta IL-1 beta level was a difference between pre and posttransfusion IL-1 beta level. Correlation test carried out between storage time of PRC and delta IL-1 beta level. Results: The research subjects were 32 people with average age 54.2 kurang lebih 11.3 years. There were significant increase in hemoglobin after transfusion (p < 0.05) but not in leukocyte and thrombocyte count parameter (p = 0.72 and 0.66). Packed red cell used in this study have a varied storage time between 1 to 9 days, with the most number was PRC have been stored for 2 days (12 bags; 37.5%). There were no significant differences between PRC storage time groups based on volume of PRC used (p = 0.19). IL-1 beta levels increased from 1.7 (1.2-23.4) pg/mL pre transfusion to 2.65 (1.3-24.4) pg/mL post transfusion. The median IL-1 beta delta was 0.75 (1.5-12.8) pg/mL. Storgae time of PRC correlates with delta IL-1 beta levels with r value 0.52 (p < 0,05).. Conclusion: Storage timeof PRC was moderately associated with IL-1 beta delta in adult malignancy patients after PRC transfusion.

Kata Kunci : Storage time of PRC, interleukin-1 beta, PRC transfusion, red cell storage lesion, cancer related anemia.