PERBANDINGAN DELTA KADAR TUMOR NECROSIS FACTOR-ALFA PASCATRANSFUSI PACKED RED CELL (PRC) LEKODEPLESI DAN NONLEKODEPLESI PADA PASIEN DEWASA DENGAN KEGANASAN

AMANATUS SOLIKHAH, Dr. dr. Teguh Triyono, M.Kes., Sp.PK (K)

2020 | Tesis-Spesialis | PATOLOGI KLINIK

Latar belakang: Anemia pada keganasan umumnya diberikan transfusi packed red cell (PRC) yang berulang sehingga meningkatkan risiko terjadinya reaksi transfusi. Selama proses penyimpanan darah dapat terjadi akumulasi TNF-alfa yang dihasilkan oleh lekosit dalam PRC dan berkontribusi terhadap peningkatan risiko reaksi transfusi febrile non haemolytic transfusion reaction (FNHTR), transfusion related immunomodulation (TRIM), dan transfusion related acute lung injury (TRALI). Proses lekodeplesi dengan mengurangi jumlah lekosit dalam PRC diharapkan dapat menurunkan akumulasi TNF-alfa dalam PRC dan mengurangi angka kejadian reaksi transfusi. Tujuan: Penelitian ini bertujuan untuk mengetahui dan membandingkan delta kadar TNF-alfa pascatransfusi PRC lekodeplesi dengan nonlekodeplesi pada pasien dewasa dengan keganasan. Metode: Disain penelitian ini adalah quasi experimental. Subjek penelitian adalah pasien dewasa dengan keganasan di Instalasi Kanker Terpadu TULIP RSUP Dr. Sardjito Yogyakarta yang mendapatkan transfusi PRC lekodeplesi atau nonlekodeplesi dan memenuhi kriteria inklusi. Sampel darah EDTA diambil dua kali, sesaat sebelum transfusi dan satu jam pascatransfusi PRC (lekodeplesi atau nonlekodeplesi). Sampel diperiksa darah lengkap, TNF-alfa, dan delta kadar TNF-alfa diukur dari selisih antara kadar TNF-alfa pra dan pascatransfusi. Uji Mann Whitney dilakukan untuk menganalisis perbedaan median delta kadar TNF-alfa antara kedua kelompok. Hasil: Subjek penelitian sejumlah 67 pasien, 34 orang pada kelompok lekodeplesi dan 33 orang pada kelompok nonlekodeplesi. Rerata umur subjek penelitian adalah 55,55 ����¯�¿�½������± 12,45 tahun. Pada kedua kelompok tidak terdapat perbedaan bermakna berdasarkan usia (p = 0,666), jenis kelamin (p = 0,264) dan jenis keganasan (p = 0,323). Median kadar TNF-alfa pratransfusi dan pascatransfusi pada kelompok nonlekodeplesi didapatkan lebih tinggi (p<0,001). Delta kadar TNF-alfa lebih rendah secara bermakna pada kelompok lekodeplesi dibandingkan dengan nonlekodeplesi (4,83 pg/mL vs 9,88 pg/mL; p < 0,001). Simpulan: Delta kadar TNF-alfa pascatransfusi PRC lekodeplesi lebih rendah secara bermakna dibandingkan dengan nonlekodeplesi.

Background: Cancer related anemia commonly given repeated packed red cell transfusion, which may increase risk of transfusion reaction. During the blood storage process, there can be accumulation of TNF-alfa produced by leukocytes in the PRC and contributes to an increased risk of febrile transfusion reactions non-haemolytic transfusion reaction (FNHTR), transfusion related immunomodulation (TRIM), and transfusion related acute lung injury (TRALI). The leukodepletion process by reducing the number of leucocytes in PRC is expected to reduce the accumulation of TNF-alfa in PRC and reduce the incidence of transfusion reactions. Objective: This study aimed to determine and compare the delta TNF-alfa level of post-transfusion with leucodepleted and nonleucodepleted PRC in adult patients with malignancy. Methods: This was a quasi experimental study. Subjects were adult patients with malignancy at the "TULIP" Integrated Cancer Center RSUP Dr. Sardjito Yogyakarta who received leucodepleted or nonleucodepleted PRC transfusion and met the inclusion criteria. EDTA blood samples were taken pre and one hour post PRC transfusion. These samples were examined for complete blood count, TNF-alfa level, and delta TNF-alfa is a difference between pre and posttransfusion TNF-alfa level. Mann Whitney test was used to analize the difference of median delta TNF-alfa level between two groups. Results: There were 67 subjects of the study with 34 and 33 subjects in leucodepleted and nonleucodepleted group respectively. The mean age of the subjects was 55.55����¯�¿�½������± 8.49 years. There was no significant difference based on age (p = 0.666), sex (p = 0.264) and type of malignancy (p = 0.323) between both groups. The median delta TNF-alfa levels were higher in nonleucodepleted group (p <0.001). The levels of delta TNF-alfa in leucodepleted group was significantly lower compared to nonleucodepleted group (4.83 pg / mL vs 9.88 pg / mL; p <0.001). Conclusion: Delta TNF-alfa levels in leukodepleted group was significantly lower compared to nonleucodepleted group.

Kata Kunci : Kata kunci: TNF-alfa, lekodeplesi, transfusi PRC