KORELASI LAMA SIMPAN PACKED RED CELL DENGAN DELTA TUMOR NECROSIS FACTOR-ALFA PASCATRANSFUSI PADA PASIEN DEWASA DENGAN KEGANASAN

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

2021 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang: Transfusi Packed Red Cell (PRC) sering digunakan untuk mengatasi anemia pada keganasan. Pemberian PRC dapat disertai dengan reaksi transfusi, risiko tersebut akan meningkat pada pasien keganasan yang mendapatkan atau memiliki riwayat transfusi berulang. Penyebab reaksi transfusi tersebut dikaitkan dengan adanya akumulasi sitokin proinflamasi seperti TNF-alfa yang dihasilkan oleh lekosit dalam PRC serta dipengaruhi oleh lama simpan darah. Delta kadar TNF-alfa yang tinggi berkontribusi terhadap peningkatan risiko reaksi transfusi febrile non haemolytic transfusion reaction (FNHTR), transfusion related immunomodulation (TRIM), dan transfusion related acute lung injury (TRALI). Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi antara lama simpan PRC dengan delta kadar TNF-alfa pascatransfusi PRC pada pasien dewasa dengan keganasan. Metode: Disain penelitian ini adalah cross sectional. Subjek penelitian adalah pasien dewasa dengan keganasan di Instalasi Kanker Terpadu TULIP RSUP Dr. Sardjito Yogyakarta yang mendapatkan transfusi PRC dan memenuhi kriteria inklusi. Sampel darah EDTA diambil dua kali, sesaat sebelum transfusi dan satu jam pascatransfusi PRC. Sampel diperiksa darah lengkap, TNF-alfa, dan delta kadar TNF-alfa diukur dari selisih antara kadar TNF-alfa pascatransfusi (maksimal dalam 1 jam pascatransfusi) dengan kadar TNF-alfa pratransfusi pada pasien. Uji Korelasi Pearson dilakukan untuk menganalisis hubungan antara lama simpan PRC dengan delta kadar TNF-alfa. Hasil: Subjek penelitian sejumlah 33 pasien. Rerata umur subjek penelitian adalah 55,88± 11,65 tahun. Median delta kadar TNF-alfa pada populasi penelitian adalah sebesar 7,55 pg/mL. Hasil uji korelasi antara lama simpan PRC dengan delta kadar TNF-alfa menghasilkan nilai r = 0,87; p < 0,05. Simpulan: Lama simpan PRC berkorelasi sangat kuat dengan delta kadar TNF-alfa pascatransfusi PRC pada pasien dewasa dengan keganasan (r = 0,87; p < 0,05).

Background: Packed Red Cell (PRC) transfusion is often used to treat anemia in malignancy. PRC administration can be accompanied by a transfusion reaction, this risk will increase in malignant patients who get or have a history of repeated transfusions. The cause of the transfusion reaction was associated with the accumulation of proinflammatory cytokines such as TNF-alpha produced by leucocytes in the PRC and influenced by the length of storage of blood. Delta high TNF-alpha levels contribute to an increased risk of febrile transfusion non-haemolytic transfusion reaction (FNHTR), transfusion related immunomodulation (TRIM), and transfusion related acute lung injury (TRALI). Objective: This study aimed to determine the correlation between the duration of PRC storage and the delta TNF-alpha level of posttransfusion PRC in adult patients with malignancy. Methods: This was a cross sectional study. Subjects were adult patients with malignancy at the TULIP Integrated Cancer Center RSUP Dr. Sardjito Yogyakarta who received 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-alpha level, and delta TNF-alpha measured from the difference between post-transfusion TNF-alpha levels (maximum within 1 hour post-transfusion) and pre-transfusion TNF-alpha levels in patients. Pearson Correlation Test was conducted to analyze the relationship between PRC storage time and delta TNF-alpha levels Results: There were 33 subjects of the study. The mean age of the subjects was 55.88 ± 11.65 years. The median delta TNF-alpha levels in the study population was 7.55 pg/mL. The analysis showed a significant correlation between the duration of PRC storage and the delta TNF-alpha levels (r = 0.87; p <0.05). Conclusion: The duration of PRC storage has a strong correlation with the delta TNF-alpha levels posttransfusion in adult patients with malignancy (r = 0.87; p <0.05).

Kata Kunci : Lama simpan, delta kadar TNF-alpha, transfusi PRC