FAKTOR RISIKO REFRAKTER TROMBOSIT PADA ANAK

dr. Jonliberti Purba, Dr. dr. Sri Mulatsih, SpA(K)

2012 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar Belakang: Transfusi trombosit sering dilakukan pada pasien anak. Transfusi trombosit sendiri memiliki risiko terhadap pasien dan menambah biaya perawatan, sehingga perlu dievaluasi efektifitasnya. Tujuan Penelitian: Menilai faktor risiko klinis yakni sepsis, splenomegali, DIC, pendarahan berat dan riwayat transfusi trombosit terhadap kejadian refrakter trombosit. Metode Penelitian: Penelitian ini merupakan penelitian kasus kontrol untuk menilai faktor risiko terjadinya refrakter trombosit seperti sepsis, DIC, splenomegali, pendarahan berat, riwayat transfusi trombosit. Dari analisis Hasil: Selama periode Agustus 2010 sampai September 2011 terdapat 1403 kasus transfusi, dari keseluruhan kasus tersebut diambil 86 kejadian refrakter dan 86 nonrefrakter. bivariat didapatkan sepsis [OR 5.91 (2.90-12.05)], p = 0.000], splenomegali [OR 2.82 (1.32- 6.04.12), p = 0.006] pendarahan berat [OR 8.41(4.19-16.871), p = 0.000], DIC [OR 22.96 (6.73- 78.35), p = 0.000] riwayat transfusi trombosit [OR 5.33(2.78-10.23), p = 0.000] meningkatkan risiko refrakter trombosit. Pada analisis multivariat sepsis (OR 2.96 [95%IK; 1.19-7.32], p = 0.019), splenomegali (OR 3.94 [IK 95%;2.21-16.00], p = 0.000), pendarahan berat (OR 3.53 [95% IK; 1.40-8.89], p = 0.008), DIC (OR 5.54 [95% IK; 1.29-22.75], p =0.021) dan riwayat transfusi trombosit(OR 2.84 [95% IK; 2.74-9.77], p =0.001) merupakan faktor risiko independen terjadinya refrakter pada anak. Simpulan: Sepsis, splenomegali, pendarahan berat, DIC dan riwayat transfusi trombosit merupakan faktor risiko terjadinya refrakter trombosit pada pasien anak.

Background. Platelet transfusions are performed in pediatric patients. Platelet transfusion itself has a risk to the patient and adds to the cost of care, so it needs to evaluate its effectiveness. Purpose: This study aims to assess the clinical risk factors namely sepsis, splenomegaly, DIC, severe bleeding and a history of platelet transfusion on the incidence of refractory platelets. Metodilogy: This study is a case-control study to assess risk factors such as platelet refractory sepsis, DIC, splenomegaly, severe bleeding, history of transfusion of platelets. Results. During the period August 2010 to September 2011 there were 1403 cases of transfusion was taken 86th overall incidence of cases of refractory and 86 nonrefrakter. Obtained from the bivariate analysis sepsis [OR 5.91 (2.90-12.05)], p = 0.000], splenomegaly [OR 2.82 (1.32-6.04.12), p = 0006] heavy bleeding [OR 8:41 (4.19-16.871), p = 0.000 ], DIC [OR 22.96 (6.73-78.35), p = 0.000] history of platelet transfusions [OR 5:33 (2.78-10.23), p = 0.000] increase the risk of refractory platelets. On multivariate analysis, sepsis (OR 2.96 [95% CI: 1:19 to 7:32], p = 0019), splenomegaly (OR 3.94 [95% CI: 2:21 to 16:00], p = 0.000), severe bleeding (OR 3:53 [95% CI : 1.40-8.89], p = 0.008), DIC (5:54 OR [95% CI: 1.29-22.75], p = 0021) and platelet transfusion history (OR 2.84 [95% CI: 2.74-9.77], p = 0.001) is an independent risk factor for the occurrence of refractory childhood. Conclusion. Sepsis, splenomegaly, severe bleeding, DIC, and a history of platelet transfusion is a risk factor in pediatric patients refractory platelets.

Kata Kunci : refrakter trombosit, CCI, angka trombosit, anak.