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Strategi penatalaksanaan dan pencegahan Transfusion-Associated Circulatory Overload (TACO): tinjauan pustaka



Abstract

Background: Transfusion-associated circulatory overload (TACO) is a serious complication after blood transfusion. Although the incidence of TACO ranges from 0.1% to 10% of all blood transfusions, the mortality rate is quite high, up to 11 cases per 100,000 transfusions. This literature review aims to identify strategies for managing and preventing TACO in daily clinical practice.

Methods: This literature review was conducted by searching studies on online databases in the form of PubMed, Cochrane Library, and Google Scholar using the keywords “Transfusion-Associated Circulatory Overload” (TACO)”, “blood transfusion”, “pathophysiology”, “management”, “prevention”. Appropriate studies then carried out a narrative synthesis analysis.

Results: In TACO, excess fluid causes pulmonary edema, which can lead to respiratory distress. The main mechanism of TACO is hydrostatic pulmonary edema, in which the accumulation of fluid in the pulmonary capillaries then causes an increase in hydrostatic pressure. The management of TACO includes immediately stopping the administration of transfusion products and supportive therapy in the form of supplemental oxygen administration and administration of diuretics such as furosemide. In contrast, prevention of TACO can be done with a restrictive transfusion strategy, rules for using single-dose red blood cell transfusions, identification of high-risk patients using algorithms or checklists, intensive monitoring of at-risk patients, administration of blood product infusions at a slow rate, and use of diuretic drugs preemptive in at-risk patients.

Conclusion: The main key to the management of TACO is to prevent the further formation of pulmonary edema by stopping the administration of transfusions and giving oxygen and diuretics. Meanwhile, preventive measures can be taken by restricting blood product administration, identifying high-risk patients and pre-emptive diuretic administration.

 

Latar belakang: Transfusion-associated circulatory overload (TACO) merupakan salah satu komplikasi serius pasca transfusi darah. Meskipun insiden TACO berkisar antara 0,1% hingga 10% dari semua transfusi darah., angka mortalitasnya tergolong cukup tinggi yakni hingga 11 kasus per 100.000 transfusi. Tinjauan pustaka ini bertujuan untuk mengetahui strategi penatalaksanaan dan pencegahan TACO dalam praktik klinis sehari-hari.

Metode: Tinjauan pustaka ini dilakukan dengan pencarian studi pada basis data online berupa PubMed, Cochrane library, dan Google Scholar dengan menggunakan kata kunci “Transfusion-Associated Circulatory Overload” “(TACO)”, “blood transfusion”, “pathophysiology”, “management”, “prevention”.  Studi yang sesuai kemudian dilakukan analisis sintesis secara naratif.

Hasil: Pada TACO terjadi kelebihan cairan yang menimbulkan edema paru yang dapat berujung pada distres nafas. Mekanisme utama terjadinya TACO adalah edema pulmoner hidrostatik, dimana akumulasi cairan pada kapiler pulmoner kemudian menyebabkan peningkatan tekanan hidrostatik. Penatalaksanaan TACO meliputi pengehentian pemberian produk transfusi dengan segera dan terapi suportif berupa pemberian oksigen supplemental serta pemberian diuretik seperti furosemide. Sedangkan pencegahan TACO dapat dilakukan dengan strategi transfusi yang restriktif, aturan penggunaan transfusi sel darah merah dosis tunggal, identifikasi pasien berisiko tinggi dengan menggunakan algoritma atau ceklist, monitoring intensif pada pasien berisiko, pemberian infus produk darah dengan kecepatan lambat, dan penggunaan obat-obatan diuretik preemtif pada pasien berisiko.

Simpulan: Kunci utama penatalaksanaan TACO adalah mencegah terbentuknya edema paru lebih lanjut dengan menghentikan pemberian transfusi dan pemberian oksigen serta diuretik. Sedangkan tindakan pencegahan dapat dilakukan dengan restriksi pemberian produk darah, identifikasi pasien berisiko tinggi hingga pemberian diuretik preemtif.

Keywords: komplikasi penatalaksanaan Pencegahan Transfusi Darah Transfusion-associated circulatory overload (TACO)

References

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How to Cite

Jayaprawira, D. (2023). Strategi penatalaksanaan dan pencegahan Transfusion-Associated Circulatory Overload (TACO): tinjauan pustaka. Intisari Sains Medis, 14(2), 568–575. https://doi.org/10.15562/ism.v14i2.1765
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