Tesis

Efektivitas, Keamanan dan Potensi Efisiensi Biaya Transfusi Darah Predeposit Autologous pada Operasi Elektif Pasien Bedah Saraf di RSUPN Dr. Cipto Mangunkusumo: Strategi Transfusi Darah = Effectivity, Safety and Cost Efficiency of Autologous Predeposit Blood Transfusion in Elective Surgery of Neurosurgery Patients at Dr. Cipto Mangunkusumo National Hospital: Blood Transfusion StrategyEffectivity, Safety and Cost Efficiency of Autologous Predeposit Blood Transfusion in Elective Surgery of Neurosurgery Patients at Dr. Cipto Mangunkusumo National Hospital: Blood Transfusion Strategy.

Pendahuluan: Dalam beberapa prosedur bedah saraf, kebutuhan transfusi darah seringkali tidak terhindarkan. Data RSCM (Jan-Jun 2021) menunjukkan 35,4% pasien bedah saraf elektif memerlukan transfusi. Di tengah tantangan ketersediaan serta risiko dari transfusi homologus, eksplorasi metode konservasi darah yang inovatif perlu untuk dilakukan. Penelitian ini bertujuan mengevaluasi efektivitas dan keamanan transfusi predeposit autologus pada pasien bedah saraf yang direncanakan tindakan kraniotomi elektif di RSCM. Transfusi Predeposit Autologus diharapkan hadir menjadi solusi, alternatif dan strategi konservasi darah yang aman. Selain itu dapat membantu ketersediaan darah di bank darah. Tujuan: Studi ini diajukan untuk mengetahui apakah metode transfusi predeposit autologus dapat dilakukan pada pasien bedah saraf dengan rencana operasi kraniotomi elektif di RSCM. Selain itu untuk menilai efektivitas dan keamanan dari transfusi predeposit autologous pada pasien tersebut. Metode: Penelitian ini menggunakan pendekatan kohort prospektif selama Januari 2024 - Januari 2025 di Rumah Sakit Cipto Mangunkusumo. Subjek penelitian adalah pasien bedah saraf yang terindikasi operasi kraniotomi elektif. Pasien-pasien tersebut dibagi menjadi dua kelompok yakni kelompok transfusi autologous dan transfusi homologous. Untuk kelompok autologus, pasien harus lolos screening donor darah serta membutuhkan transfusi darah selama perawatan perioperatif. Dilakukan penilaian klinis dan laboratorium hematologi secara prospektif pada kedua kelompok dan dilakukan penilaian pada setiap variabelnya. Hasil: Terdapat 16 pasien yang memenuhi kriteria inklusi pada penelitian ini, yaitu 8 pasien kelompok autologus dan 8 pasien kelompok homologus. Tidak ada perbedaan profil demografi yang bermakna pada kedua kelompok. Dari 8 pasien autologus, hanya 4 pasien yang benarbenar hanya mendapatkan transfusi darah predeposit. Keempat pasien lainnya masih membutuhkan darah selain predeposit. Pada penelitian ini, juga ditemukan adanya peningkatan delta HB pre-post transfusi yang lebih tinggi dan bermakna secara statistik (p 0.038) pada kelompok autologus dibandingkan kelompok homologus. Pada seluruh pasien di kedua kelompok tidak timbul reaksi transfusi. Kesimpulan: Transfusi dengan metode predeposit autologus terbukti layak, aman, dan efektif untuk pasien bedah saraf yang direncanakan tindakan kraniotomi elektif di RSCM. Prosedur ini dapat dilaksanakan secara internal, di Unit Transfusi Darah RSCM dengan hasil sebanding transfusi homologus. Jika dilakukan sesuai protokol, metode ini meminimalkan risiko transfusi dan menjadi strategi menjanjikan untuk mengatasi keterbatasan darah dalam bedah saraf.


Introduction: In several neurosurgical procedures, the need for blood transfusion is often unavoidable. Data from RSCM (Jan-Jun 2021) indicated that 35.4% of elective neurosurgical patients required transfusion. Amidst the challenges of blood availability and the risks associated with homologous transfusion, the exploration of innovative blood conservation methods is necessary. This study aims to evaluate the effectiveness and safety of predeposit autologous transfusion in neurosurgical patients scheduled for elective craniotomy at RSCM. Predeposit Autologous Transfusion is expected to be a safe solution, alternative, and blood conservation strategy, while also helping to improve blood availability in the blood bank. Objective: This study was conducted to determine whether the predeposit autologous transfusion method is feasible in neurosurgical patients planned for elective craniotomy at RSCM. Furthermore, it aims to assess the effectiveness and safety of predeposit autologous transfusion method in these patients. Methods: This study employed a prospective cohort design conducted at Cipto Mangunkusumo Hospital from January 2024 to January 2025. The study population comprised neurosurgical patients indicated for elective craniotomy. Eligible patients were consecutively enrolled and categorized into two cohorts: the predeposit autologous transfusion group and the homologous transfusion group. Patients allocated to the autologous group underwent standard blood donor screening to ensure eligibility for autologous blood donation and were anticipated to require blood transfusion during their perioperative care. Comprehensive clinical assessments and serial hematological laboratory analyses were prospectively performed on both cohorts. Standardized protocols were utilized for data collection, and all relevant variables were systematically evaluated throughout the study period. Results: A total of 16 patients met the inclusion criteria for this study, with 8 patients in the autologous group and 8 patients in the homologous group. There was no significant difference in demographic profiles between the two groups. Out of the 8 autologous patients, only 4 patients exclusively received predeposited blood. The other four patients still required blood in addition to the predeposit. This study also found a statistically significant higher increase in delta hemoglobin pre-post transfusion (p 0.038) in the autologous group compared to the homologous group. No transfusion reactions occurred in any patients in either group. Conclusions: Transfusion using the predeposit autologous method has been proven feasible, safe, and effective for neurosurgical patients scheduled for elective craniotomy at RSCM. This procedure can be implemented internally within the RSCM Blood Transfusion Unit with results comparable to homologous transfusion. When performed according to protocol, this method minimizes transfusion risks and represents a promising strategy to overcome blood limitations in neurosurgery