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"[ABSTRAKLatar Belakang: Penghitungan Estimated Blood Loss (EBL) berdasarkan rumus Allowable Blood Loss (ABL) dengan target hemoglobin tertentu, kerap dijadikan panduan untuk memutuskan secara cepat transfusi intraoperatif. Penghitungan EBL mengandalkan penilaian visual sulit untuk distandardisasi. Seiring perkembangan teknologi, Point of Care Testing (POCT) makin memudahkan pemeriksaan hemoglobin. Penelitian ini bertujuan membandingkan akurasi penghitungan hemoglobin intraoperatif antara EBL dan POCT, dibandingkan dengan Hematology Analyzer yang merupakan pengukuran baku di laboratorium. Metode: Penelitian ini menggunakan Uji Bland-Altman pada pengukuran hemoglobin intraoperatif terhadap pasien yang menjalani operasi elektif yang diperkirakan mengalami banyak perdarahan dan memerlukan transfusi, di Instalasi Bedah Pusat (IBP) RSUPN Cipto Mangunkusumo, antara Desember 2014 hingga Maret 2015. Subjek penelitian dipilih dengan metode consecutive sampling. Saat penghitungan EBL mencapai ABL dengan target Hb 7 g/dL sebelum transfusi diberikan, sampel darah diambil untuk pengukuran hemoglobin dengan Sysmex XE-2100® sebagai Hematology Analyzer dan HemoCue® Hb 201+ sebagai POCT. Hasil: Sebanyak 43 subjek diikutsertakan dalam penelitian. Uji Bland-Altman Hb ABL (7 g/dL) terhadap Hb Sysmex. Interval yang dianggap akurat terhadap kadar Hb 7 g/dL adalah -1 hingga 1, diperoleh limits of agreement yang besar yaitu -2,267 hingga 2,467. Uji Bland-Altman Hb HemoCue terhadap Hb Sysmex, diperoleh limits of agreement yang kecil yaitu -0.418 hingga 0.372. Simpulan: Terdapat perbedaan bermakna dalam akurasi penghitungan hemoglobin intraoperatif antara EBL dengan Hematology Analyzer, sedangkan pengukuran dengan HemoCue® Hb 201+ sebagai perangkat POCT, mempunyai keakuratan yang baik. EBL berdasarkan rumus ABL dengan target Hb 7 g/dL tidak bisa digunakan untuk pengambilan keputusan transfusi intraoperatif karena tidak mempunyai keakuratan yang baik.

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ABSTRACTBackground: Measurement of Estimated Blood Loss (EBL) based on the Allowable Blood Loss (ABL) formula with certain hemoglobin target is often used as a guidance to make a fast decision for intraoperative transfusion. Measurement of EBL relies on visual assessment is difficult to standardized and a new technique called Point of Care Testing (POCT) offered easier way to measure haemoglobin. This study aimed to compare the accuracy of the intraoperative hemoglobin measurement by EBL and POCT with Hematology Analyzer in the laboratory as a golden standard. Methods: This study used a Bland-Altman test on intraoperative hemoglobin measurement in patients undergoing elective surgery which was expected to experience a lot of bleeding and require blood transfusions in Center Operating Theater of Cipto Mangunkusumo Hospital from December 2014 until March 2015. Subjects were selected by consecutive sampling method. When EBL had reached ABL with a Hb level target 7 g / dL before transfusion was given, blood samples were taken for measurement of hemoglobin with Sysmex XE-2100® as Hematology Analyzer and HemoCue® Hb 201+ as POCT. Results: A total of 43 subjects were included in the study. Bland-Altman analysis of Hb EBL (7 g / dL) to Hb Hematology Analyzer with interval considered as accurate for Hb 7 g / dL was -1 to 1, revealed wide limits of agreement (-2.267 to 2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealed narrow limits of agreement (-0418 to 0372). Conclusion: There was a significant difference in the accuracy of intraoperative hemoglobin measurement by EBL compared to Hematology Analyzer, while the measurement by POCT device had good accuracy. EBL based on the formula ABL with a Hb level target 7 g / dL could not be used for intraoperative transfusion decision making because it did not has good accuracy., Background: Measurement of Estimated Blood Loss (EBL) based on the formulaAllowable Blood Loss (ABL) with certain hemoglobin target, is often used as aguidance to make a quick decision for intraoperative transfusion. Measurement ofEBL relies on visual assessment cannot be standardized. As developingtechnology, Point of Care Testing (POCT) makes hemoglobin measurementeasier. This study aimed to compare the accuracy of the intraoperativehemoglobin measurement by EBL and POCT with Hematology Analyzer in thelaboratory as a golden standard.Methods: This study used a Bland-Altman test on intraoperative hemoglobinmeasurement in patients undergoing elective surgery that was expected toexperience a lot of bleeding and need transfusion in Center Operating Theater ofCipto Mangunkusumo Hospital from December 2014 until March 2015. Subjectswere selected by consecutive sampling method. When EBL had reached ABLwith a Hb level target 7 g / dL before transfusion was given, blood samples weretaken for measurement of hemoglobin with Sysmex XE-2100® as HematologyAnalyzer and HemoCue® Hb 201+ as POCT.Results: A total of 43 subjects were included in the study. Bland-Altman analysisof Hb EBL (7 g / dL) to Hb Hematology Analyzer with interval considered asaccurate for Hb 7 g / dL was -1 to 1, revealed wide limits of agreement (-2.267 to2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealednarrow limits of agreement (-0418 to 0372).Conclusion: There was a significant difference in the accuracy of intraoperativehemoglobin measurement by EBL compared to Hematology Analyzer, while themeasurement by POCT device had good accuracy. EBL based on the formulaABL with a Hb level target 7 g/dL could not be used for intraoperative transfusion decision making because it did not has good accuracy.]"

"Pendahuluan: Perdarahan intraoperatif menjadi penyebab utama terjadi henti jantung di ruang operasi. Perdarahan dapat ditangani dengan pemberian transfusi. Pemberian transfusi berisiko menyebabkan infeksi dan reaksi alergi sehingga tidak semua pasien dengan perdarahan diberikan transfusi. Jumlah transfusi dapat dipengaruhi oleh berbagai faktor seperti kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik serta perkiraan allowable blood loss. Berdasarkan hal tersebut, penelitian ini dilakukan untuk membuktikan hipotesis terdapat hubungan antara faktor-faktor tersebut terhadap jumlah transfusi pada pasien perdarahan intraoperatif Metode: Penelitian ini bersifat analitik observasional dengan desain potong-lintang. Data diperoleh dari 84 rekam medis pasien di Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dianalisa adalah kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik, perkiraan allowable blood loss dan jumlah transfusi intraoperatif. Uji yang dilakukan adalah uji bivariat pada masing-masing faktor dengan uji korelasi Pearson, Spearman dan uji komparatif Mann Whitney menggunakan perangkat lunak SPSS versi 20. Hasil: Didapatkan bahwa jumlah perdarahan (p=0,000) mempengaruhi jumlah transfusi. Pada kelompok dengan gangguan hemodinamik didapatkan perbedaan jumlah transfusi dibandingkan dengan kelompok tanpa gangguan hemodinamik (p=0,009). Hb praoperasi dan perkiraan allowable blood loss tidak mempengaruhi jumlah transfusi (p=0,794, p=0,250). Kesimpulan: Jumlah perdarahan berhubungan dengan jumlah transfusi. Nilai Hb praoperasi dan perkiraan allowable blood loss tidak berhubungan dengan jumlah transfusi intraoperatif.

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Introduction: Intraoperative haemorrhage is the leading cause of cardiac arrest in surgery. Transfusion can be given to replace intraoperative blood loss. Transfusion can trigger infection and allergy reactions. Hence it must be given cautiously. Blood transfusion volume can be related to many factors, ie, preoperative hemoglobin value, blood loss volume, the presence or absence of hemodynamic instability, and allowable blood loss value. This study aimed to know the relationship between those factors and the blood transfusion volume. Method: This was an observational analytic study with a cross-sectional design that included 84 patients who had received an intraoperative blood transfusion in Ciptomangunkusumo Hospital, Jakarta. Preoperative hemoglobin, blood loss volume, estimated allowable blood loss, hemodynamic instability, and intraoperative blood transfusion volume data were obtained from medical records and analyzed. Bivariate test (Pearson, Spearman correlation test, and the Mann Whitney comparative test, was performed using SPSS ver. 20.0. Results: Blood loss volume (p=0,000) was significantly associated with the blood transfusion volume. Blood transfusion volume was significantly different in patients with hemodynamic instability than patients with stable hemodynamic (p=0.009). Preoperative hemoglobin level and estimated allowable blood loss value were not significantly associated with blood transfusion volume (p=0.794 and p=0.250, respectively). Conclusion: Blood loss volume was significantly related to blood transfusion volume. Preoperative hemoglobin level and estimated allowable blood loss were not significantly associated with blood transfusion volume."