Penanganan Transfusion Associated Circulatory Overload (Taco) pada Pasien Anak dengan Chronic Kidney Disease Stage 5 Akibat Sindroma Nefrotik

Pemberian komponen darah bisa sangat dibutuhkan untuk menyelamatkan nyawa pasien namun tindakan ini memiliki efek samping yang cukup berisiko. Efeknya bisa menyebabkan transfusion associated infection dan transfusion associated non infection. Kewaspadaan tentang transfusion associated infection sudah sangat baik dengan adanya tindakan skrining terhadap sediaan darah di Palang Merah Indonesia (PMI). Komplikasi akibat transfusion associated non infection masih butuh perhatian, diantaranya adalah transfusion associated circulatory overload (TACO), transfusion related acute lung injury (TRALI) dan haemolytic transfusion reaction. Manifestasi klinis dan imaging antara TACO dan TRALI sangat mirip sehingga diperlukan tindakan dan pemeriksaan untuk membedakannya. Dilaporkan kasus anak perempuan, 15 tahun, dengan chronic kidney disease (CKD) stage 5D akibat sindroma nefrotik yang mengalami acute lung oedema yang disebabkan TACO DD/ TRALI pasca transfusi akibat syok haemoragik. Pasien ditransfusi saat tindakan operatif explore untuk  memperbaiki pseudoaneurisma vena femoralis kanan dan kiri. Setelah operasi pasien mengalami edema paru diduga akibat transfusi darah saat operasi. Pasien mendapat ventilasi mekanik dan hemodialisa selama perawatan di ICU, bisa diekstubasi hari keenam. Kondisi membaik dan pindah ke ruangan high care unit (HCU) pada hari ketujuh. Kata Kunci : CKD, Edema Paru, TACO Management of Transfusion Associated Circulatory Overload (Taco) in Pediatric Patient with Chronic Kidney Disease Stage 5 Caused by Nephrotic  Syndrome Administration of blood component can be essential to rescue a patient life but these actions also have dangerous side effects. The effects can cause transfusion associated infection dan transfusion associated non infection. Awareness against transfusion associated infection has been well established and well managed with screening action of the blood bag transfusion sample at the Indonesian red cross. Complications due to transfusion associated non infection still requires attention. Among them are transfusion associated circulatory overload (TACO), transfusion related acute lung injury (TRALI) dan haemolytic transfusion reaction. The clinical manifestation and imaging appearance between TACO and TRALI are very much alike, so it require advanced examination to differentiate them. It had been reported a 15 year old girl with chronic kidney disease (CKD) stage 5D caused by nephrotic syndrome who suffers acute lung oedema caused by TACO DD/ TRALI after transfusion due to haemorrhagic shock. Patient received transfusion during an operation procedure to repair a pseudoaneurysm at her right and left femoral vein. After the operation, patient experienced lung edema presumably because of blood transfusion. Patient received mechanical ventilation and hemodyalisis in the ICU and was extubated on the sixth day of care in the ICU. Her condition was stable and was moved to the high care unit (HCU) in the seventh day. Key words : CKD, Lung edema, TACO