Uji diagnostik berbagai indeks eritrosit untuk membedakan anemia defisiensi besi dengan thalassemia trait di RSCM = Diagnostic test of erythrocyte indices for differentiang iron deficiency anemia and trait thalassemia in Cipto Mangunkusumo Hospital / Yohanes Salim

Yohanes Salim, author

Uji diagnostik berbagai indeks eritrosit untuk membedakan anemia defisiensi besi dengan thalassemia trait di RSCM = Diagnostic test of erythrocyte indices for differentiang iron deficiency anemia and trait thalassemia in Cipto Mangunkusumo Hospital / Yohanes Salim

Yohanes Salim; Ninik Sukartini, supervisor; Arini Setiawati, supervisor; Loho, Tonny, examiner; Suzanna Immanuel, examiner; Rahayuningsih Dharma Setiabudy, examiner ([Publisher not identified] , 2015)

Abstrak

[ABSTRAK

Anemia defisiensi besi dan thalassemia β trait merupakan penyebab

tersering anemia mikrositik hipokrom di Indonesia. Kedua penyakit tersebut sulit

dibedakan hanya dengan pemeriksaan hematologi, oleh karena itu diperlukan

pemeriksaan tambahan seperti feritin dan analisis hemoglobin. Namun tidak semua

laboratorium dapat melakukan pemeriksaan ini. Banyak penelitian yang

membedakan kedua penyakit tersebut dengan indeks eritrosit. Namun indeks

eritrosit memiliki nilai diagnostik yang berbeda di setiap negara dan belum ada data

di Indonesia. Penelitian ini melakukan uji diagnostik Indeks Mentzer, RDW, Green-

King, Sirdah, dan mencari nilai cut-off baru yang memberikan nilai diagnostik lebih

baik.

Penelitian terdiri dari 98 subyek definitif anemia defisiensi besi dan 80

subyek thalassemia β trait. Nilai diagnostik Indeks Mentzer untuk anemia defisiensi

besi adalah sensitivitas 83.6%, spesifisitas 66.2%, NPP 75.2%, NPN 76.8%, RKP

2.4, RKN 0.2. Nilai diagnostik Indeks Mentzer untuk thalassemia β trait adalah

sensitivitas 66.2%, spesifisitas 83.6%, NPP 76.8%, NPN 75.2%, RKP 4.0, RKN

0.4. Nilai diagnostik Indeks RDW untuk anemia defisiensi besi adalah sensitivitas

91.8%, spesifisitas 75%, NPP 81.8%, NPN 88.2%, RKP 3.6, RKN 0.1. Nilai

diagnostik Indeks RDW untuk thalassemia β trait adalah sensitivitas 75%,

spesifisitas 91.8%, NPP 88.2%, NPN 81.8%, RKP 9.1, RKN 0.2. Nilai diagnostik

Indeks Green-King untuk anemia defisiensi besi adalah sensitivitas 96.9%,

spesifisitas 67.5%, NPP 78.5%, NPN 94.7%, RKP 2.9, RKN 0.04. Nilai diagnostik

Indeks Green-King untuk thalassemia β trait adalah sensitivitas 67.5%, spesifisitas

96.9%, NPP 94.7%, NPN 78.5%, RKP 22.0, RKN 0.3. Nilai diagnostik Indeks

Sirdah untuk anemia defisiensi besi adalah sensitivitas 92.8%, spesifisitas 58.7%,

NPP 73.3%, NPN 87.0%, RKP 2.2, RKN 0.1.Nilai diagnostik Indeks Sirdah untuk

thalassemia β trait adalah sensitivitas 58.7%, spesifisitas 92.8%, NPP 87.0%, NPN

73.3%, RKP 8.2, RKN 0.4. Nilai cut-off baru Indeks Mentzer adalah 13.44, RDWI

233.4, Green-King 75.06, dan Sirdah 32.52.

Keempat indeks eritrosit dapat diaplikasikan untuk orang Indonesia dengan

Indeks Green-King sebagai indeks yang terbaik.

ABSTRACT

Iron deficiency anemia and β trait thalassemia are the most common causes

of microcytic hypochromic anemia in Indonesia. Differentiation between them is

difficult when solely based on a hematology examination, so additional laboratory

tests are required such as ferritin and hemoglobin analysis. However, not all

laboratories can perform these tests. Many erythrocytes indices have been proposed

to determine whether a blood sample is more suggestive for iron deficiency anemia

or β trait thalassemia. Unfortunately these indices have different diagnostic value

in many countries and there is no data about diagnostic value in Indonesia. This

study performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index and

develops a new cut-off point that could make a better diagnostic value.

This study consists of 98 subjects of iron deficiency anemia and 80 subjects

of β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiency

anemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+

2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia were

sensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4.

Diagnostic values of RDW Index for iron deficiency anemia were sensitivity

91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnostic

values of RDW Index for β trait thalassemia were sensitivity 75%, specificity

91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green-

King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%,

PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-King

Index for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%,

NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for iron

deficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV

87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemia

were sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR-

0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was

13.44, 233.4, 75.06, and 32.52 respectively.

All indices can be applied for Indonesian people, among which Green-King

Index had the best diagnostic value, Iron deficiency anemia and β trait thalassemia are the most common causes