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"ABSTRAKPemeriksaan koagulasi rutin PT dan APTT sangat dipengaruhi oleh variabel pra analitik yaitu perbandingan darah dengan antikoagulan sitrat 0,109 M adalah 9:1. Kurangnya volume darah dalam tabung menyebabkan rasio berubah sehingga terjadi pengenceran sampel disebut underfilling. Underfilling pada tabung sitrat 0.109 M menyebabkan nilai PT dan APTT memanjang. Penelitian ini bertujuan untuk membuktikan underfilling menyebabkan pemanjangan PT dan APTT, melihat adakah perbedaan rerata PT dan APTT antar berbagai volume dalam tabung, sekaligus menentukan volume minimal spesimen dalam tabung sitrat yang direkomendasikan untuk pemeriksaan PT dan APTT. Desain penelitian potong lintang dengan 38 subjek sehat dan 38 pasien dengan warfarin. Hasil penelitian ini membuktikan bahwa underfilling menyebabkan pemanjangan PT dan APTT. Terdapat perbedaan rerata PT dan APTT pada berbagai volume spesimen, dan volume minimal spesimen dalam tabung sitrat yang direkomendasikan untuk pemeriksaan PT dan APTT adalah 90 untuk subjek sehat dan 100 untuk pasien dengan warfarin.Kata kunci: pra analitik; pemeriksaan koagulasi; underfilling; pemanjangan PT dan APTT; volume minimal spesimen

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ABSTRACTThe routine coagulation measurement PT and APTT are highly influenced by pre analytical variables, one of which is the ratio of 9 1 between blood and citrate 0.109 M as anticoagulant. Lesser than minimum amount of blood volume in sample tube causes sample dilution known as underfilling. Underfilling of citrate 0.109 M tube results in prolonged PT and APTT. This study aims to prove that underfilling leads to prolonged PT and APTT by comparing mean PT and APTT value between sample tubes with different volume of blood. Furthermore, the recommended minimal volume of specimen in citrated tube would be sought. The study design was cross sectional with 38 healthy subjects and 38 patients on warfarin. This study indeed found that underfilling causes prolonged PT and APTT. There were significant mean difference of each PT and APTT for various specimen volumes. The recommended minimum specimen volume in citrate tube for PT and APTT measurement was 90 for healthy subject and 100 for patients on warfarin.Keywords pra analytic, coagulation measurement, underfilling, prolonged PT APTT, minimum specimen volume."

"Metode pengambilan sampel melalui Dried Blood Spot DBS terus dikembangkan. DBS memiliki banyak kelebihan seperti kemudahan penyimpanan sampel dan sampel yang dibutuhkan lebih kecil. Walau demikian, analisis dalam sampel DBS lebih sulit dilakukan karena banyaknya faktor yang mempengaruhi analisis sehingga diperlukan penyelidikan lebih lanjut. Penelitian ini bertujuan untuk melihat adanya perbedaan hasil yang diakibatkan jenis kertas, hematokrit darah, volume penotolan, pemberian baku dalam, dan suhu penyimpanan yang berbeda terhadap analisis sampel. Sampel darah dengan hematokrit tertentu yang mengandung 6-merkaptopurin 6-MP dan 6-tioguanin 6-TG pada konsentrasi 25 ng/ml dan 1000 ng/ml ditotolkan dengan volume yang berbeda pada kertas CAMAG DBS dan Perkin Elmer 226. Setelah kering, kertas dipotong dengan diameter 8 mm dan diekstraksi dengan metanol yang mengandung baku 5-fluorourasil 5-FU . Selain di dalam larutan pengekstraksi, baku dalam diberikan di dalam darah dan ditotolkan ke dalam kertas untuk dilihat perbedaan kromatogramnya. Pemisahan dilakukan dengan kolom Waters Acquity UPLC Class BEH Amide 1,7 ?m 2,1 x 100 mm dengan fase gerak berupa asam format 0,2 dalam air ndash; asam format 0,1 dalam asetonitril ndash; metanol dengan elusi gradien dan laju alir 0,2 mL/menit. Hasil penelitian ini memperlihatkan perbedaan pemberian baku dalam mempengaruhi puncak baku dalam. Perbedaan jenis kertas mempunyai korelasi.

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The collection method of dried blood spot DBS is being developed. DBS offers a number of advantages over conventional blood collection such as easier storage and smaller samples. However, the analysis of the DBS sample is more difficult due to many factors that affect the analysis so that further investigation is needed. The aim of this study was to saw the presence of differences in results because of paper type, hematocrit, blood volume, provisions of internal standard, and temperature of sample storage differences. Blood samples with specific hematocrit containing 25 and 1000 ng ml 6 mercaptopurine 6 MP and 6 thioguanine 6 TG were spotted at the different volume of blood on CAMAG DBS paper and Perkin Elmer 226. The DBS paper was punched with a diameter of 8 mm and extracted using methanol containing internal standard 5 fluorouracil 5 FU . In addition in the methanol, the internal standard was also added in the blood and spotted into the paper to see the chromatogram difference. The separation was carried out using a Waters Acquity UPLC Class BEH Amide 1.7 m 2.1 x 100 mm column with a mobile phase of 0.2 formic acid in water 0.1 formic acid in acetonitrile methanol with gradient elution at flow rate 0.2 mL minute. The results of this study indicated the differences provisions of internal standard affected the chromatogram of the internal standard. Different types of paper and blood volume affected."

"Latar Belakang: Induksi sputum merupakan metode alternatif untuk mendapatkan spesimen dari saluran respiratori bawah yang bersifat semi-invasif. Induksi sputum belum menjadi pemeriksaan standar pada anak, padahal sputum merupakan spesimen yang baik untuk berbagai pemeriksaan penunjang, misalnya pulasan sitologi dan biakan bakteri. Keberhasilan induksi sputum dalam mendapatkan spesimen dari saluran respiratori bawah pada anak masih diragukan. Tujuan: Mengetahui keberhasilan induksi sputum dalam mendapatkan spesimen dari saluran respiratori bawah pada anak dengan infeksi saluran respiratori bawah, toleransi induksi sputum, dan pola biakan dari spesimen sputum yang didapatkan. Metode: Penelitian potong lintang deskriptif pada subjek anak berusia 1 bulan hingga 18 tahun dengan infeksi respiratori bawah yang dipilih secara konsekutif. Subjek menjalani induksi sputum. Sputum diperiksa jumlah sel makrofag alveolar, kadar protein surfaktan A (SP-A), serta biakan bakteri aerob, atau pulasan bakteri tahan asam dan biakan M. tuberculosis. Hasil: Empat puluh orang subjek berpartisipasi dalam penelitian ini, induksi sputum berhasil dilakukan pada seluruh subjek. Usia termuda 2 bulan dan tertua 16 tahun 7 bulan. Sebagian besar subjek (27 dari 40 orang) didiagnosis dengan tuberkulosis, diikuti pneumonia dan bronkiolitis. Median durasi induksi sputum 45 menit, dan sebagian besar volume 3 atau 4 mL. Efek samping berupa perdarahan hidung (40%) dan muntah (2,5%). Jumlah sel makrofag alveolar lebih dari 5 buah ditemukan pada 97,5% subjek. Sementara, SP-A diperiksa pada 30 spesimen dan SP-A dideteksi pada seluruh spesimen dengan median 264,528 pg/mL. Pulasan bakteri tahan asam negatif pada seluruh subjek yang diperiksa, sementara biakan M. tuberculosis positif pada 1 dari 27 (3%) subjek. Biakan bakteri aerob positif pada 5 dari 13 (38,5%) orang subjek. Simpulan: Induksi sputum memiliki keberhasilan yang baik untuk mendapatkan spesimen dari saluran respiratori bawah pada anak dan aman dilakukan. Spesimen sputum yang diperoleh secara induksi memiliki hasil positif biakan bakteri aerob yang cukup baik.

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Background: Sputum induction is an alternative method to obtain specimen from lower respiratory tract. Although sputum is a good specimen for various examination such as cytology and microbiological culture, sputum induction is not a standard method in children. The efficacy of sputum induction to obtain specimen from lower respiratory tract in children is unclear. Objective: To identify the efficacy of sputum induction to obtain specimen from lower respiratory tract in children with lower respiratory tract infection. Also, to identify side effects of sputum induction and the result of microbiological culture. Design: A cross sectional study was performed in children from age 1 month old to 18 years old with lower respiratory tract infection, consecutively. Subject underwent sputum induction, and specimens were examined for number of alveolar macrophage cell, surfactant protein A (SP-A) concentration, also aerobic microbial culture, or acid-fast bacili smear and M. tuberculosis culture. Result: Forty subjects participated in this study, and sputum induction was succesfully performed in all subjects. Youngest subject was 2 months old, while the eldest was 16 years 7 months old. Most subjects (27 of 40) were diagnosed with tuberculosis, followed by pneumonia and bronchiolitis. Median duration of sputum induction was 45 minutes, and majority of volume was 3 or 4 mL. Side effects were nose bleeds (40%) and vomiting (3%). Macrophage alveolar more than 5 cells in one specimen was found in 97.5% subjects. Laboratory examination for SP-A was performed in 30 subjects? specimens, and SP-A was detected in all examined specimens with median concentration 264.528 pg/mL. Culture for M. tuberculosis was positive in 1 of 27 subjects (3%), while acid fast bacili smear was negative in all examined subjects. Aerobic microbial culture was positive in 5 of 13 subjects (38.5%), Conclusions: Sputum induction has good efficacy in obtaining lower respiratory tract specimen and it is safe to perform in children. Specimen from sputum induction yields good positive result for aerobic microbial cultures."

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