Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
ABSTRAK
Secondary iron overload pada thalassemia mayor terjadi karena eritropoiesis inefektif dan tranfusi berkala. Besi melebihi transferin sehingga banyak non transferin bound iron NTBI yang mengkatalisasi terjadinya ion radikal bebas yang merusak jaringan. Pengendapan besi pada saluran cerna mengakibatkan perubahan fungsi, kerusakan organ, gangguan ketersediaan asam amino. Iron overload dikurangi dengan kelasi besi. Transferin merupakan kelator alami tubuh terdiri asam amino dominan alanin, leusin, glisin, asam aspartat. Berdasarkan penelitian, pasien iron overload memiliki transferin lebih rendah dibandingkan non iron overload. Penelitian bertujuan mengetahi perubahan status besi, profil asam amino dan hubungan iron overload dengan profil asam amino. Parameter yang diteliti : besi serum, unsaturated iron binding capacity UIBC , total iron binding capacity TIBC , feritin, saturasi transferin, indeks transferin, alanin, leusin, glisin, asam aspartat. Desain penelitian kohort dengan 21 subjek, yaitu 13 thalassemia beta mayor dan 8 thalassemia beta HbE. Hasil penelitian didapatkan perubahan status besi bermakna yaitu peningkatan feritin pasca transfusi, penurunan feritin pasca kelasi 1 bulan, peningkatan kadar besi pasca kelasi 3 bulan. Perubahan asam amino bermakna yaitu penurunan alanin, leusin, serta peningkatan glisin pasca kelasi 1 bulan Terdapat hubungan kuat, bermakna searah antara indeks transferin dan alanin pre transfusi. Terdapat hubungan kuat, bermakna, searah antara indeks transferin dengan alanin dan glisin pasca transfusi.

---

ABSTRACT
Secondary iron overload in thalassemia major occurs due to ineffective erythropoiesis and periodic transfusions. The excess of iron exceed transferrin so there are many non transferrin bound iron NTBI that induce tissue damaging free radical ion. Accumulation of iron in intestine can lead to changes in the function, organ damage, lack of amino acid availability. Iron overload can be reduced by iron chelation. Transferrin is the body 39 s natural chelator comprising of dominant amino acid alanine, leucine, glycine, aspartic acid. Research found that transferrin were lower in iron overload patients. This study aims to acquire the changes of iron status, amino acid profile, and correlation between iron overload and amino acid profile. Studied parameter were serum iron, unsaturated iron binding capacity UIBC , total iron binding capacity TIBC , ferritin, transferrin saturation, transferrin index, alanine, leucine, glycine, aspartic acid. The study design were cohort with 21 subjects consisted of 13 beta major thalassemia and 8 beta Hbe thalassemia. The result showed significant iron status changes ferritin increased post transfusion, ferritin decreased after 1 month chelation and serum iron increased after 3 months chelation. Significant amino acid profile changes decreased of alanine and leucine, and glycin increased after 1 month chelation. There rsquo s significant correlation between transferrin index and alanine pre transfusion. There rsquo s significant correlation between transferrin index and alanine, glycine after 3 month chelation.

Abstrak :
ABSTRAK
Latar Belakang: Mangiferin diketahui memiliki aktivitas sebagai agen pengikat besi, namun pemberian mangiferin melalui oral memiliki bioavailabilitas yang rendah. Sistem hantaran dengan nanopartikel diharapkan dapat meningkatkan bioavailabilitas dan efektivitas mangiferin. Penelitian bertujuan menguji efektivitas mangiferin nanopartikel kitosan-alginat dalam menurunkan kadar besi di plasma dan organ, kadar ferritin, transferrin, SGOT dan SGPT. Metode: Penelitian menggunakan desain eksperimental in vivo dengan hewan coba tikus Sprague-Dawley dibagi dalam 5 kelompok, yaitu kelompok normal, kelebihan besi, terapi mangiferin 50 mg/KgBB, terapi mangiferin dalam nanopartikel kitosanalginat 25 mg/KgBB, dan terapi mangiferin dalam nanopartikel kitosan-alginat 50 mg/KgBB. Pengukuran kadar Fe plasma, hati dan jantung, kadar Ferritin, kadar Transferrin, dan nilai aktivitas SGPT dan SGOT. Hasil: Kadar besi plasma, besi hati dan jantung, ferritin, dan transferrin pada kelompok kelebihan besi adalah 45,52 mg/L; 3661,98 μg/gram; 1734,4 μg/gram; 3578,16 ng/mL; 388,96 μg/dL, sedangkan pemberian terapi mangiferin 50 mg/KgBB (p < 0,05) menghasilkan 5,17 mg/L; 1572,96 μg/gram; 776,68 μg/gram; 1136,51 ng/mL; 272,18 μg/dL, pemberian terapi mangiferin dalam nanopartikel kitosan-alginat 25 mg/KgBB (p < 0,05) menghasilkan 5,74 mg/L; 1090,01 μg/gram; 753,90 μg/gram; 520,89 ng/mL; 231,97 μg/dL, pemberian terapi mangiferin dalam nanopartikel kitosan-alginat 50 mg/KgBB (p < 0,05) menghasilkan 3,34 mg/L; 1703,92 μg/gram; 759,2 μg/gram; 559,48 ng/mL; 235,70 μg/dL. Tidak terdapat perbedaan bermakna antar kelompok terhadap nilai aktivitas SGOT dan SGPT Kesimpulan: Mangiferin dalam nanopartikel kitosan-alginat efektif menurunkan kadar besi, ferritin, transferrin plasma, dan kadar besi di organ hati dan jantung, namun tidak menurunkan nilai aktivitas SGOT dan SGPT. Efektivitas mangiferin dalam nanopartikel kitosan-alginat tidak berbanding lurus dengan dosis.

---

ABSTRACT
Background: Mangiferin was known to have activity as an iron-chelating agent, but oral administration of mangiferin has poor bioavailability. Nanoparticles delivery system is expected to increase bioavailability and effectiveness of mangiferin. This study aims to examine the effectiveness of mangiferin in chitosanalginate nanoparticles in reducing iron levels in plasma and organs, ferritin, transferrin, SGOT and SGPT activities. Methods: This is an in vivo experimental study using Sprague-Dawley rats, divided into 5 groups, normal, iron overload, mangiferin 50mg/KgBW, mangiferin in chitosan-alginate nanoparticles 25mg/KgBW, and mangiferin in chitosanalginate nanoparticles 50mg/KgBW. Fe levels were measured in plasma, liver and heart. In addition ferritin levels, transferrin levels, and SGPT and SGOT activities also measure at day 29th. Results: Plasma iron levels, liver and heart iron levels, ferritin, and transferrin in the iron overload group were 45.52 mg/L; 3661.98 μg/gram; 1734.4 μg/gram; 3578.16 ng/mL; 388.96 μg/dL, treatment with mangiferin 50 mg/KgBW (p < 0.05) reduced those parameters to 5.17 mg/L; 1572.96 μg/gram; 776.68 μg/gram; 1136.51 ng/mL; 272.18 μg/dL, treatment with mangiferin in chitosan-alginate nanoparticles 25 mg/KgBW (p < 0.05) reduced those parameters 5.74 mg/L; 1090.01 μg/gram; 753.90 μg/gram; 520.89 ng/mL; 231.97 μg/dL, treatment with mangiferin in chitosan-alginate nanoparticles 50 mg/KgBW (p < 0.05) reduced those parameters 3.34 mg/L; 1703.92 μg/gram; 759.2 μg/gram; 559.48 ng/mL; 235.70 μg/dL. There is no significant difference in SGOT and SGPT activities. Conclusions: Mangiferin in chitosan-alginate nanoparticles was effective in preventing the increase of iron, ferritin, transferrin plasma levels, and iron levels in the liver and heart, but not prevent the increasing of SGOT and SGPT. The effectiveness of mangiferin in chitosan-alginate nanoparticles is not directly proportional to the dose.

Abstrak :
Latar Belakang: Harapan hidup pasien thalasemia bergantung transfusi bertambah baik karena transfusi darah dan terapi kelasi besi yang sesuai. Penyakit jantung akibat toksisitas besi tetap menjadi penyebab utama kematian pada pasien thalasemia bergantung transfusi. MRI T2* jantung dapat mendeteksi dini toksisitas besi di jantung dan dapat mengevaluasi hasil pengobatan dengan membandingkan nilai T2* pra dan pasca terapi kelasi besi. Tujuan Penelitian: Penelitian ini bertujuan mendapatkan profil perbaikan toksisitas besi di jantung pada pasien thalasemia dewasa bergantung transfusi. Penelitian ini juga bertujuan untuk melihat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum dan saturasi transferin. Metode Penelitian: pre and post test dengan data sekunder retrospektif pada pasien dewasa thalasemia bergantung transfusi yang kontrol di poliklinik thalasemia Kiara dan poliklinik dewasa hematologi-onkologi medik RSUPN Cipto Mangukusumo. Penelitian dilakukan pada bulan Juli-Desember 2019. Data sekunder diperoleh dari rekam medis dan registri pasien thalasemia berupa riwayat medis, jenis obat kelasi besi, nilai T2* jantung satu tahun berturut-turut, kadar feritin serum dan saturasi transferin. Analisis data berupa data deskriptif dan uji marginal homogeneity serta uji kappa. Hasil: Sebanyak 115 pasien dilibatkan dalam penelitian ini. Terdapat perbaikan T2* jantung sebanyak 7,0% dan menetap baik (T2* jantung tetap >20 milidetik) sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum (nilai kappa = 0,044) dan perbaikan nilai T2* jantung dengan saturasi transferin ( nilai kappa = 0,011). Simpulan: Perbaikan toksisitas besi di jantung pasca terapi kelasi besi sebanyak 7,0% dan menetap baik sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan kadar feritin serum dan saturasi transferin.

---

Background: Life expectancy of the transfusion dependent thalassemia patients is getting better because of blood transfusion and appropriate iron chelation therapy. Heart disease due to iron toxicity remains the leading cause of death in thalassemia patients who need transfusion. MRI T2* can allow to detect premature iron toxicity in the heart and can evaluate the results by comparing myocardial T2* pre and post iron chelation therapy. Objectives: This study aims to obtain a profile of improvement in cardiac iron toxicity in adult thalassemia patients who need transfusion. This study also supports to see aggrement between improvement in myocardial T2* with improved serum ferritin level and transferrin saturation. Methods: pre and post test with retrospective secondary data in adult thalassemia patients requiring controlled transfusions in Kiara thalassemia clinic and hematology-medical oncology clinic Cipto Mangukusumo General Hospital. The study was conducted in July-Desember 2019. Data were obtained from medical records and thalassemia registry, which consisted of medical history, type of chelation, myocardial T2* within one year, serum ferritin level and transferrin saturation. Data analysis was performed in descriptive data and marginal homogeneity test and Kappa test. Results: A total of 115 patients were included in this study. There was an improvement of a myocardial T2* in 7.0% patients and persistently good (myocardial T2* remains >20 milliseconds) in 72.2%. There was no agreement between improvement in myocardial T2* with improvement in serum ferritin level (kappa value 0.044) and improvement in myocardial T2* with transferrin saturation (kappa value 0.011). Conclusion: Improvement of cardiac iron toxicity after iron chelation therapy was 7.0% and persistently good in 72.2%. There was no agreement between the improvement in myocardial T2* with improvement in serum ferritin level and transferrin saturation.

Abstrak :
Latar Belakang: Harapan hidup pasien thalasemia bergantung transfusi bertambah baik karena transfusi darah dan terapi kelasi besi yang sesuai. Penyakit jantung akibat toksisitas besi tetap menjadi penyebab utama kematian pada pasien thalasemia bergantung transfusi. MRI T2* jantung dapat mendeteksi dini toksisitas besi di jantung dan dapat mengevaluasi hasil pengobatan dengan membandingkan nilai T2* pra dan pasca terapi kelasi besi. Tujuan Penelitian: Penelitian ini bertujuan mendapatkan profil perbaikan toksisitas besi di jantung pada pasien thalasemia dewasa bergantung transfusi. Penelitian ini juga bertujuan untuk melihat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum dan saturasi transferin. Metode Penelitian: pre and post test dengan data sekunder retrospektif pada pasien dewasa thalasemia bergantung transfusi yang kontrol di poliklinik thalasemia Kiara dan poliklinik dewasa hematologi-onkologi medik RSUPN Cipto Mangukusumo. Penelitian dilakukan pada bulan Juli-Desember 2019. Data sekunder diperoleh dari rekam medis dan registri pasien thalasemia berupa riwayat medis, jenis obat kelasi besi, nilai T2* jantung satu tahun berturut-turut, kadar feritin serum dan saturasi transferin. Analisis data berupa data deskriptif dan uji marginal homogeneity serta uji kappa. Hasil: Sebanyak 115 pasien dilibatkan dalam penelitian ini. Terdapat perbaikan T2* jantung sebanyak 7,0% dan menetap baik (T2* jantung tetap >20 milidetik) sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan feritin serum (nilai kappa = 0,044) dan perbaikan nilai T2* jantung dengan saturasi transferin ( nilai kappa = 0,011). Simpulan: Perbaikan toksisitas besi di jantung pasca terapi kelasi besi sebanyak 7,0% dan menetap baik sebanyak 72,2%. Tidak terdapat kesesuaian antara perbaikan nilai T2* jantung dengan perbaikan kadar feritin serum dan saturasi transferin.

---

Background: Life expectancy of the transfusion dependent thalassemia patients is getting better because of blood transfusion and appropriate iron chelation therapy. Heart disease due to iron toxicity remains the leading cause of death in thalassemia patients who need transfusion. MRI T2* can allow to detect premature iron toxicity in the heart and can evaluate the results by comparing myocardial T2* pre and post iron chelation therapy. Objectives: This study aims to obtain a profile of improvement in cardiac iron toxicity in adult thalassemia patients who need transfusion. This study also supports to see aggrement between improvement in myocardial T2* with improved serum ferritin level and transferrin saturation. Methods: pre and post test with retrospective secondary data in adult thalassemia patients requiring controlled transfusions in Kiara thalassemia clinic and hematology-medical oncology clinic Cipto Mangukusumo General Hospital. The study was conducted in July-Desember 2019. Data were obtained from medical records and thalassemia registry, which consisted of medical history, type of chelation, myocardial T2* within one year, serum ferritin level and transferrin saturation. Data analysis was performed in descriptive data and marginal homogeneity test and Kappa test. Results: A total of 115 patients were included in this study. There was an improvement of a myocardial T2* in 7.0% patients and persistently good (myocardial T2* remains >20 milliseconds) in 72.2%. There was no agreement between improvement in myocardial T2* with improvement in serum ferritin level (kappa value 0.044) and improvement in myocardial T2* with transferrin saturation (kappa value 0.011). Conclusion: Improvement of cardiac iron toxicity after iron chelation therapy was 7.0% and persistently good in 72.2%. There was no agreement between the improvement in myocardial T2* with improvement in serum ferritin level and transferrin saturation.

Abstrak :
Anemia defisiensi besi merupakan salah satu komplikasi penyakit ginjal kronis (PGK) yang sering dijumpai terutama pada pasien yang menjalani hemodialisis rutin. Inflamasi merupakan kondisi yang selalu ada pada pasien PGK yang menjalani hemodialisis, dengan salah satu markernya yaitu C-reactive protein (CRP). Marker besi yang rutin digunakan seperti feritin dan saturasi transferin dipengaruhi oleh inflamasi sehingga status besi pada pasien PGK menjadi sulit dinilai. Marker lain seperti persentase eritrosit hipokrom (%Hypo-He), reticulocyte haemoglobin content (Ret-He), soluble transferrin receptor (sTfR), indeks sTfR, dan persentase eritrosit mikrositik (%MicroR) dapat digunakan untuk menilai status besi, namun belum rutin digunakan. Tujuan penelitian ini adalah untuk mengetahui pengaruh inflamasi terhadap %Hypo-He, Ret-He, sTfR, indeks sTfR, dan %MicroR pada pasien PGK dengan hemodialisis rutin dalam menentukan status besi. Penelitian ini merupakan studi potong lintang yang melibatkan 123 pasien hemodialisis rutin berusia lebih dari 18 tahun di Unit Hemodialisis RS Cipto Mangunkusumo yang berlangsung pada bulan Agustus sampai September 2018. Setiap subjek diperiksakan parameter %Hypo-He, Ret-He, dan %MicroR menggunakan alat automated hematology analyzer Sysmex XN 3000, sedangkan sTfR, indeks sTfR, dan CRP diperiksa menggunakan alat Cobas c311. Didapatkan median CRP sebesar 3,99 (0,2- 129,97) mg/L dengan proporsi pasien PGK dengan hemodialisis rutin yang mengalami inflamasi sebanyak 45,5%. Pada penelitian ini tidak didapatkan perbedaan %Hypo-He, Ret-He, sTfR, indeks sTfR, dan %MicroR pada pasien yang menjalani hemodialisis rutin yang mengalami inflamasi dan noninflamasi sehingga marker-marker tersebut dapat digunakan untuk menentukan status besi pada pasien PGK dengan hemodialisis rutin. ......Iron deficiency anemia is one of the complications seen in chronic kidney disease especially in routine hemodialysis patients. Inflammation, marked by C-reactive protein (CRP), is often found in chronic kidney disease (CKD) patients with hemodialysis. Routine iron markers, such as ferritin and transferrin saturation, are influenced by inflammation. Hence the iron status in CKD patients is difficult to interpret. Other markers like hypochromic erythrocytes percentage (%Hypo-He), reticulocyte haemoglobin content (Ret-He), soluble transferrin receptor (sTfR), sTfR index, and microcytic erythrocytes percentage (%MicroR) can be used to evaluate iron status, but these markers are not commonly used. This study aims to evaluate the influence of inflammation in %Hypo-He, Ret-He, sTfR, sTfR index, and %MicroR in routine hemodialysis patients to determine the iron status. This study was a cross sectional study comprised of 123 routine hemodialysis patients, aged over 18 years old, in Hemodialysis Unit Cipto Mangunkusumo Hospital during August to September 2018. Blood samples from all subjects were evaluated using automated hematology analyzer Sysmex XN 3000 for %Hypo-He, Ret-He, and %MicroR, and Cobas c311 for sTfR, sTfR index, and CRP. Median CRP in all patients was 3,99 (0,2-129,97) mg/L with inflammation occurred in 45,5% patients. There were no differences found in %Hypo-He, Ret-He, sTfR, sTfR index, and %MicroR in routine hemodialysis patients with inflammation and noninflammation so these markers could be used to evaluate iron status in hemodialysis patients.

Abstrak :
Ruang lingkup dan cara penelitian: Penderita kanker kolorektal sering mengalami malnutrisi. Untuk memperkecil komplikasi paska bedah, diperlukan tunjangan nutrisi bagi penderita pra bedah kanker kolorektal dengan malnutrisi. Sebagai tunjangan nutrisi, susu lazim digunakan di rumah sakit. Tetapi pemberian susu pada orang dewasa dan keadaan malnutrisi sering menimbulkan intoleransi, sehingga diperlukan bahan makanan lain sebagai penggantl susu. Tempe merupakan sumber gizi tradisional yang memiliki banyak kelebihan karakteristik, diharapkan dapat sebagal pengganti susu. Tujuan penelitian ini adalah membandingkan pengaruh suplementasi formula tempe dan susu terhadap .perubahan kadar transperin serum penderita kanker kolorektal dengan malnutrisi. Penelitian dilakukan di RSUPNCM, Jakarta. Penderita pra bedah kanker kolorektal yang memenuhi kriteria penerimaan di bagi dua kelompok secara acak. Pada kelompok tempe mendapat suplementasi formula tempe 100 g/hari dan kelompok susu diberikan suplementasi susu full cream 75 g/hari, selama 7hari. Pada awal dan akhir penelitian diperiksa kadar transferin serum sebagai parameter status protein. Hasil: Terjadi peningkatan kadar transferin serum yaitu dari (200,36 ± 29,10) mg/dL menjadi (250,36 ± 91,00) mg/dL pada kelompok tempe dan dari {195,33 ± 29,70) mg/dL., menjadi (276,13 ± 134,15) mg/dL pada kelompok susu. Peningkatan ini secara statistik bermakna (p < 0,05). Bila dibandingkan kedua kelompok tersebut, kadar transferin serum sesudah suplementasi secara statistik tidak berbeda bermakna (p > 0,05). Kesimpulan: Suplementasi formula tempe atau susu pada penderita pra bedah kanker kolorektal dengan malnutrisi, dapat meningkatkan kadar transferin serum yang setara. Formula tempe merupakan sumber protein nabati dapat digunakan sebagai pilihan alternatif pengganti susu. ...... Comparison Study Of The Influence Of Tempe Formula And Milk Supplementation Towards The Transferrin Serum Content Of Pre Surgery Colorectal Cancer Patient With Malnutrition.Scope and Method of Study. A colorectal cancer victim often suffers of malnutrition. To reduce complications a colorectal cancer patient with malnutrition requires nutritional support before surgery. Generally in hospitals milk is used as nutritional support. However milk otten causes intolerance to adults and cases of malnutrition, therefore other foodstuff is required to substitute for milk. Tempe represents a traditional source of nutrition with many characteristic advantages and expected useable as a substitute for milk. The aim of this study is to compare the influence of tempe formula and milk supplementation towards the change of transferrin serum content in colorectal cancer patients with malnutrition. The study is conducted at the RSUPNCM in Jakarta. Pre surgery colorectal cancer patients fulfilling the criteria are divided at random into two groups. The tempe group receives a supplementation of 100 grams per day tempe formula, while the milk group is given supplementation of full cream milk powder of 75 grams per day for 7 days. At the beginning and conclusion of the study the transferrin serum content is examined as a paramenter of the protein status. Result: An increase of the transferrin serum content has 1 occured, i.e. from (100,36 ± 29,10) mg/dL to (250,36 ± 91,00) 1 mg/dL in the tempe group and from (195,33 ± 20,70) mg/dL to (276,13 ± 134,15) mg/dL in the milk group. Statistically the increase is significant (p < 0,05). When comparing the two groups the transferrin serum content supplementation does not differ significantly statistic-wise (p > 0,05). Conclusions: The supplementation of either tempe formula or milk to pre surgery colorectal cancer patients with malnutrition equally increases the transferrin serum content. The tempe formula represents a vegetative source of protein and can be used as an alternative option of milk.

Abstrak :
Pada wanita hamil trimester kedua terjadi peningkatan kebutuhan besi. Defisiensi besi yang terjadi pada awal kehamilan akan menjadi anemia defisiensi besi pada akhir kehamilan. Defisiensi besi pada kehamilan dapat menimbulkan komplikasi seperti perdarahan akibat atonia uteri. Akhir-akhir ini dikembangkan parameter baru untuk mendeteksi defisiensi besi yaitu soluble transferrin receptor serum (sTfR) yang diharapkan tidak dipengaruhi oleh adanya inflamasi. Penggabungan parameter kadar feritin dan sTfR menjadi rasio sTfR 1 log. feritin diharapkan lebih baik dalam deteksi defisiensi besi. Pada penelitian secara potong lintang pada 108 wanita hamil primigravida trimester kedua didapatkan proporsi defisiensi besi sebesar 43,5% terdiri dari defisiensi besi tahap I sebesar 31,5% ; defisiensi besi tahap II sebesar 8,3% dan defisiensi besi tahap III sebesar 3,7%. Dijumpai 8 (7,4%) wanita hamil dengan anemia, 4 (3,7%) orang diantaranya disebabkan karena defsiensi besi. Pemeriksaan kadar sTfR menggunakan cara imunonephelometri. Dari hasil penelitian ini didapatkan nilai median kadar sTfR pads wanita hamil tanpa defisiensi besi (n=61) sebesar 1,3 mg/L ( 0,97 - 2,32 mg/L), pada defisiensi besi tahap I (n=34) sebesar 1,6 mg/L ( 0,92 - 3,26 mg/L), pada defisiensi besi tahap II (n=9) ditemukan rentang nilai 1,19 - 2,64 mg/L dan pada defisiensi besi tahap III (n=4) ditemukan rentang nilai 3,03 - 5,16 mg/L. Kadar sTfR pada defisiensi besi tahap I Iebih tinggi dibanding tanpa defisiensi besi, pada defisiensi besi tahap II dan III tampak lebih tinggi dibanding defisiensi besi tahap I. Rasio sTfR / log. feritin pada wanita hamil tanpa defisiensi besi didapatkan nilai median 0,68 (0,46-1,34); defisiensi besi tahap I sebesar 1,26 (0,71-3,54); defisiensi besi tahap II didapatkan rentang nilai 0,94-3,22 dan pada defisiensi besi tahap III sebesar 4,28-14,74. Rasio sTfR 1 log. feritin pada defisiensi besi tahap I Iebih tinggi dibanding tanpa defisiensi besi. Pada 50% wanita hamil didapatkan peningkatan kadar CRP. Kadar sTfR pada kadar CRP meningkat maupun normal tidak ditemukan adanya perbedaan yang bermakna. Kadar feritin dan sTfR ditemukan korelasi negatif dengan kekuatan sedang (r = - 0,676; r2 = 0,46); dan sebesar 46% penurunan feritin yang disertai dengan peningkatan kadar sTfR. Pada 47 wanita hamil dengan defisiensi besi ditemukan 19% subyek dengan peningkatan kadar sTfR, sedangkan peningkatan rasio sTfR 1 log. feritin dijumpai pada 55% subyek. Penghitungan rasio sTfR / log. feritin lebih baik dibandingkan hanya memakai kadar sTfR saja dalam hal mendeteksi defisiensi besi. Disarankan untuk melakukan penelitian lebih lanjut untuk membuktikan bahwa rasio sTfR 1 log. feritin yang lebih sensitif dalam hal mendeteksi adanya defisiensi besi, dengan memakai pemeriksaan baku emas untuk mengetahui cadangan besi yaitu pemeriksaan cadangan besi di dalam sum-sum tulang.

---

In the pregnant women second trimester, the iron demand is increased. Iron deficiency that occurs in the early pregnancy can develop to be iron deficiency anemia. One of the complications of iron deficiency in pregnant women is bleeding due to atonia uteri. Recently there is a new parameter for detection iron deficiency, i.e. soluble transferring receptor serum (sTfR), which is not influenced by inflammation process. We hope that the use of ratio sTfR/ log. feritin will be better than sTfR alone in the detection of iron deficiency. This is a cross sectional study, with 108 pregnant women who were in the second trimester of their 1 6' pregnancy, as subjects. The proportion of iron deficiency is 43,5%; 31,5% had level I iron deficiency; 8,3% had level II iron deficiency and 3,7% was level III. We found 8 (7,4%) pregnant women with anemia; 4 (3,7%) was caused by iron deficiency. We measure sTfR level by immunonephelometry. The result of this research showed that the median of sTfR level in pregnant women without iron deficiency (n=61) was 1,3 mg/L (0,97 - 2,32 mg1L); level i iron deficiency (n=34) was 1,6 mg1L (0,92 - 3,26 mg1L). The range of sTfR value in level II was 1,19 -2,64 mg1L and in the level III (n=4) was 3,03 - 5,16 mg/L. The sTfR level in level I iron deficiency was higher than in pregnant women without iron deficiency. in level II and Ill sTfR was apparently higher than level I iron deficiency. Soluble transferring receptor 1 log. feritin ratio in pregnant women without iron deficiency (n=61) the median value was 0,68 (0,46 -1,34); in the level I iron deficiency (n=34) was 1,26 (0,71 - 3,54). The range in level II iron deficiency was 0,94 - 3,22 and in level III iron deficiency was 4,28-14,74. The sTfR 1 log. feritin in the level I iron deficiency was higher than without iron deficiency. In this research we found that CRP level were increased in 50% subjects. The sTfR level in the higher CRP level was not different from the normal CRP level. Feritin and sTfR level in the iron deficiency state was negatively correlated with moderate strength (r 0,676; rr=0,46) and 46% of subjects showed decreased feritin level associated with increased sTfR level. In the 47 pregnant women with iron deficiency; increased sTfR level was found in 19% of subjects and the ratio sTfR 1 log. feritin was found in 55% of subjects. The sTfR 1 log. feritin ratio was better than sTfR level in the detection of iron deficiency. We suggested to continue this research to prove that sTfR 1 log. feritin ratio more sensitive in the detection of iron deficiency, with the bone marrow iron stores as gold standard.

Abstrak :
ABSTRACT
Background: routine blood transfusion in transfusion-dependent-thalassemia (TDT) causes iron accumulation in various organ. Serum markers of iron overload, serum ferritin and transferrin saturation, are sensitive but not specific. MRI T2-star (T2*) is valuable for detecting iron level in organs. This study aimed to explore the degree of iron overload in various organs, iron deposition difference between children and adults, also its correlation with serum marker of iron overload. Methods: this was a cross-sectional study of TDT patients who had been evaluated by MRI T2* examination in Cipto Mangunkusumo Hospital from 2014 to 2018. Results: a total of 546 subjects was included in this study. The number of subjects between children and adults was almost equal. Most of subjects had normal cardiac iron deposition. The difference of cardiac iron overload between children and adults was significant (p=0.009). Liver evaluation showed that most of subjects had moderate to severe iron overload. This difference between children and adults was significant (p=0.017). Pancreas evaluation showed that either children or adults mostly had mild pancreatic iron overload. Analysis of T2* showed that pancreatic iron deposition progressed with increasing age. Serum ferritin had weak correlation with heart T2* MRI, moderate correlation with pancreas and liver T2* MRI. Relationship between transferrin saturation and T2* MRI was extremely weak. Conclusion: cardiac and hepatic iron deposition between children and adults differ significantly. Liver has the greatest iron overload, followed by pancreas and heart. Iron deposition in liver and pancreas has been started from earlier age. Pancreatic iron deposition rises with increasing age. Serum ferritin and transferrin saturation should not be used solely to predict iron overload in various organs. We suggest that MRI evaluation must be conducted at least once to assess iron deposition in organs.

Abstrak :
Latar Belakang: Transfusi darah dan kelasi besi merupakan terapi utama thalasemia khususnya pada thalassemia beta mayor yang bergantung transfusi. Harapan hidup dan prognosis pada pasien pasien tersebut telah bertambah baik dalam beberapa dekade terakhir. Namun demikian gangguan pada jantung masih merupakan penyebab mortalitas utama pada pasien thalassemia beta mayor bergantung transfusi. Toksisitas besi pada jantung merupakan penyebab utama kelainan jantung pada pasien-pasien tersebut. Modalitas utama untuk deteksi toksisitas besi pada jantung adalah dengan MRIT2 yang kesediaannya terbatas. Tujuan: Penelitian ini bertujuan mendapatkan profil toksisitas besi pada jantung penderita thalassemia beta bergantung transfusi. Penelitian ini juga bertujuan melihat korelasi antara toksisitas besi dengan fungsi sistolik jantung, fungsi diastolik jantung dan kadar NTproBNP. Selain itu penelitian ini bertujuan untuk melihat korelasi muatan besi dengan toksisitas besi pada jantung, fungsi sistolik jantung, fungsi diastolik jantung dan kadar NTproBNP. Metode: Penelitian potong lintang pada penderita dewasa dengan thalassemia beta mayor yang bergantung transfusi di Poliklinik Thalasemia Dewasa RSCM Jakarta pada bulan Desember 2017. Data sekunder diperoleh dari rekam medik pasien berupa riwayat medis, hasil lab, hasil pemerikssan MRI T2 dan ekokardiografi. Dilakukan pemeriksaan fisik dan pengambilan darah untuk pemeriksaan NTproBNP. Analisis data berupa data deskriptif dan uji korelasi dengan uji Pearson dan Spearman. Hasil: Sebanyak 62 orang pasien dilibatkan dalam studi. Median untuk T2 jantung adalah 24,96 ms. Terdapat 27,4 pasien dengan hemosiderosis jantung yang ringan-sedang dan 11,3 dengan hemosiderosis jantung yang berat. Tidak terdapat korelasi antara toksisitas besi pada jantung dengan fraksi ejeksi, ratio E/A maupun kadar NTproBNP. Terdapat korelasi lemah antara ferritin serum dan toksisitas besi pada jantung r=-0,312, p=0,007. Terdapat korelasi lemah antara ferritin serum dan fraksi ejeksi r=-0,281, p=0,013. Simpulan: Toksisitas besi pada jantung ditemukan pada 38,7 penderita dewasa dengan thalassemia beta bergantung transfusi. Tidak terdapat korelasi antara toksisitas besi pada jantung dengan fungsi sistolik, fungsi diastolik mauapun kadar NTproBNP pada penderita dewasa dengan thalssemia beta bergantung transfusi. Terdapat korelasi lemah antara ferritin serum dengan toksisitas besi pada jantung dan fungsi sitolik jantung. Tidak terdapat korelasi antara muatan besi dengan NTproBNP.

---

Background Regular blood transfusions and chelation are the mainstay of treatment in TDT patients. This has improved the survival and prognosis of the patients. Cardiac complications still remain to be the main cause of mortality. Cardiac iron toxicity is the main cause of complications leading to cardiac failure. MRI T2 is the gold standard for diagnosing cardiac iron toxicity, however this facility is limited in Indonesia.Objective. This study aimed to get a profile of the cardiac iron toxicity in adult TDT beta major patients to obtain a correlation of cardiac iron toxicity with cardiac function and NTproBNP levels and to evaluate if there is any correlation between iron overload with cardiac iron toxicity, cardiac function and NTproBNP levels. Methods Cross sectional study was done which included thalassemia beta major transfusion dependent patients from the adult thalassemia policlinic of RSCM hospital during desember 2017. Data was obtained from the medical records including history, laboratory results and results of MRIT2 and echocardiography. Physical examination was done and blood drawn for NTproBNP estimation. Data was analysed for descriptive data and correlation tests using pearsons or spearman rsquo s test. Results 62 patients were included in the study. Median cardiac T2 was 24.96 ms. 27.4 patients had mild moderate cardiac hemosiderosis and 11.3 had severe cardiac siderosis. There was no correlation between cardiac iron toxicity and ejection fraction, E A ratio and NTproBNP levels. There was a weak correlation between ferritin levels and cardiac toxicity r 0,312, p 0,007 as well as with ejection fraction r 0,281, p 0,013. There was no correlation between ferritin levels and E A or NTproBNP. There was no correlation between transferrin saturation levels with cardiac iron toxicity, ejection fraction, E A ratio as well as NTproBNPConclusion Cardiac iron toxicity was seen in 38,7 of TDT patients in this study. There was no correlation between cardiac toxicity and cardiac functions as well as NTproBNP levels. There was a weak correaltion between ferritin levels with cardiac toxicity and systolic function but no correlation with diastolic function. There was no correlation between transferrin saturation levels with cardiac toxicity, systolic function, diatolic function as well NtproBNP levels.