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Abstrak :
Anemia merupakan penyakit yang penyebarannya cukup luas secara global. Indonesia merupakan salah satu Negara yang mempunyai angka kejadian anemia tinggi. Dari berbagai tipe anemia, hemoglobinopati adalah tipe anemia yang mengakibatkan beban penyakit yang berat, dan studi mengenai hemoglobinopati secara keseluruhan masih termasuk sedikit. Penelitian ini memiliki tujuan untuk mengetahui proporsi hemoglobinopati pada pasien Rumah Sakit Cipto Mangunkusumo. Selain proporsi, asosiasi antara jenis kelamin dan penyakit tersebut juga diselidiki. Dalam metode untuk mencapai tujuan tersebut, metode cross sectional digunakan pada data sekunder pasien (n = 172) yang berasal dari Departemen Patologi Klinik Rumah Sakit Cipto Mangunkusumo. Hasil menunjukkan bahwa proporsi dari hemoglobinopati pada pasien di Rumah Sakit Cipto Mangunkusumo pada bulan Januari dan Februari 2013 adalah 16.9%. Mengenai asosiasi hemoglobinopati dengan jenis kelamin, tidak ditemukan adanya hasil yang signifikan secara statistic pada analisis data.

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Anemia is a disease which affects the world globally. Indonesia is one of the country which has high occurrence of anemia. From various types of anemia, hemoglobinopathy is the type of anemia which causes the heavy burden of disease, and the studies about this particular disease as a whole are still quite few. This study has the objectives to find about the proportion of hemoglobinopathy in patients of Cipto Mangunkusumo Hospital. Aside from the proportion, the association between gender and the disease was also explored. In order to achieve the objectives, cross sectional method was used with the patient's secondary data (n = 172) which collected from Clinical pathology Department of Cipto Mangunkusumo Hospital. The results showed that the proportion of hemoglobinopathy in patients of Cipto Mangunkusumo Hospital during January-February 2013 was 16.9 %. As for the association of hemoglobinopathy with patients? gender, the analysis showed that the result was not statistically significant.

Abstrak :
Kenaikan prevalensi anemia berdampak buruk bagi kualitas hidup seseorang. Beberapa faktor resiko yang berkaitan dengan anemia berhubungan dengan umur dan jenis kelamin. Penilitian ini ditujukan untuk mengetahui hubungan antara anemia dengan umur dan jenis kelamin. Penilitian ini menggunakan metode cross sectional dengan menggunakan data sekunder pasien rawat inap Rumah Sakit Cipto Mangunkusumo (RSCM) selama bulan Maret tahun 2011 (n=3,200) yang memiliki informasi mengenai umur, jenis kelamin, dan kadar Hemoglobin (Hb). Hasil menunjukkan bahwa proporsi anemia di RSCM selama bulan Maret tahun 2011 sebesar 83.5%. Hubungan antara anemia dengan kelompok umur menunjukan hasil yang tidak bermakna (Chi-Square p = 0.167). Namun, hubungan antara prevalensi anemia dan median umur menunjukkan bahwa median umur populasi dengan anemia (47 tahun) lebih tinggi dibanding populasi yang tidak anemia (43 tahun) (Mann-Whitney p < 0.0001). Tidak terdapat hubungan bermakna antara prevalensi anemia dengan jenis kelamin (Chi-Square p = 0.929). Walaupun hubungan antara jenis kelamin dan kadar Hb menunjukkan hasil yang bermakna dimana median kadar Hb pada perempuan lebih rendah (10,1 gr/dl) daripada laki-laki (10,3 gr/dl) (Mann-Whitney p < 0.0001), namun hasil tersebut tidak bermakna secara klinis.

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The increasing prevalence of anemia has decreased the quality of life of the society. Some risk factors are associated with age and gender. This study is aimed to analyse the relation between anemia and age and gender. This research uses cross sectional study by taking the secondary data of patients at the in-patient ward of Cipto Mangunkusumo Hospital in March 2011 (n=3,200) which has the information about age, gender, and Hemoglobin (Hb) level. The result shows that the proportion of anemia at the in-patient ward RSCM in March 2011 was 83.5%. The association between anemia and age groups is not statistically significant (Chi-Square p = 0.167). The median age of people with anemia is higher (47 years) than people without anemia (43 years) (Mann-Whitney p < 0.0001). There is also no association between anemia and gender (Chi-Square p = 0.929). Although the median of Hb level is lower in female (10.1 g/dl) than male population (10.3 g/dl) (Mann-Whitney p < 0.0001), the result is not clinically significant.

Abstrak :
Anemia normositik normokromik adalah suatu kondisi di mana konsentrasi hemoglobin di darah menurun tanpa ditemukan kelainan pada sel darah merah. Prevalensi kondisi ini masih tinggi di semua pelosok dunia. Tujuan studi ini adalah untuk mencari tahu proporsi kondisi ini dalam ruang rawat inap RS Cipto Mangunkusumo dan mendeteksi adanya pola penyebaran umur dan jenis kelamin pada kelopok pasien tersebut. Data pasien sebanyak 3,160 didapatkan dari Bagian Patologi Klinik pada bulan Maret 2011. Proporsi kondisi ini yang ditemukan adalah 42.2%. Sebagian besar pasien adalah orang dewasa, paling banyak antara umur 30 hingga 50 tahun. Perbedaan yang bermakna secara statistik ditemukan antara jumlah wanita dan pria dengan kondisi ini, namun studi lebih lanjut dibutuhkan untuk mendeteksi adanya hubungan yang penting antara jenis kelamin dan anemia normositik normokromik. Berdasarkan studi ini, anemia normositik normokromik masih salah satu masalah besar di Indonesia.

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Normocytic normochromic anemia is a condition where level of hemoglobin in the blood is reduced, without any abnormalities in the erythrocytes itself. Literature has shown that the prevalence of this condition is high all around the world. This study aims to identify the proportion of normocytic normochromic anemia the in-patient ward of Cipto Mangunkusumo Hospital and to investigate the presence of any pattern in the distribution of age and gender of those affected by this condition. A total of 3,160 patient records were obtained from the Clinical Pathology Department in March 2011. The proportion of this condition was found to be 42.2%. Majority of those affected were adults, highest at the third and fourth decades of life. Furthermore, a statistically significant difference was found between the number of males and females affected, though further studies would be required to investigate any possible associations. Based on this study, it may be deduced that normocytic normochromic anemia is still a major problem in Indonesia.

Abstrak :
Anemia makrositik merupakan salah satu jenis anemia yang masih sering dijumpai di Indonesia. Namun, masih sedikit penelitian yang membahas tentang prevalensi anemia makrositik. Penelitian ini bertujuan untuk mencari tahu proporsi anemia makrositik pada pasien rawat inap Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta dan untuk mengidentifikasi pola penyebaran usia dan jenis kelamin pada kelompok pasien tersebut. Penelitian ini menggunakan desain studi deskriptif cross-sectional dengan menggunakan data sekunder pada pasien rawat inap di RSCM (n=3,688). Hasil penelitian menunjukkan bahwa proporsi makrositik anemia pada pasien rawat inap di RSCM selama bulan Maret tahun 2011 sebesar 7.2%. Hal ini menunjukkan bahwa proporsi anemia makrositik pada populasi rendah. Selain itu, jumlah pria dengan kondisi ini lebih besar dibandingkan dengan wanita. Sebagian besar pasien adalah orang dewasa dengan usia median 47tahun, usia minimal 0 tahun dan usia maksimal 90 tahun.

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Macrocytic anemia is one of types of anemia which is common in Indonesia. However, there is a lack of studies that aimed at determining the prevalence of macrocytic anemia. This study is aimed to investigate the proportion ofmacrocytic anemia among patients at the in-patient ward of Cipto Mangunkusumo Hospital. This study uses a cross sectional descriptive study by takingsecondary data of patients at the in-patient ward of Cipto Mangunkusumo Hospital (RSCM) (n=3,668). The result shows that the proportion of macrocytic anemia at the in-patient ward RSCM in March 2011 was 7.2%. It indicates that the proportion of macrocytic anemia is considerably small within the population. In addition, there was difference between the number of males and females that suffered from macrocytic anemia. Male is slightly higher than female in this condition. Furthermore, majority of those affected were adults and the median age was 47 years with the minimum and maximum age of 0 and 90 years, respectively.

Abstrak :
Berdasarkan bentuk dari sel darah merah, mikrositik hipokromik anemia adalah tipe anemia yang paling sering dijumpai. Tipe ini bisa disebabkan oleh anemia dengan defisiensi besi atau beta thallasemia. Akan tetapi, tidak banyak literatur dan jurnal yang membahas tentang epidemiologi dari mikrositik hipokromik anemia. Penelitian ini ditujukan untuk mengevaluasi proporsi dari mikrositik hipokromik anemia dan asosiasinya dengan umur dan jenis kelamin pada pasien rawat inap di RSUPN DR. Cipto Mangunkusumo. Penelitian ini menggunakan metode cross-sectional dan data seperti umur, jenis kelamin, hasil hemoglobin, MCV dan MCH, dari pasien diambil pada bulan Maret 2011. 3197 pasien diikutsertakan dalam penelitian ini, 1674 perempuan (52.4%), 1523 lelaki (47.6%). Pasien dengan mikrositik hipokromik anemia berjumlah 674 (21.1%). Umur median dari pasien dengan mikrositik hipokromik anemia adalah 46.50 tahun, sedangkan pasien tanpa mikrositik hipokromik anemia adalah 46 tahun (p = 0.791). Ditemukan 387 perempuan dengan mikrositik hipokromik anemia (23.1%) dan 287 lelaki dengan mikrositik hipokromik anemia (18.8%) (p = 0.03). Penelitian ini menemukan bahwa tidak ada asosiasi antara umur dengan pasien yang mempunyai mikrositik hipokromik anemia. Akan tetapi, ditemukan asosiasi antara jenis kelamin dan mikrositik hipokromik anemia; jumlah wanita yang mempunyai mikrositik hipokromik anemia lebih banyak dibandingkan lelaki.

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Worldwide, iron deficiency is one of the most frequent and significant causes of anemia. The commonest form of anemia is microcytic hypochromic anemia which may be caused by iron deficiency. This study aims to evaluate the proportion of microcytic hypochromic anemia and analyze its correlation with age and gender in the in-patient ward of RSUPN DR. Cipto Mangunkusomo. A cross-sectional study design was applied and the data on the patient?s age, gender, hemoglobin level, MCV and MCH level was taken on March 2011. 3197 subjects were included in this study, 1674 female (52.4%), 1523 male (47.6%). 674 subjects (21.1%) diagnosed with microcytic hypochromic anemia. The median age of patients with microcytic hypochromic anemia was 46.50 years old, while patients without microcytic hypochromic anemia was 46 years old (p = 0.791). There were 387 women (23.1%) found with microcytic hypochromic anemia, whereas, 287 men (18.8%) with microcytic hypochromic anemia (p = 0.03). Overall, the occurrence of microcytic hypochromic anemia is not associated with age, but an increased occurrence of microcytic hypochromic anemia was found in female patients as compared to male patients.

Abstrak :
ABSTRAK
Hipertensi merupakan kelainan yang umum dijumpai pada kehamilan. Sekitar 70% wanita hamil mengalami gestational hypertension dan preeklampsia. Disfungsi endotel pada preeklampsia menyebabkan permukaan endotel yang nontrombogenik menjadi trombogenik sehingga dapat terjadi aktivasi koagulasi. Preeklampsia meningkatkan keadaan hiperkoagulabel yang sudah ada pada kehamilan normal. Gestational hypertension pada wanita hamil adalah hipertensi yang tidak memenuhi kriteria preeklampsia. Hampir setengah dari pasien dengan gestational hypertension akan berkembang menjadi preeklampsia. Fibrin monomer merupakan petanda aktivasi koagulasi yang digunakan pada keadaan pretrombotik oleh karena terbentuk terlebih dahulu pada keadaan hiperkoagulabel daripada D-dimer yang terbentuk setelah fibrinolisis. Tujuan penelitian adalah mendapatkan gambaran fibrin monomer pada gestational hypertension dan preeklampsia. Penelitian ini adalah penelitian potong lintang pada 30 wanita hamil gestational hypertension dan 30 wanita hamil preeklampsia yang dilakukan pada Oktober sampai November 2015. Pemeriksaan FM menggunakan reagen STA-Liatest memakai koagulometer STA Compact Analyzer. Kadar fibrin monomer pada gestational hypertension didapatkan mean 4,61 µg/mL dengan standar deviasi 0,86 µg/mL. Kadar fibrin monomer pada preeklampsia didapatkan median 10,5 µg/mL dengan mean 11.99 µg/mL dan rentang 6,12 ? 23,26 µg/mL. Didapatkan perbedaan bermakna kadar fibrin monomer pada gestational hypertension dan preeklampsia dengan nilai p<0,001. ABSTRACT
Hypertension is a common disorder in pregnancy. Approximately 70% of pregnant women is gestational hypertension and preeclampsia. Endothelial dysfunction in preeclampsia causes the endothelial surface of the nonthrombogenic be thrombogenic so it can activated coagulation. Preeclampsia increase hypercoagulability state in normal pregnancy. Gestational hypertension is a hypertension in pregnancy who do not meet the criteria of preeclampsia. Nearly half of patients with gestational hypertension develop into preeclampsia. Fibrin monomers are used for coagulation activation marker on the prethrombotic state therefore formed before on hypercoagulability state hiperkoagulabel than D-dimer formed after fibrinolysis. The objective of this study is to gain description of fibrin monomer levels and it was a cross-sectional study 30 pregnant women with gestational hypertension and 30 pregnant women with preeclampsia. The study was conducted in October and November 2015. Examination of fibrin monomer using the reagent STA-Liatest and analyzer STA Compact. Mean of fibrin monomer in gestational hypertension was 4.61 µg/mL with standard deviation was 0.86 µg/mL. Median of fibrin monomer in preeclampsia was 10.5 µg / mL with range was 6.12 to 23.26 µg/mL. Fibrin monomer levels found significant differences in gestational hypertension and preeclampsia with p <0.001. ;Hypertension is a common disorder in pregnancy. Approximately 70% of pregnant women is gestational hypertension and preeclampsia. Endothelial dysfunction in preeclampsia causes the endothelial surface of the nonthrombogenic be thrombogenic so it can activated coagulation. Preeclampsia increase hypercoagulability state in normal pregnancy. Gestational hypertension is a hypertension in pregnancy who do not meet the criteria of preeclampsia. Nearly half of patients with gestational hypertension develop into preeclampsia. Fibrin monomers are used for coagulation activation marker on the prethrombotic state therefore formed before on hypercoagulability state hiperkoagulabel than D-dimer formed after fibrinolysis. The objective of this study is to gain description of fibrin monomer levels and it was a cross-sectional study 30 pregnant women with gestational hypertension and 30 pregnant women with preeclampsia. The study was conducted in October and November 2015. Examination of fibrin monomer using the reagent STA-Liatest and analyzer STA Compact. Mean of fibrin monomer in gestational hypertension was 4.61 µg/mL with standard deviation was 0.86 µg/mL. Median of fibrin monomer in preeclampsia was 10.5 µg / mL with range was 6.12 to 23.26 µg/mL. Fibrin monomer levels found significant differences in gestational hypertension and preeclampsia with p <0.001. ;Hypertension is a common disorder in pregnancy. Approximately 70% of pregnant women is gestational hypertension and preeclampsia. Endothelial dysfunction in preeclampsia causes the endothelial surface of the nonthrombogenic be thrombogenic so it can activated coagulation. Preeclampsia increase hypercoagulability state in normal pregnancy. Gestational hypertension is a hypertension in pregnancy who do not meet the criteria of preeclampsia. Nearly half of patients with gestational hypertension develop into preeclampsia. Fibrin monomers are used for coagulation activation marker on the prethrombotic state therefore formed before on hypercoagulability state hiperkoagulabel than D-dimer formed after fibrinolysis. The objective of this study is to gain description of fibrin monomer levels and it was a cross-sectional study 30 pregnant women with gestational hypertension and 30 pregnant women with preeclampsia. The study was conducted in October and November 2015. Examination of fibrin monomer using the reagent STA-Liatest and analyzer STA Compact. Mean of fibrin monomer in gestational hypertension was 4.61 µg/mL with standard deviation was 0.86 µg/mL. Median of fibrin monomer in preeclampsia was 10.5 µg / mL with range was 6.12 to 23.26 µg/mL. Fibrin monomer levels found significant differences in gestational hypertension and preeclampsia with p <0.001. ;Hypertension is a common disorder in pregnancy. Approximately 70% of pregnant women is gestational hypertension and preeclampsia. Endothelial dysfunction in preeclampsia causes the endothelial surface of the nonthrombogenic be thrombogenic so it can activated coagulation. Preeclampsia increase hypercoagulability state in normal pregnancy. Gestational hypertension is a hypertension in pregnancy who do not meet the criteria of preeclampsia. Nearly half of patients with gestational hypertension develop into preeclampsia. Fibrin monomers are used for coagulation activation marker on the prethrombotic state therefore formed before on hypercoagulability state hiperkoagulabel than D-dimer formed after fibrinolysis. The objective of this study is to gain description of fibrin monomer levels and it was a cross-sectional study 30 pregnant women with gestational hypertension and 30 pregnant women with preeclampsia. The study was conducted in October and November 2015. Examination of fibrin monomer using the reagent STA-Liatest and analyzer STA Compact. Mean of fibrin monomer in gestational hypertension was 4.61 µg/mL with standard deviation was 0.86 µg/mL. Median of fibrin monomer in preeclampsia was 10.5 µg / mL with range was 6.12 to 23.26 µg/mL. Fibrin monomer levels found significant differences in gestational hypertension and preeclampsia with p <0.001. ;Hypertension is a common disorder in pregnancy. Approximately 70% of pregnant women is gestational hypertension and preeclampsia. Endothelial dysfunction in preeclampsia causes the endothelial surface of the nonthrombogenic be thrombogenic so it can activated coagulation. Preeclampsia increase hypercoagulability state in normal pregnancy. Gestational hypertension is a hypertension in pregnancy who do not meet the criteria of preeclampsia. Nearly half of patients with gestational hypertension develop into preeclampsia. Fibrin monomers are used for coagulation activation marker on the prethrombotic state therefore formed before on hypercoagulability state hiperkoagulabel than D-dimer formed after fibrinolysis. The objective of this study is to gain description of fibrin monomer levels and it was a cross-sectional study 30 pregnant women with gestational hypertension and 30 pregnant women with preeclampsia. The study was conducted in October and November 2015. Examination of fibrin monomer using the reagent STA-Liatest and analyzer STA Compact. Mean of fibrin monomer in gestational hypertension was 4.61 µg/mL with standard deviation was 0.86 µg/mL. Median of fibrin monomer in preeclampsia was 10.5 µg / mL with range was 6.12 to 23.26 µg/mL. Fibrin monomer levels found significant differences in gestational hypertension and preeclampsia with p <0.001.

Abstrak :
ABSTRAK
Pemeriksaan 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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ABSTRACT
The 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.

Abstrak :
ABSTRAK
Hemolisis merupakan masalah yang umum dijumpai dalam praktik laboratorium dengan prevalensi 3,3 dari total spesimen yang diterima di laboratorium. Hemolisis memiliki pengaruh yang berbeda pada pemeriksaan PT dan APTT pada subyek sehat dan pasien Sysmex CS2100i merupakan alat koagulometer yang menggunakan prinsip deteksi koagulasi dengan transmisi cahaya foto-optikal yang dilengkapi dengan detektor hemolisis ikterik dan lipemik HIL dan multiple wavelength detector. Aspek terpenting dalam praktik laboratorium terkait hemolisis adalah mengetahui batasan indeks hemolisis yang dapat menimbulkan bias bermakna di dalam suatu pemeriksaan dalam hal ini PT dan APTT. Jumlah subyek penelitian sebesar 70 orang yang dibagi dua yaitu, kelompok sehat sebesar 35 orang dan kelompok sakit dengan warfarin sebesar 35 orang. Pembuatan hemolisat dilakukan dengan metode trauma mekanik menggunakan syringe insulin dengan jarum 30G. Pada hasil PT dan APTT subyek sehat didapatkan uji repeated measures ANOVA bermakna, p=0,001 dan subyek sakit dengan warfarin didapatkan uji Friedman bermakna, p=0,001. Uji post-hoc Dunnett subyek sehat untuk hasil PT didapatkan nilai bermakna pada konsentrasi hemolisis 150, 200, 250, 330 dan 500 mg/dL, sedangkan hasil APTT didapatkan hasil bermakna pada konsentrasi hemolisis 250, 330, dan 500 mg/dL. Uji post-hoc Wilcoxon subyek sakit untuk hasil PT didapatkan nilai bermakna pada konsentrasi hemolisis 100, 150, 200, 250, 330 dan 500 mg/dL, sedangkan hasil APTT didapatkan nilai bermakna pada konsentrasi hemolisis 250, 330 dan 500 mg/dL.Bias hemolisis maksimal yang masih dapat diterima dengan kriteria Ricos dkk untuk PT dan APTT subyek sehat masing-masing adalah 100 mg/dL, sedangkan subyek sakit dengan warfarin adalah 50 mg/dL dan 200 mg/dL. Batasan dengan kriteria CLIA untuk PT dan APTT subyek sehat adalah 330 mg/dL dan 250 mg/dL, sedangkan subyek sakit dengan warfarin adalah 330 mg/dL baik untuk PT maupun APTT. Dari grafik scatter didapatkan tren pemanjangan hasil PT dan APTT subyek sehat, sedangkan pada subyek sakit dengan warfarin didapatkan tren pemanjangan hasil PT dan pemendekan hasil APTT. Penerapan batasan bias hemolisis maksimal memungkinkan praktisi laboratorium untuk tetap menerima spesimen dengan interferensi hemolisis pada pemeriksaan PT dan APTT, memastikan hasil yang dikeluarkan tetap akurat, tanpa menunda penatalaksanaan terhadap pasien dan mengurangi biaya dan ketidaknyamanan yang timbul akibat pengambilan kembali spesimen.

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ABSTRACT
Hemolysis is a common problem in laboratory practice with a prevalence of 3.3 of the total specimens received in the laboratory. Haemolysis have a different influence on the examination of the PT and APTT in healthy and patients subjects. Sysmex CS2100i is a coagulometer with the photo optical method, equipped with hemolysis, icteric and lipemic detector HIL and multiple wavelength. The most important aspect in laboratory practice is to know the limits associated with haemolysis that can cause significant bias in PT and APTT assay. The total number of research subjects are 70 people, divided into 35 healthy subjects and 35 patient subject undergoing warfarin therapy. Hemolysate was conducted using a mechanical trauma using insulin syringe with 30G needle.. Repeated measures ANOVA test of PT and APTT on healthy subjects obtained a significant statistical result, p 0.001. The warfarin users also had a significant statistical result with Friedman test, p 0.001. Post hoc Dunnett test on PT values of healthy subjects, obtained a statisticaly significant results in hemolysis concentration of 150, 200, 250, 330 and 500 mg dL, while the APTT results obtained significant statistical results in haemolysis concentration of 250, 330, and 500 mg dL. Wilcoxon post hoc test of PT on patient subjects obtained significant result in the haemolysis concentration of 100, 150, 200, 250, 330 and 500 mg dL, while the APTT values obtained significant results in hemolysis concentration 250, 330 and 500 mg dL. The maximum bias that still could acceptable by Ricos et al criteria for PT and APTT on healthy subjects for both were 100 mg dL, whereas patient subjects undergoing warfarin therapy was 50 mg dL and 330 mg dL. Using CLIA criteria for PT and APTT on healthy subjects resulted maximum bias was 330 mg dL and 250 mg dL, whereas warfarin users was 330 mg dL for PT and APTT. There was a trend of increase in the readings of PT and APTT on healthy subjects, while on patient subjects undergoing warfarin there was a trend of increase in PT and decrease of APTT results. The application of acceptable hemolysis bias limit, enable laboratory practitioners to process hemolysis specimens in PT and APTT assays, ensuring the results is still accurate without delaying clinical decision and to reduce the cost and inconvenience arising from the specimen recollection.

Abstrak :
Hiperglikemia merupakan salah satu faktor risiko terjadinya nefropati diabetik pada pasien diabetes melitus tipe 2. American Diabetes Association (ADA) merekomendasikan pemeriksaan albumin-to-creatinine ratio (ACR) setiap tahun untuk mendeteksi adanya nefropati diabetik. Pemeriksaan 1,5-anhydroglucitol (1,5-AG) merupakan salah satu pemeriksaan untuk monitoring kontrol glikemik. 1,5-AG merupakan penanda yang lebih sensitif untuk mengetahui adanya fluktuasi glukosa dan hiperglikemia postprandial. Beberapa penelitian menunjukkan bahwa hiperglikemia yang terjadi secara intermiten lebih merusak endotel dibandingkan hiperglikemia yang stabil. Desain studi pada penelitian ini adalah potong lintang. Pada penelitian ini dilakukan analisis statistik untuk mendapatkan hubungan 1,5-AG dan HbA1c, 1,5-AG dan glukosa darah 2 jam PP, area under curve dan titik potong 1,5-AG sebagai indikator kontrol glikemik, dan perbedaan median kadar 1,5-AG serta HbA1c pada pasien dengan ACR < 30 mg/g dan ≥ 30 mg/g. Hasil penelitian ini didapatkan koefisien korelasi Spearman antara kadar 1,5-AG dan HbA1c pada pasien DMT2 adalah -0,74 (p<0,001), sedangkan nilai koefisien korelasi antara kadar 1,5-AG dan glukosa darah 2 jam PP pada pasien diabetes melitus tipe adalah -0,45 (p<0,001). Luas area under curve 1,5-AG sebagai indikator kontrol glikemik sebesar 87,1%. Titik potong 1,5-AG untuk indikator kontrol glikemik adalah 10,7 μg/mL. Pasien DMT2 dengan kadar ACR ≥ 30 mg/g memiliki median kadar 1,5-AG yang lebih rendah (6,4 μg/mL) dibandingkan pasien DMT2 dengan ACR < 30 mg/g (median kadar 1,5-AG 12,4 μg/mL), p = 0,007. Terdapat perbedaan median kadar HbA1c yang bermakna (p<0,001) pada pasien DMT2 dengan ACR < 30 mg/g dan ACR ≥ 30 mg/g. Pasien DMT2 dengan kadar ACR ≥ 30 mg/g memiliki median kadar HbA1c yang lebih tinggi (7,9%) dibandingkan kadar HbA1c pasien DMT2 dengan ACR < 30 mg/g (6,9%). Berdasarkan hasil penelitian ini, dapat disimpulkan terdapat korelasi negatif kuat bermakna antara 1,5-AG dan HbA1c; dan korelasi negatif sedang bermakna antara 1,5-AG dan glukosa darah 2 jam PP. Terdapat perbedaan rerata kadar 1,5-AG dan HbA1c yang bermakna antara pasien diabetes melitus dengan ACR < 30 mg/g dan ≥ 30 mg/g. Titik potong 1,5-AG yang direkomendasikan sebagai indikator kontrol glikemik adalah 10,7 μg/mL.

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Hyperglycemia is one of the risk factors for diabetic nephropathy in type 2 diabetes mellitus patients. American Diabetes Association (ADA) recommended annual albumin-tocreatinine ratio (ACR) screening to detect the presence of diabetic nephropathy. 1,5-anhydroglucitol (1,5-AG) is one of the parameters for monitoring glycemic control. 1,5-AG is a more sensitive marker to detect glucose fluctuations and postprandial hyperglycemia. Previous studies showed that intermittent hyperglycemia is more damaging to endothelials than stable hyperglycemia. The study design was cross sectional. In this study, the statistical analysis was performed to obtain the association between 1,5-AG and HbA1c, 1,5-AG and 2-hour postprandial blood glucose; the area under curve and the cutoff of 1,5-AG as an indicator of glycemic control; and the median difference of 1,5-AG and HbA1c value from patients with ACR <30 mg/g and ≥ 30 mg/g. In this study, the coefficient of correlation between the value of 1,5-AG and HbA1c in patients with T2DM is -0,74 (p<0,001), while the coefficient of correlation between 1,5-AG and 2-hour postprandial blood glucose in patients with diabetes mellitus type is -0,45 (p<0,001). The area under curve of 1,5-AG as a glycemic control indicator is 87,1%. The 1,5-AG cutoff point for the glycemic control indicator is 10,7 μg/mL. Patients with T2DM with ACR levels ≥30 mg/g had significantly lower median value of 1,5-AG (6,4 μg/mL) than patients with T2DM with ACR <30 mg/g (12,4 μg/mL). There was significant difference in median HbA1c value from patients with T2DM with ACR <30 mg/g and ≥ 30 mg/g. Patients with T2DM with ACR levels ≥30 mg/g had higher median HbA1c value (7,9%) than HbA1c patients with T2DM with ACR <30 mg/g (6,9%). In this study concluded that the there was a strong and significant negative correlation between 1.5-AG and HbA1c and a moderate and significant negative correlation between 1.5-AG and 2-hour postprandial blood glucose. There was a significant difference of median value of 1,5-AG and HbA1c between patients with diabetes mellitus and ACR <30 mg/g and ACR ≥ 30 mg/g. The cutoff of 1,5-AG which was recommended as a glycemic control indicator was 10,7 μg/mL.

Abstrak :
Karsinoma kandung kemih merupakan keganasan nomor empat terbanyak. Dampak beban ekonomi karsinoma kandung kemih cukup nyata, sehingga diperlukan deteksi dini keganasan kandung kemih untuk menurunkan beban ekonomi. Sistoskopi merupakan pemeriksaan baku emas untuk identifikasi karsinoma kandung kemih, tetapi pemeriksaan tersebut invasif dan menyebabkan ketidaknyamanan bagi pasien. Sitologi urin tidak invasif, tetapi hasilnya tidak bisa didapatkan dengan cepat dan terdapat ketergantungan interpretasi pemeriksa.Tujuan penelitian ini adalah untuk membandingkan nilai diagnosis dua penanda tumor, yaitu ELISA NMP-22, ELISA UBC urin, serta kombinasi keduanya pada pasien karsinoma kandung kemih. Penelitian uji diagnostik ini terdiri dari 25 orang pasien dengan indikasi sistoskopi dan trans ureteral resection bladder tumor (TUR-BT)/biopsi tumor. Pasien yang memenuhi kriteria masukan dan tolakan dilakukan pengambilan urin pasien kemudian dilakukan pemeriksaan ELISA NMP-22 dan ELISA UBC urin. Hasil pemeriksaan ELISA NMP-22 dan ELISA UBC urin akan dibandingkan dengan pemeriksaan sistoskopi disertai dengan hasil histopatologi.Permeriksaaan ELISA NMP-22 urin dengan cut-off 10 U/ml mempunyai sensitivitas 62,3% dan spesifisitas 83,3%, nilai prediksi positif 81,8% dan nilai prediksi negatif71,4%,likelihood ratio positif3,73 dan likelihood ratio negatif0,45. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 69,2%, spesifisitas 75%, nilai prediksi positif 81,8%, nilai prediksi negatif 60%, likelihood ratio positif 2,76 , likelihood ratio negatif0,42. Pemeriksaan ELISA UBC dengan cut-off 12 ug/Lmempunyai sensitivitas 38,5% dan spesifisitas 91,7%, nilai prediksi positif 83,3% dan nilai prediksi negatif57,9%,likelihood ratio positif4,63 dan likelihood ratio negatif0,67. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 38,5%, spesifisitas 87,5%, nilai prediksi positif 83,3%, nilai prediksi negatif 46,7%, likelihood ratio positif 3,08 , likelihood ratio negatif0,70. Kombinasi pemeriksaan ELISA NMP-22 dengan UBC urin mempunyai sensitivitas 76,9% dan spesifisitas 75%, nilai prediksi positif 76,9% dan nilai prediksi negatif75%,likelihood ratio positif3,08 dan likelihood ratio negatif0,31. Jika kasus sistitis dieksklusi maka didapatkan nilai sensitivitas adalah 78,5%, spesifisitas 71,4 %, nilai prediksi positif 84,6 %, nilai prediksi negatif 62,5%, likelihood ratio positif2,74 , likelihood ratio negatif0,30. Kami menyimpulkan kombinasi pemeriksaan ELISA NMP-22 dengan ELISA UBC urin lebih baik karena mempunyai sensitivitas paling tinggi sehingga adanya tumor di kandung kemih baik primer maupun rekuren tidak akan luput dari diagnosis, meskipun harus dipastikan lagi dengan pemeriksaan sistoskopi.

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Bladder cancer is the forth most common cancer. Bladder cancer posseses a significant economic burden so that early detection of baldder cancer may decrease the economic burden. Cystoscopy is the reference standard for identification of bladder carcinoma, but it is invasive andcauses significant discomfortto the patient. Urinary cytology is noninvasive but time consuming and hampered by inter-observer variations. The aim of this study is to compare the diagnostic value of the urine NMP-22 ELISA test, UBC-ELISA test and combination of both tests on suspect bladder carcinoma patients.This diagnostic study included25 patients who were indicated for cystoscopy and trans uretheral resection bladder tumor / tumor biopsy. From patients who met requirements for the inclusion and exclusion criteria, the urine voided sample was taken and used for NMP-22 ELISA test and UBC ELISA test. The results of NMP-22 ELISA test and UBC ELISA test were evaluated against the cystoscopy and histological findings as the reference standard.The result of diagnostic study of NMP-22 ELISA test with cut-off 10 U/mlshowed that it had a sensitivity of 62,3% and a specificity of 83,3%, a positive predictive value of 81,8% and a negative predicitive value of 71,4%, a positive likelihood ratio of 3,73 and a negative likelihood ratio of 0,45. If the cystitis case was excluded, it had a sensitivity of 69,2%, and a specificity of 75%, a positive predictive value of 81,8%, and a negative predicitive value of 60%, a positive likelihood ratio of 2,76 , and a negative likelihood ratio of0,42. Diagnostic value of UBC ELISA test with cut-off 12 ug/L had a sensitivity of 38,5% and a specificity of 91,7%, a positive predictive value of 83,3% and a negative predicitive value of 57,9%, a positive likelihood ratio of 4,63 and a negative llikelihood ratio of 0,67. If the cystitis case was excluded, it had a sensitivity of 38,5%, and a specificity of 87,5%, a positive predictive value of 83,3%, and a negative predicitive value of 46,7%, a positive likelihood ratio of 3,08 , and a negative likelihood ratio of0,70.Diagnostic value of combined NMP-22 ELISA test with UBC ELISA test had a sensitivity of 76,9% and a specificity of 75%, a positive predictive value of 76,9% and a negative predicitive value of 75%, a positive likelihood ratio of 3,08 and a negative llikelihood ratio of0,31. If the cystitis case was excluded, it had a sensitivity of 78,5%, and a specificity of 71,4%, a positive predictive value of 84,6%, and a negative predicitive value of 62,5%, a positive likelihood ratio of 2,74 , and a negative likelihood ratio of0,30.The conclusion was that the combined NMP-22 ELISA test with UBC test had the highest sensitivity, thus itwould not miss any primary or recurrent tumour in the bladder, although this neededto be confirmed by cystoscopy.