Latar belakang: Retikulosit dapat dibedakan menjadi beberapa fraksi berdasarkan tingkat maturitasnya yaitu high fluorescence ratio (HFR), medium fluorescence ratio (MFR), low fluorescence ratio (LFR) yang diukur berdasarkan banyaknya kandungan RNA. Immature reticulocyte fraction (IRF) merupakan gabungan fraksi MFR dan HFR. Tingkat maturitas retikulosit dapat menjadi indikator klinis aktivitas eritropoiesis dan eritropoiesis inefektif. Eritropoiesis inefektif merupakan salah satu patofisiologi pada thalassemia dan HbE. Pada defisiensi besi, eritropoiesis menurun karena besi sebagai salah satu bahan baku pembentukan hemoglobin jumlahnya kurang sehingga jumlah retikulosit menurun.Tujuan: Mendapatkan gambaran retikulosit dan fraksinya pada orang Indonesia dewasa normal yang dapat digunakan sebagai nilai rujukan, serta pada pembawa sifat thalassemia-β dan hemoglobin E dengan dan tanpa defisiensi besi untuk menilai aktivitas eritropoiesis dan eritropoiesis inefektifMetode: Desain penelitian adalah potong lintang, dengan menggunakan 249 subjek sehat dan 98 subjek keluarga pasien thalassemia yang berobat ke poliklinik thalassemia.Hasil: Nilai rujukan retikulosit dan fraksinya pada orang dewasa adalah hitung retikulosit relatif (HRR) lelaki dan perempuan 0,7 ? 2,2%, hitung retikulosit absolut (HRA) lelaki 35.988 ? 101.198 /μL dan HRA perempuan 26.400 ? 105.000 /μL, IRF relatif lelaki dan perempuan 2,4 ? 13,4%, IRF absolut lelaki 1.343 ? 10.049 /μL dan perempuan 764 ? 11.223 /μL, LFE relatif lelaki dan perempuan 86,6 ? 97,4%, LFR absolut lelaki 32.444 ? 97.573 /μL dan perempuan 25.634 ? 92.063 /μL. HRR dan HRA subjek pembawa sifat thalassemia-β dan HbE dalam rentang nilai rujukan tetapi IRF lebih tinggi dari orang sehat. Pada pembawa sifat thalassemia-β dan HbE dengan defisiensi besi didapatkan HRR, HRA, dan IRF lebih rendah daripada subjek tanpa defisiensi besi, tetapi lebih tinggi daripada orang sehat.Kesimpulan: HRR dan HRA pembawa sifat thalassemia-β dan HbE dalam rentang nilai rujukan tetapi IRF lebih tinggi, menunjukkan terjadi eritropoiesis inefektif. HRR, HRA, dan IRF pembawa sifat thalassemia-β dan HbE dengan defisiensi besi lebih rendah daripada subjek tanpa defisiensi besi tetapi lebih tinggi daripada orang sehat, menunjukkan eritropoiesis inefektif juga terjadi pada subjek defisiensi besi walaupun aktivitas eritropoiesis lebih rendah daripada subjek tanpa defisiensi besi.
Background: Based on the measurement of RNA content, flowcytometry provides reticulocyte maturation indices, which are low fluorescence ratio (LFR), medium fluorescence ratio (MFR), and high fluorescence ratio (HFR). Immature reticulocyte fraction (IRF) consists of MFR and HFR. Reticulocyte maturity can be used as a clinical indicator of erythropoietic activity. Ineffective erythropoiesis and chronic hemolytic in thalassemia-β and hemoglobin E carriers results in anemia. Human body responds by increasing erythropoiesis. In iron deficiency, erythropoiesis will decrease as iron which is essential for hemoglobin formation is deficient.Objective: to obtain profile of reticulocyte and its fractions in normal adults that can be used as reference interval, and in β-thalassemia and hemoglobin E carriers with and without iron deficiency to assess erythropoiesis activity and ineffective erythropoiesis.Methods: a cross sectional study. There were 249 healthy subjects and 98 family members of thalassemia patients in thalassemia policlinic.Results: MFR and HFR had poor precision thus results of both parameters were unreliable. Reference interval for reticulocyte and its fractions in normal adults are relative reticulocyte count (RRC) male and female 0.7 ? 2.2%, absolute reticulocyte count (ARC) male 35,988 ? 101,198 /μL and female 26,400 ? 105,000/μL, relative IRF male and female 2.4 ? 13.4%, absolute IRF male 1,343 ? 10,049 /μL and female 764 ? 11.223 /μL, relative LFR male and female 86.6 ? 97,4%, absolute LFR male 32,444 ? 97,573 /μL and female 25.634 ? 92.063/μL. RRC and ARC of thalassemia-β and HbE carriers were within reference interval, but IRF were higher than in normal adults. RRC, ARC, and IRF in thalassemia-β and HbE carriers with iron deficiency were lower than in those without iron deficiency, but higher than in normal adultsConclusions: RRC and ARC of β-thalassemia and HbE carriers were within reference interval, but IRF were higher, showed ineffective erythropoiesis. RRC, ARC, and IRF β-thalassemia and HbE carriers with iron deficiency were lower than in those without iron deficiency, but higher than in normal adults. It showed that ineffective erythropoiesis also occurred in those with iron deficiency despite lower erythropoiesis activity. |
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