[ABSTRAK
Anemia defisiensi besi dan thalassemia β trait merupakan penyebabtersering anemia mikrositik hipokrom di Indonesia. Kedua penyakit tersebut sulitdibedakan hanya dengan pemeriksaan hematologi, oleh karena itu diperlukanpemeriksaan tambahan seperti feritin dan analisis hemoglobin. Namun tidak semualaboratorium dapat melakukan pemeriksaan ini. Banyak penelitian yangmembedakan kedua penyakit tersebut dengan indeks eritrosit. Namun indekseritrosit memiliki nilai diagnostik yang berbeda di setiap negara dan belum ada datadi Indonesia. Penelitian ini melakukan uji diagnostik Indeks Mentzer, RDW, Green-King, Sirdah, dan mencari nilai cut-off baru yang memberikan nilai diagnostik lebihbaik.Penelitian terdiri dari 98 subyek definitif anemia defisiensi besi dan 80subyek thalassemia β trait. Nilai diagnostik Indeks Mentzer untuk anemia defisiensibesi adalah sensitivitas 83.6%, spesifisitas 66.2%, NPP 75.2%, NPN 76.8%, RKP2.4, RKN 0.2. Nilai diagnostik Indeks Mentzer untuk thalassemia β trait adalahsensitivitas 66.2%, spesifisitas 83.6%, NPP 76.8%, NPN 75.2%, RKP 4.0, RKN0.4. Nilai diagnostik Indeks RDW untuk anemia defisiensi besi adalah sensitivitas91.8%, spesifisitas 75%, NPP 81.8%, NPN 88.2%, RKP 3.6, RKN 0.1. Nilaidiagnostik 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 diagnostikIndeks 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 diagnostikIndeks Green-King untuk thalassemia β trait adalah sensitivitas 67.5%, spesifisitas96.9%, NPP 94.7%, NPN 78.5%, RKP 22.0, RKN 0.3. Nilai diagnostik IndeksSirdah 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 untukthalassemia β trait adalah sensitivitas 58.7%, spesifisitas 92.8%, NPP 87.0%, NPN73.3%, RKP 8.2, RKN 0.4. Nilai cut-off baru Indeks Mentzer adalah 13.44, RDWI233.4, Green-King 75.06, dan Sirdah 32.52.Keempat indeks eritrosit dapat diaplikasikan untuk orang Indonesia denganIndeks Green-King sebagai indeks yang terbaik.
ABSTRACT
Iron deficiency anemia and β trait thalassemia are the most common causesof microcytic hypochromic anemia in Indonesia. Differentiation between them isdifficult when solely based on a hematology examination, so additional laboratorytests are required such as ferritin and hemoglobin analysis. However, not alllaboratories can perform these tests. Many erythrocytes indices have been proposedto determine whether a blood sample is more suggestive for iron deficiency anemiaor β trait thalassemia. Unfortunately these indices have different diagnostic valuein many countries and there is no data about diagnostic value in Indonesia. Thisstudy performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index anddevelops a new cut-off point that could make a better diagnostic value.This study consists of 98 subjects of iron deficiency anemia and 80 subjectsof β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiencyanemia 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 weresensitivity 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 sensitivity91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnosticvalues of RDW Index for β trait thalassemia were sensitivity 75%, specificity91.8%, 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-KingIndex 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 irondeficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemiawere 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 was13.44, 233.4, 75.06, and 32.52 respectively.All indices can be applied for Indonesian people, among which Green-KingIndex had the best diagnostic value, Iron deficiency anemia and β trait thalassemia are the most common causesof microcytic hypochromic anemia in Indonesia. Differentiation between them isdifficult when solely based on a hematology examination, so additional laboratorytests are required such as ferritin and hemoglobin analysis. However, not alllaboratories can perform these tests. Many erythrocytes indices have been proposedto determine whether a blood sample is more suggestive for iron deficiency anemiaor β trait thalassemia. Unfortunately these indices have different diagnostic valuein many countries and there is no data about diagnostic value in Indonesia. Thisstudy performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index anddevelops a new cut-off point that could make a better diagnostic value.This study consists of 98 subjects of iron deficiency anemia and 80 subjectsof β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiencyanemia 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 weresensitivity 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 sensitivity91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnosticvalues of RDW Index for β trait thalassemia were sensitivity 75%, specificity91.8%, 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-KingIndex 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 irondeficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemiawere 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 was13.44, 233.4, 75.06, and 32.52 respectively.All indices can be applied for Indonesian people, among which Green-KingIndex had the best diagnostic value] |
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