Author: Tri Ratnaningsih, Sutaryo Sutaryo, Budi Mulyono, Iwan Dwiprahasto
Diagnostic Validity of Reticulocyte Hemoglobin for Iron Deficiency Detection in Pregnancy
Indonesian Journal of Clinical Pathology and Medical Laboratory
Abstract
Background
Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume and the development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stage parameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-He examination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those in term pregnancy without anemia.
Methods
The research design was cross sectional. The subjects were women in term pregnancy, gathered from PKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from the cubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while the Ret-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serum
of the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzer C501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two (2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were also classified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%).
Results
From 291 subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency in pregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for iron deficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively.
Conclusions
The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.
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Author: Umi Intansari, Yunika puspa dewi, Marsetyawan HNE Soesatyo, Mohammad Juffrie, Yanri W Subronto, Budi Mulyono
Virological and Immunological Response to Antiretroviral Treatment in HIV-Infected Patients
Indonesian Journal of Clinical Pathology and Medical Laboratory
Abstract
Background
Infeksi HIV/AIDS masih menjadi tantangan global. Pengobatan antiretroviral (ART) berperan dalam menurunkan replikasi virus, menurunkan tingkat kematian infeksi oportunistik dan meningkatkan kualitas hidup orang yang hidup dengan HIV/AIDS. Meskipun demikian data terkait respons virologis dan imunologis termasuk aktivasi imun masih sangat terbatas. Penelitian ini bertujuan untuk mengetahui respons virologis dan imunologis pasien HIV setelah 6 bulan memulai pengobatan ARV.
Methods
Subjek dari penelitian observasional prospektif ini adalah 44 pasien HIV yang belum pernah mendapat pengobatan ARV, yang berobat di RSUP Dr. Sardjito Yogyakarta dan RSUP Dr. Kariadi, Semarang. Sampel darah EDTA sebanyak 6 mL diambil pra dan pasca 6 bulan pengobatan ARV untuk pemeriksaan jumlah sel T CD4+, kadar RNA HIV dan persentase sel T CD8+/38+.
Results
Kadar RNA HIV turun secara bermakna sejalan dengan persentase sel T CD8+/38+, sementara jumlah sel T CD4+ meningkat bermakna. Sebanyak 79,5% pasien mengalami pemulihan sel T CD4 optimal (>50 sel/μL) dan kadar RNA HIV turun lebih dari 1 log10 kopi/mL pada 93% pasien. Pasien dengan respons tidak sesuai antara virologis dan imunologis didapatkan sebanyak 13,6%. Kadar HIV bernasab positif dengan persentase sel T CD8+/38+ (r=0,58, p<0,0001) dan bernasab negatif dengan jumlah sel T CD4+ (r=–0,470 (p<0,0001).
Conclusions
Berdasarkan telitian ini, sebagian besar pasien mempunyai respons virologis dan imunonologis yang sesuai 6 bulan setelah ART. Sebanyak 20,45% pasien tidak berespons atau mengalami ketidaksesuaian respons virologis dan imunologis dan memerlukan penilaian dan pengobatan secara terus menerus.