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Jantung adalah organ kedua setelah paru-paru yang banyak dipengaruhi oleh Severe Acute Respiratory Syndrome Corona Virus-2 (SARS CoV-2), mengalami cedera akibat virus tersebut ditandai dengan peningkatan kadar troponin. Kadar troponin-I secara signifikan lebih tinggi pada pasien COVID-19 berat, mendapat perawatan intensif, dan meninggal. Penelitian ini bertujuan menganalisis hubungan kenaikan kadar troponin-I dengan mortalitas pasien dewasa terkonfirmasi Corona Virus Disease-19 (COVID-19). Penelitian ini bersifat deskriptif retrospektif dilakukan pada pasien COVID-19 rawat inap di RSUP Dr. Hasan Sadikin Bandung dari Desember 2020 hingga Maret 2021 sesuai kriteria inklusi dan eksklusi. Data kadar troponin-I dan karakteristik pasien diambil dari sistem informasi laboratorium dan rekam medis. Hubungan kenaikan kadar troponin I dengan mortalitas dianalisis dengan uji chi-square. Hasil penelitian menunjukkan bahwa dari 90 pasien usia 20-60 tahun sebanyak 48 orang (53,3%), pasien laki-laki sebanyak 57 orang (63,3%), dan pasien dengan komorbid sebanyak 64 orang (71,1%). Peningkatan kadar troponin-I terjadi pada 80% pasien berhubungan secara signifikan dengan mortalitas (p 0,0001) dengan Odds Ratio (OR) sebesar 6,40. Hal ini berarti pasien dengan kadar troponin I meningkat memiliki kemungkinan untuk meninggal 6,4 kali lebih besar daripada pasien dengan kadar troponin-I normal. Kondisi COVID-19 berat dapat menyebabkan kerusakan pada berbagai organ termasuk otot jantung. Pada penelitian ini, pasien COVID-19 dengan kenaikan kadar troponin-I pada masa perawatan memiliki risiko kematian lebih tinggi daripada pasien dengan kadar troponin-I yang normal. Untuk mengevaluasi apakah troponin-I merupakan faktor penyebab kematian yang kuat pada pasien COVID-19 dewasa diperlukan analisis multivariat.

Amaylia Oehadian,1 Ian Huang,2,3 Andini Kartikasari,4 Bachti Alisjahbana,5 Delita Prihatni6 1Division of Hematology and Oncology Medic, Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 3Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia; 4Bandung City Regional General Hospital, Bandung, Indonesia; 5Division of Infectious and Tropical Diseases, Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 6Department of Clinical Pathology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Amaylia Oehadian, Department of Internal Medicine, Padjadjaran University/Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Email amaylia.oehadian@unpad.ac.idBackground: During COVID-19 pandemic, it is difficult to distinguish febrile patient infected by SARS-CoV-2 or bacterial causes. Howell-Jolly bodies are a well-known entity found in red blood cells. They are nuclear fragments, composed of deoxyribonucleic acid, commonly observed in the peripheral blood smears of hyposplenic or asplenic patients. Recently, similar inclusions often referred to as Howell-Jolly body-like inclusions (HJBLIs) have been reported in the neutrophils of patients with acquired immune deficiency syndrome (AIDS) and COVID-19 patient.Aim: To explore whether HJBLIs in peripheral blood smear could differentiate between patients with confirmed SARS-CoV-2 and bacterial pneumonia.Methods: We performed cross-sectional study using secondary data from COVID-19 database and re-evaluated peripheral blood smears to identify HJBLIs. We included confirmed COVID-19 adults age > 18 years who were hospitalized in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from March 1st 2020–May 31st 2020. We also examined peripheral blood smears in patients with confirmed bacterial pneumonia as a control group. Clinical characteristics including disease severity, CURB-65 score, comorbidity, and the present of HJBLIs in peripheral blood smears were evaluated.Results: Overall, 33 patients were included: 22 were confirmed COVID-19 and 11 were confirmed bacterial pneumonia. The median (interquartile range) age in COVID-19 and patients with bacterial pneumonia were 53 years (40– 64) vs 57 years (53– 71), respectively. Compared with patients with bacterial pneumonia, HJBLIs were significantly higher in COVID-19 patients [21/22 (80.8%) vs 5/11 (45.5%), p 0.001].Conclusion: Howell-Jolly body-like inclusions could be a potential feature to help differentiate between COVID-19 and bacterial pneumonia.Keywords: Howell-Jolly body-like inclusions, COVID-19, bacterial pneumonia, peripheral blood smear

Coronavirus Disease-19 (COVID-19) is caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2). In severe cases, the immune response may cause a cytokine storm. Neutrophil Lymphocyte Ratio (NLR) and D-dimer are parameters that may be used to predict the severity of COVID-19. This study aims to determine the diagnostic validity of the combination of NLR and D-dimer on the severity of COVID-19 patients. The study population was hospitalized COVID-19 patients whose diagnosis were confirmed by real time-PCR. This was a retrospective cross-sectional study. The cut-off value was based on the Area Under Curve (AUC) of the Receiver Operator Characteristic Curve (ROC) analysis and the combination of NLR and D-Dimer validity was tested against the severe and non-severe COVID-19 groups by assessing sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), positive Likelihood Ratio (LR+) and negative Likelihood Ratio (LR-). There were 1,314 subjects. Seven hundred and forty-four were in the severe group, 570 in the non-severe group. The combination of NLR > 4.02 and D-dimer > 1.12 mg/L on the severity of COVID-19 showed a sensitivity value of 70.8%, specificity 98.3%, PPV 98.1%, NPV 72.1%, LR+ 40.38 and LR- 0.30. The combination of NLR >4.02 and D-dimer >1.12 mg/L for the severity of COVID-19 showed high specificity and PPV (98.3% and 98.1%). This was also supported by the LR+ value, which indicates that if NLR > 4.02 and D-dimer > 1.12 mg/L, it may cause severe COVID-19 by 40.38 times compared to NLR ≤4.02, and D-dimer ≤1.12 mg/L. The combination of NLR and D-Dimer can be used to predict the severity of COVID-19.

Hemophilia A is an inherited factor VIII deficiency disease, related to X chromosome. Diagnosis of Hemophilia A is made based on Factor VIII assay. Nowadays, Hemophilia A therapy is by giving factor VIII concentrate, so that monitoring of this therapy must be done by examine Factor VIII activity, but examination of Factor VIII activity is currently still limited in facilities and quite expensive. One of activated partial thromboplastin time (aPTT) optical methods can provide information about every stage of coagulation through clot waveform analysis. Factor VIII activity can describe in slope 2 of clot waveform analysis, which deficiency of factor VIII will cause slope 2 slighter than normal, because the clot form is not optimal and the light transmission recorded at clot waves do not decrease maximally. The aim of this study was to analyze the correlation between slope 2 on the clot waveform analysis of the optical method on aPTT test with Factor VIII activity in hemophilia A subjects. This was a correlative observational study cross sectional study, conducted at Hasan Sadikin General Hospital Bandung in August 2018-September 2019. The subjects were member of Hemophilia A sufferers of West Java Hemophilia Society. The research subjects were assesed for Factor VIII activity and optical method of aPTT. Slope 2 calculated from the clot waveform analysis that formed in aPTT examination. This study involved 43 subjects, with a median age of 6 years, an age range of 1-45 years, and 51.2% of patients aged 6-17 years. The results of Factor VIII activity in this study had a median 0% with a range 0-25.9%, and the value of slope 2 had a median 1.0%T/sec with a range 0.5-3.5%T/sec. The correlation test between slope 2 and Factor VIII activity with 95% confidence interval using Spearman's correlation test showed very strong positive correlation which statistically significant (r = 0.854 and p

BACKGROUND: Being located in the global thalassemia belt area, Indonesia is estimated harboring about 10% thalassemia carriers; however, screening program is still diversely scattered across the country. Numerous erythrocyte indices have been introduced to help identifying thalassemia carriers with contradictory results. Therefore, this study had compared the use of mean corpuscular volume (MCV) and/or mean corpuscular hemoglobin (MCH) values and the most erythrocyte indices used in Indonesia which were Mentzer Index (MI) and Shine & Lal Index (SLI), as a first attempt in a mass screening for β-thalassemia carrier.METHODS: This was a retrospective study, evaluating laboratory data from family members of thalassemia major subjects. The sensitivity and specificity of MI and SLI were calculated. HbA2 >3.5% was used as a golden standard for β-thalassemia carrier and DNA examination was conducted to confirm β-globin mutation.RESULTS: Out of 160, 28.8% of the subjects had low Hb concentration. Interestingly, 79.4% of the subjects had low MCV and/or MCH with or without low Hb concentration. In this study, specificity and sensitivity of MI were 82.2% and 83.8%, whereas of SLI were 96% and 40.5%, respectively. Low MCV and/or MCH had covered IVS1nt5 and Cd26 mutation at β-globin gene; whereas MI and SLI had missed some samples, leading to false negative of thalassemia carrier results, when using MI or SLI only.CONCLUSION: MCV

Carrier screening for early detection of thalassemia in the general population needs a careful approach, especially in areas with limited health services. Various erythrocyte indices have been introduced as options for the first stage; however, the low-reliability value of these erythrocyte indices remains the problem. This study aimed to determine the most reliable index for screening beta-thalassemia carriers and distinguish it from iron deficiency anemia. A cross-sectional study was designed to explore thalassemia carrier status among medical students. Inter-rater reliability value of various indices was compared to Shine and Lal index. The Cohen's Kappa coefficient was calculated using SPSS v. 25.0. Among 320 respondents, 295 subjects were non-anemic and 25 were anemic subjects, whereas 105 subjects had low MCV and/or MCH values. Cohen's Kappa value showed moderate reliability results compared to Shine and Lal index for example Mentzer index (0.58), Ehsani index (0.57), Srivastava index (0.53), and Bordbar index (0.41), but showed very low-reliability results with Green and King index (0.04). New cut-off indices based on Kumar et al. were also compared, resulting in moderate reliability results. Since there was no Hb-electrophoresis test, the sensitivities and specificities of those indices could not be calculated. For this reason, a complete blood count can only be used for the early stages of screening for beta-thalassemia carriers, whereas Hb-electrophoresis and DNA tests were considered necessary to perform to confirm a diagnosis.

Background: Acute myeloblastic leukemia (AML) is a subtype of leukemia characterized by myeloid infiltration into the bone marrow, blood, and other tissues. AML ranks 5th malignancy in children and the prognosis is poor. After chemotherapy, the outcomes vary. Therefore, this study aimed to provide further insight into the therapeutic outcomes of pediatric AML patients. Methods: This study was conducted with a cross-sectional descriptive method. The data were obtained from the medical records of children diagnosed with AML at the Department of Child Health of Dr. Hasan Sadikin General Hospital in 2017–2019 with the total sampling method. Data including age at determination, gender, laboratory values including hemoglobin, leukocyte, thrombocyte as well as blast cell count on peripheral blood smear were collected. Also, the bone marrow punctures gathered were clustered based on the French-American-British (FAB) classification. Data were presented in tables. Results: In total, 46 data of AML patients were retrieved, with the age category at first diagnosis was >5–12 years (48%) and predominantly males (63%), children with moderate anemia (41%), leukocytosis (35%), severe thrombocytopenia (46%), and blast cell count ≥20% (83%). AML-M2 was the most common subtype (30.4%). The majority of patients (91%) underwent chemotherapy and most (45%) patients died during chemotherapy Conclusion: The outcome of AML therapy among children is mostly poor, and particularly die during chemotherapy. Early detection and follow-up of patients to continue therapy are important aspects to reduce the mortality rate of AML.

Thalassemia is an inherited genetic disease caused by the disruption in globin chain synthesis. Inefective erythropoiesis in thalassemia leads to moderate to severe anemia, requiring routine blood transfusions. To evaluate erythropoiesis, immature reticulocyte fractions (IRF) can be measured using the hematology analyzer, avoiding the need of invasive bone marrow examination. The purpose of this study was to analyze the differences in the IRF percentage between moderate and severe anemia in transfusion-dependent thalassemia (TDT) patients. This was a cross-sectional comparative observational analytic study conducted at the Pediatric Thalassemia Clinic of Dr. Hasan Sadikin General Hospital Bandung in August–September 2020. The IRF was examined using the fluorescence flowcytometry method with whole blood sample added by EDTA anticoagulant. The statistical analysis used in this study was unpaired t-test and Mann Whitney’s test. Subjects were 93 TDT pediatric patients, consisting of 48 boys (52%) and 45 girls (48%). The majority (72%) of the patients had been diagnosed with thalassemia for more than 5 years with moderate anemia (40%) and severe anemia (60%). The median IRF percentage in moderate anemia was 6.4% (range 0-22.7) while the range in severe anemia was 11.7% (range 4.1–35.8), suggesting a statistically significant difference (p

The thalassemia screening program in Indonesia mostly conducted sporadically. Ideal prospective screening is still limited. This study aimed to compare thalassemia screening methods using the extended family approach with and without a history of severe thalassemia and the feasibility of implementing extended family screening method. A case control study was conducted in Dr. Hasan Sadikin General Hospital Bandung with 3 generations of extended families. Data were collected from 150 subjects of 8 extended families with severe thalassemia as an index case entry and 151 subjects of 12 families with no history of thalassemia. All subjects were examined for Hb, MCV, MCH, and peripheral blood smear (PBS) as initial laboratory examinations. Subjects with MCV p p = 0.244). The mean age was 31.9 ± 21.2 vs. 31.1 ± 20.8 years (p = 0.782). The median family size was 28.5 vs. 20 subjects per family (p = 0.245). The types of identified thalassemia carrier in both groups consisted of β-thalassemia, β-thalassemia/HbE, suspected α-thalassemia, and β-thalassemia Hb variant. All carriers continued the counseling process. The extended family method seems feasible to be implemented for thalassemia screening in West Java, Indonesia.

Transfusion-dependent thalassemia (TDT) is a type of beta-thalassemia that needs regular and long-term blood transfusions. Complications can occur due to the deposition of iron in TDT patients, including endocrine complications causing deficiency of testosterone that plays a role in the secondary sexual development in males. The objective of this study was to understand the correlation between ferritin and testosterone level in male adolescences with transfusion-dependent thalassemia. This cross-sectional observational correlative study was conducted from April to August 2019 on 74 males aged 12-18 years old who were presented to the Thalassemia Outpatient clinic, Dr. Hasan Sadikin General Hospital, Bandung. Blood was collected using phlebotomy for ferritin and total testosterone serum examination. Data were then analyzed using SPSS version 17.0. Low testosterone level (

Introduction: We aim to describe the performance of combined IgM and IgG point-of-care antibody test (POC-Ab) (Wondfo®) compared to real-time reverse transcriptase (rRT-PCR) (Allplex™ 2019-nCoV Assay) in detecting coronavirus disease 2019 (COVID-19). Methodology: We compared POC-Ab with rRT-PCR results among patients in a tertiary hospital from January to March 2020 in Bandung, Indonesia. We selected presumptive COVID-19 patients with positive rRT-PCR consecutively and 20 patients with negative rRT-PCR results were selected randomly from the same group of patients as controls. We described the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with corresponding 95% confidence interval using serum and capillary blood samples. We also tested POC-Ab using non-COVID-19 (confirmed dengue and typhoid) patients’ sera. Results: Twenty-seven patients with positive rRT-PCR result and 20 negative controls were included (68.1% males, mean age 46 (SD: 15.4)). Using the serum, the sensitivity of the POC-Ab was 63.0% (42.4-80.6), specificity was 95.0% (75.1-99.9), PPV was 94.4% (72.7-99.8), NPV was 65.5% (45.7-82.1). A subset of 20 patients was tested using a capillary blood sample. The accuracy of the capillary blood sample is lower compared to serum (50.0% vs. 78.7%). None of the non-COVID-19 sera tested were reactive. Conclusions: POC-Ab for COVID-19 has a high specificity with no false-positive result in non-COVID-19 sera. Therefore, it can be used to guide diagnostic among symptomatic patients in resource limited settings. Given its low sensitivity, patients with high suspicion of COVID-19 but non-reactive result should be prioritized for rRT-PCR testing.

Background: Increased Neutrophil-to-Lymphocyte Ratio (NLR) is an independent risk factor for mortality in Covid-19 patients and is considered as an early warning sign of Covid-19 severity. This study aimed to observe the differences in NLR at admission between patients with mild, moderate, and severe symptoms of Covid-19 treated in a referral hospital in Banda Aceh, Indonesia.Methods: A total of 114 patients with Covid-19 admitted to a referral hospital in Banda Aceh, Indonesia, during March–September 2020 were included in this study. Demographic information and baseline laboratory data, including the NLR, were collected. Descriptive and inferential statistics were used to analyze the data. Results: The median NLR at admission was higher among patients with moderate to severe symptoms than those with mild symptoms [6.54 (2.80–97.00, IQR 4.81–9.44) vs 2.27 (0.79–5.07, IQR 1.43-2.98), p

Thrombus formation in non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) causes increased plateletconsumption, leading to a 20-fold increase of Reticulated Platelets (RP) release. Reticulated platelets have more granulesand proteins that make them quickly forming thrombus than mature platelets, potent to form bigger thrombus, andincrease the risk of Major Adverse Cardiac Events (MACE). HEART score is a risk stratification for possible NSTE-ACS, whichcan predict MACE. The study aimed to analyze the correlation between the percentage of reticulated platelets and HEARTscore. This research was a correlation observational cross-sectional study performed in Dr. Hasan Sadikin Hospital,Bandung, from August 2018 to May 2019. The subjects were patients suspected with NSTE-ACS by clinicians in theEmergency Department of Dr. Hasan Sadikin Hospital. These subjects were assessed for the HEART score andRP percentage. This study involved 52 subjects consisting of a higher number of males (76.9%) aged 45-64 years old (69.2%).HEART score stratification in this study was mostly high risk (69.2%), but none was low risk. Mean of platelet count, absolute3 3 RP, and RP percentage were 271±73 x103/mm , 9.3±4.3 x 103/mm , and 3.6±1.7%, respectively. The correlation testbetween RP percentage and HEART score with a 95% confidence interval using Spearman's correlation test showed asignificant positive correlation with moderate strength (p < 0.001 and r=0.475). The percentage of RP in this study was in thenormal range. However, there was a significant positive correlation with moderate strength between the percentage of RPand HEART scores in patients with suspected non-ST elevation acute coronary syndrome.

Thromboembolic events are potentially life-threatening clinical complications found in β-thalassemia patients. The pathogenesis of the hypercoagulable state in β-thalassemia patients results from the degradation of excess α-globin chains in red blood cells, leading to intracellular labile iron accumulation, oxidative stress, and more rigid, deformed, and eventually prematurely damaged red blood cells. This process is associated with the loss of the normal asymmetrical distribution of membrane phosphatidylserine and its exposure to the outer surface of the blood cell membrane resulting in the formation of tenase complexes, prothrombinase, and thrombin complexes. Increased thrombins lead to platelet activation and platelet-derived microparticles synthesis, which in turn contributes to thrombus formation. This study aimed to determine the increase in the platelet-derived microparticle count by direct labeling of CD62P and CD41 monoclonal antibodies in β-thalassemia patients when compared with normal subjects. This was a cross-sectional analytical quantitative study conducted in Dr. Hasan Sadikin General Hospital Bandung and Dharmais Cancer Hospital Jakarta Indonesia between August and September 2019. Sixty patients, divided evenly into β-thalassemia group and control group, were labeled by CD62P and CD41 monoclonal antibodies. Results showed that the β-thalassemia group had a platelet count of 197x103/uL (58–1,261) with a median count for platelet-derived microparticles of 10,553 events/uL (779–90,971) as opposed to 1,861 events/uL (1,244–3,174) in the normal group (p

Background: Acute lymphoblastic leukemia (ALL) is a disease caused by a mutation of lymphoid progenitor cells in bone marrow, that induces uncontrolled lymphoid cell proliferation. ALL is the most common type of leukemia in children. Various clinical and laboratory manifestation makes the diagnostic process more complicated. This study aimed to observe the clinical and laboratory manifestation of children with ALL in Dr. Hasan Sadikin General Hospital for diagnostic and assessment. Methods: The design of this study was a descriptive cross-sectional with a total sampling method. Data of all children under 18 years old with ALL diagnosed in 2015 to 2017 were included. The diagnosis of ALL was confirmed by examination of hematology indices, peripheral blood smear, and bone marrow aspiration classified by FAB. Inaccessible or incomplete medical records were excluded. Results: In total, 192 data of ALL patients were included. Most ALL patients predominantly occurred in boys (59.9%), and the age group of 1–5 years old (40.6%). The clinical manifestations were pallor (89.6%), hepatomegaly (79.7%) and fever (75%). Most patients experienced severe anemia with hemoglobin level 20.000 cells/mm3 (46.9%), severe thrombocytopenia with platelet count 50% (45.3%). Based on FAB classification, the majority of the patients were classified as ALL type L2 (65.6%). Conclusions: Clinical and laboratory manifestation of ALL patients can be used as a parameter for diagnostic and assessment of severity. Earlier diagnosis would result in better prognosis and more precise treatment for ALL patients.

Thalassemia is a disease caused by reduced or loss of synthesis of globin chains and then hemoglobin becomes abnormal. Characteristic screening in the population needs to be done to prevent marriage among people with thalassemia minor and reduce the birth of babies with thalassemia mayor. Combining several simple tests such as MCV, Mentzer index and single tube osmotic fragility test can increase the effectiveness of the test for screening of thalassemia minor. The purpose of this study was to determine the sensitivity and specificity of each panel for MCV-Mentzer index, MCV-single tube osmotic fragility, and Mentzer index- single tube osmotic fragility test panel against HbA2 in screening for the thalassemia minor. This study is observational with cross-sectional study design. The study was conducted at the Clinical Pathology Laboratory of Arifin Achmad Hospital Pekanbaru in June-August 2020. There were 27 subjects who had MCV values

Background: Transfusion is an essential component of supportive management for cancer patients with anemia and thrombocytopenia. It is generally safe; however, it has several risks and complications including those caused by transfusion reactions. This study aimed to describe transfusion reactions in pediatric cancer patients in a tertiary hospital in Indonesia. Methods: This was a descriptive cross-sectional study with a total sampling method. A prospective analysis was performed on episodes of blood transfusion in pediatric patients aged younger than 18 years old with cancer and were hospitalized at the Department of Child Health of the hospital from July to August 2019. After the consent of the parents, the patients were interviewed for various transfusion reactions. Data collected were presented using tables and charts. Results: Leukemia was the most frequent cancer in children cancer patients who need transfusion. Out of 42 children included, 155 episodes of transfusion were observed with 22 episodes showed transfusion reactions (14.2%). The most frequent manifestations were pruritus (31.8%), followed by combination of pruritus and erythema (27.4%) and fever (13.6%). These reactions appeared mostly in 1 to 2 hours (27.2%), with most were mild reactions (59.1%). Conclusion: Transfusion reactions mostly occurred among pediatric patients with cancer in the acute phase with clinical manifestation of allergic reactions, predominantly mild. Early identification of these reactions would result in better treatment and prevention for recurrence of transfusion reactions.

Chronic Myeloid Leukemia (CML) adalah keganasan hematopoetik pertama yang dihubungkan dengan jejas genetik. Chronic MyeloidLeukemia digolongkan sebagai penyakit mieloproliferatif kronis disebabkan translokasi resiprokal kromosom 9 dan 22 yang disebutkromosom Philadelphia (Ph). Kromosom Ph membentuk gen yang disebut BCR-ABL. Pemeriksaan molekuler CML bertujuan untukmengetahui aktivitas transkripsi mRNA gen BCR-ABL, yang berguna untuk menetapkan diagnosis dan pemantauan pengobatan pasienCML. Saat ini, WHO mempublikasikan ada sembilan (9) gen baku yang digunakan secara luas. Tujuan penelitian ini adalah untukmengetahui angka banding gen BCR-ABL/G6PD dan BCR-ABL/ABL di pasien CML dengan kromosom Ph (+) secara membandingkan.Penelitian ini menggunakan 79 bahan biologis tersimpan (BBT) mRNA Ph (+) dari leukosit pasien CML yang datang ke RSUPDr. Hasan Sadikin Bandung selama masa waktu antara bulan April 2012−April 2014. Pemeriksaan angka banding gen BCR-ABL/G6PDdengan metode Real-time Quantification PCR menggunakan alat LightCycler® Roche. Angka banding gen BCR-ABL/ABL diperiksamenggunakan alat Bioneer®. Gen baku G6PD dapat mendeteksi tipe b2a2, b3a2 dan e1a2. Gen baku ABL hanya dapat mendeteksi tipeb2a2 dan b3a2, tetapi lebih stabil bila dibandingkan dengan gen baku G6PD. Bentuk penelitian adalah perbandingan analitik denganrancangan kajian potong lintang. Analisis statistik menggunakan uji nonparametrik Wilcoxon. Hasil angka banding mRNA gen BCRABL/G6PD dan gen BCR-ABL/ABL [1,93% (0,0–59,7 fg) vs 15,37% (0,04–35,7 kopi), p

Tuberculosis (TB) is still a major health problem, especially in the developing countries. The combination of antituberculosis drugs are generally recommended for the treatment of tuberculosis. Van Crevel study in Jakarta found that most (70%) of patients with pulmonary TB who received combined antituberculosis drugs with standard (450 mg) dose rifampicin had very low plasma rifampicin level. Based on this results, TB Research and Clinical Trial Centre Bandung & University Medical Centre Nijmegen, The Netherlands conduct the study which compared clinical outcome between standard and high (600 mg) dose of rifampicin. Most of antituberculosis drugs currently available are very low in causing acute and chronic toxicities, however we must keep aware of side effect during the treatment. The most serious adverse effect of several drugs is liver damage (drug induced hepatitis) and potentially fatal hepatitis. To detect liver demage earlier aspartate aminotransferase( AST) and alanine aminotransferase (ALT) serum level were examined during antituberculosis treatment. The aim of this study was to determine AST and ALT serum level at intensif phase of antituberculosis treatment with standard and high dose rifampicin. The study had been done from August 2003 to September 2004 at Dr Hasan Sadikin Hospital and Balai Pengobatan Penyakit Paruparu, Bandung. The subjects were divided randomly into 2 groups. The first group consisted of patients with category I antituberculosis drugs with standard dose rifampicin and the second group patients also category I with high dose rifampicin. Aspartate aminotransferase and ALT serum level were examined at week 0 (before treatment), 2nd, 4th, and 8th. This was randomized clinical trial with paralel design study. Statistical analysis used paired t test to compare the dose effect of rifampicin to AST and ALT serum level changes, t independent test to compared mean difference of AST and ALT serum level changes which is projected by profile analysis. p value < 5%.. The prevalence of the hepatotoxicity were 17.39% of standard dose and 18.17% of high dose rifampicin. The hepatotoxicity were mild and moderate level,and it was already present at 2 weeks of therapy. There were no significant difference of AST and ALT serum level beetween those two groups. Conclusion: In this study antituberculosis drugs with high dose rifampicin were safe for TB patients.

D-Dimer parameter is the most usefull laboratory assay to detect the present of activated coagulation. The D-Dimer fragment directly indicate the fibrinolitic proccess whereas the increasing mark of D-Dimer is the most hemostatic parameter that was used to detect the early stage of Disseminated Intravascular Coagulation ( DIC ) and has a correlation with the patient prognosis. D-Dimer assay by immunoturbidimetric method was used to detect antigen-antibody reaction automatically and it can detect D-Dimer concentration less than 0.5 μg/mL. The immunoturbidimetric method has a good correlation with the ELISA method , but the proccess is complicated , is high costed , and need the competence of practical human resource. D-Dimer assay with immunofiltration method has the same principle as immunoturbidimetric method , but it's work more simpler , low cost and does not need the competence of practical human resource. The aim of this study is to compare the D-Dimer assay concentration between immunofltration and immunoturbidimetric method. There were 30 plasma samples assayed with these two methods ( immunoturbidimetric and immunofiltration ), and then compared between them. The samples were collected between November until December 2008 at Rumah Sakit dr. Hasan Sadikin Bandung. The validity of D-Dimer using immunofiltration method showed sensitivity 74% , specificity 95% , predictive value of negative test ( PV- ) 22% , predictive value of positive test ( PV+ ) 95% with likelihood ratio 5.2. The conclusion of this study so far that the immunofiltration method has a good validity for diagnosing. D-Dimer work rapidly with low cost laboratory assay than the immunoturbidimetric method.

A research has been done to compare the differences on the enzyme creatine phosphokinase (CPK) level and muscle soreness before and after 4-weeks swim practices on swimmers of College swimming club. Eighteen healthy male swimmers (mean ± SD; age: 19,94 ± 1,86 years; weight: 65,28 ± 6,14 kg; height: 1,72 ± 0,43 m) participated in this study. All subjects performed their 4-weeks swim practices which consist of 2x120 hours per week with 500 meters average daily swim distance and weight training. Blood was collected before and after the practices and CPK were analyzed. Questionnaires concerning muscle soreness were filled put before each blood draw. Results were analyzed using normality test and Wilcoxon signed rank test (p

Background and objective: The measurement of haemoglobin was carried out by using hematology analyzer with specthrophotometermethod which measured light absorbance at 540 nm. However, this measurement affected by increase turbidity as a result of leucocytosis.The turbidity can be eliminated by using HemoCue method that detect absorbance at 570 nm and 880 nm. The aim of this study wasto compare the measurement of haemoglobin obtained between specthrophotometer method and HemoCue method. Materials andmethod: Blood EDTA sample that have been measured with MEK-6318K Nihon Kohden hematology analyzer for haemoglobin levelswith spectrophotometer methods with leucocyte > 100.000/mm3 were included in this study. Blood sample are measured again forthe haemoglobin level with HemoCue B-Haemoglobin Analyzer. This study was conducted at Clinical Pathology Laboratory, Dr. HasanSadikin Hospital Bandung from August–October 2008. Result: Seventeen leucocytosis sample were enroled in this study. The meanhaemoglobin level from specthrophotometer method is higher than HemoCue method, however there was no statistically significantdifference between haemoglobin result from specthrophotometer method and HemoCue method (p = 0.742 > a = 0.05). Conclusion:There was no significant difference beetween specthrophotometer method and HemoCue method for haemoglobin measurement ofleucocytosis sample.

Sepsis is a clinical syndrome caused by the entry of harmful pathogens toxins into the blood vessels, which will cause the immune system response and ultimately will also interfere with hemostasis system including coagulation system which can end up with DIC. Therefore, monitoring of coagulation in sepsis becomes very important. The examination of coagulation such as PT and aPTT by mechanical methods only provide information about the timing of the coagulation and completely unknown how the coagulation process occurs. The Currently available coagulometer tool that checks the coagulation system with photo optical method to visualize the waveforms clot (Clot Waveform Analysis). This study was to determine the difference between CWA of normal and abnormal aPTT in sepsis patients. It was conducted at the Laboratory of Clinical Pathology, RSUP Dr. Hasan Sadikin Bandung. The subjects were all patients diagnosed with sepsis based on SOFA sepsis criteria, in the period of May 1, 2016, until August 31, 2016, were examined aPTT by CS2100i. The CWA were obtained from the examination of aPTT with the tool. Waveform of aPTT in sepsis was a biphasic waveform if the value of slope_ 1> -0.25% T / sec. The waveform were found in normal aPTT (83.33%) and prolonged aPTT group (100%). It were occured in the most normal aPTT groups and in all subjects with prolonged aPTT.This finding was useful for the treatment of sepsis patients when aPTT is normal because it proved that in sepsis patients with normal aPTT shows a biphasic waveform.

Background: Thalassemia is an autosomal recessive disease. It occurs due to abnormalities in hemoglobin synthesis, causes the imbalance of globin production. Identification of thalassemia’s carrier plays a role to prevent disease’s inheritance. Diagnostic approaches regarding anemia, especially in families are important because they are prone to inherit the disease. This study was aimed to know the compatibility of Mentzer, England & Fraser, Shine & Lal, and Srivastava indices with hemoglobin electrophoresis in transfusion-dependent thalassemia patient’s family.Methods: This was a cross sectional study by obtaining routine hematology and hemoglobin electrophoresis from thalassemia major patient’s family screening. The data then analyzed with Kappa and chi-square to get the compatibility and significance between variables. Data were analyzed using Microsoft Excel and SPSS version 17 for WindowsResults: From 99 subjects, most of them are women aged 18-55 years. Beta thalassemia trait based on Mentzer, England & Fraser, Srivastava, and Shine & Lal was in 46,5%, 55,6%, 55,6%, and 54,5% research subjects respectively. Hemoglobin electrophoresis results showed that beta thalassemia trait was in 47.5% subjects. Kappa test showed good and significant compatibility result of hemoglobin electrophoresis with Mentzer (k=0,663,p= 0,0001) and England & Fraser (k=0,636,p=0,002) indices, also moderate and significant compatibility for Srivastava (k=0,558,p=0,018) and Shine & Lal indices(r=0,527,p= 0,015) with hemoglobin electrophoresis Conclusions: There were compatible and significant results between Mentzer and England & Fraser with hemoglobin electrophoresis. Meanwhile, Srivastava and Shine & Lal indices have medium compatibility so that they can be used as an initial screening for beta thalassemia trait in transfusion-dependent thalassemia patient’s family

Chronic myeloid leukemia (CML) is a type of Chronic myeloproliferative disorders in pluripotencial stem cell haematopoiesis cell disease caused by somatic mutation chromosomal translocation of the Abelson (ABL) and Breakpoint Cluster Region (BCR) genes on chromosomes 9 and 22. The Breakpoint Cluster Region Abelson Kinase (BCR-ABL) gene encodes different fusion transcripts of messenger Ribo Nucleic acid (m RNA)/type of fusion gene that vary in size depending on the breakpoint in the BCR gene. The majority of CMLcases have been shown to have either b3a2 or b2a2 fusion gene. This research is a preliminary study designed to know how to identify a quantification BCR-ABL gene and expression fusion of gene and its relation to routine haematological parameters. The researchers analyzed 12 adults who were positive using a quantification ratio BCR-ABL and Glucose-6-Phosphate Dehydrogenase (G6PDH) as a house keeping gene by real-time quantitative polymerase chain reaction (RQ PCR) of chronic phase of CML patients, qualitative of translocation of BCR-ABL gene by gel agarose and routine haematological tests by a haematologic analyzer. The average quantification ratio of BCRABL gene and G6PDH was 0.0881, 50% patients had b3a2 fusion gene, 41.6% had b2a2 dan 0.4% had e1a1. Fusion gene b3a2 showed a quantification ratio, haemoglobin level and leukocyte count higher compared to b2a2 fusion gene.

SummaryIntroduction Distinguishing dengue virus infection from other febrile thrombocytopenic illnesses such as leptospirosis or enteric fever is important but difficult, due to the unavailability of reliable diagnostic tests. Sysmex XE-5000 hematology analyzers use fluorescence flow cytometry to quantitate new parameters including cells in the atypical lymphocyte area (AL), high-fluorescent lymphocyte counts (HFLC), immature granulocytes (IG), and immature platelets (IPF). This study aimed to investigate whether these parameters can help to discriminate between the diseases. Material and methods We compared hematocytometry performed by a Sysmex XE-5000 analyzer in Indonesian adults with dengue (n = 93), leptospirosis (n = 11), and enteric fever (n = 6) infection, and in healthy controls (n = 28). Results Receiver operating characteristic curves comparing dengue and leptospirosis showed that dengue was characterized by increased %AL (AUC 0.87; 95% CI 0.70–1.03), %HFLC (AUC 0.89; 95% CI 0.78–0.99), and %IPF (AUC 0.81; 95% CI 0.65–0.97), while patients with leptospirosis had increased %IG (AUC 0.86; 95% CI 0.71–1.02). Low %AL, %HFLC, and %IG supported a diagnosis of enteric fever. Conclusions The detection of AL, HFLC, IG, and IPF by Sysmex XE-5000 hematology analyzers can help to differentiate between common causes of febrile illnesses with thrombocytopenia in dengue endemic areas. We recommend further investigating the discriminatory value of these parameters in clinical practice.