Pengaruh Anemia Terhadap Kewaspadaan dan Ketelitian Pada Anak Usia Sekolah Di SMP "X" Kabupaten Jawa Barat 2011.
ABSTRAK
PENGARUH ANEMIA TERHADAP KEWASPADAAN DAN
KETELITIAN PADA ANAK USIA SEKOLAH DI SMP “X”
KABUPATEN JAWA BARAT
2011
Christina Beatrice, 2011
Pembimbing I : dr. Adrian Suhendra, Sp.PK., M.Kes
Pembimbing II: dr. Dani, M.Kes
Latar belakang : Setiap negara akan selalu mengadakan pembangunan nasional
dalam tujuannya untuk meningkatkan kualitas sumber daya manusianya. Di
Indonesia pembangunan kesehatan yang merupakan salah satu aspek dalam
pembangunan nasional masih terhambat berbagai masalah, antara lain masalah
kekurangan gizi seperti anemia. Angka kejadian anemia pada anak Indonesia
cukup tinggi, terutama di wilayah Jawa Barat. Dampak yang ditimbulkan anemia
pada anak antara lain meningkatkan angka kesakitan dan kematian, menghambat
pertumbuhan fisik, motorik dan mental, serta menurunkan daya tangkap belajar.
Keadaan ini tentu memprihatinkan bila menimpa anak-anak Indonesia yang akan
menjadi penerus pembangunan.
Tujuan : Mengetahui pengaruh anemia terhadap tingkat kewaspadaan dan
ketelitian pada anak usia sekolah.
Metode : Metode penelitiannya observational analitik dengan rancangan
penelitian case-control. Subjek penelitian diminta mengerjakan Additional test
serta Johnson Pascal test dan setelah itu akan dilakukan pemeriksaan kadar
hemoglobin darah melalui darah vena kapiler. Analisis data dilakukan dengan uji
T tidak berpasangan dengan α = 0.05.
Hasil : Rerata nilai Additional test pada kelompok anemia adalah sebesar 30,65
dan pada kelompok non anemia sebesar 34,64, sehingga didapat p-hitung 0,023.
Sedangkan hasil rerata waktu yang diperlukan dalam menyelesaikan Johnson
Pascal test pada kelompok anemia adalah 194,89 detik dan 163,99 detik yang
diperlukan pada kelompok non anemia, didapatkan p-hitung 0,026.
Simpulan : Anemia menurunkan kewaspadaan dan ketelitian pada anak usia
sekolah.
Kata kunci : anemia, anak sekolah, kewaspadaan, ketelitian
vii
Universitas Kristen Maranatha
ABSTRACT
THE EFFECT OF ANEMIA ON VIGILANCE AND THOROUGHNESS
IN THE SCHOOL-AGE CHILDREN AT THE “X” JUNIOR HIGH SCHOOL
DISTRICT IN WEST JAVA
2011
Christina Beatrice, 2011
Tutor I: dr. Adrian Suhendra, Sp.PK., M.Kes
Tutor II: dr. Dani, M.Kes
Backgrounds: Every country will always hold a national development in its
aim to improve the quality of human resources. Health development in Indonesia
which is one aspect of national development is still inhibited various
problems, including malnutrition such as anemia. The incidence of anemia in
Indonesian children is quite high, especially in West Java. Impact of anemia
especially in children among others increased morbidity and mortality, physical
growth, motor and mental are stunted and also learning comprehension is
decreased. This state of affairs is certainly sadden when it happens to the
Indonesian children who will be the successor of development.
Objectives: To find out whether anemia affects the level of vigilance and
thoroughness in the school-age children.
Methods: The method of this research is observational analysis with case-control
design. Research subjects are asked to do the Additional test and also the Johnson
Pascal test. After that, they will be measured the levels of blood hemoglobin by
venous blood capillaries. Data analysis was performed with independent-samples
T-test with α = 0.05.
Results: The mean value of anemia group on Additional test is 30.65 and nonanemic group at 34.64, so we get p= 0.023. While the average time required to
complete the Johnson Pascal test on the anemia group is 194,89 seconds and nonanemic group at 163,99 seconds, so p= 0.026.
Conclusions: Anemia reduce the level of vigilance and thoroughness in the
school-age children.
Key words: anemia, school-age children, vigilance, thoroughness
viii
Universitas Kristen Maranatha
DAFTAR ISI
Halaman
JUDUL ...............................................................................................................
i
LEMBAR PERSETUJUAN .............................................................................
ii
SURAT PERNYATAAN ................................................................................... iii
ABSTRAK........................................................................................................... iv
ABSTRACT........................................................................................................... v
KATA PENGANTAR.......................................................................................... vi
DAFTAR ISI ...................................................................................................... viii
DAFTAR TABEL ............................................................................................... xi
DAFTAR GAMBAR.......................................................................................... xii
DAFTAR LAMPIRAN ..................................................................................... xiii
BAB I PENDAHULUAN
1.1 Latar Belakang ..................................................................................................
1.2 Identifikasi Masalah.........................................................................................
1.3 Maksud dan Tujuan Penelitian .........................................................................
1.3.1 Maksud Penelitian ...................................................................................
1.3.2 Tujuan Penelitian.....................................................................................
1.4 Manfaat Penelitian ...........................................................................................
1.4.1 Manfaat Akademik ................................................................................
1.4.2 Manfaat Praktik.......................................................................................
1.5 Kerangka Pemikiran dan Hipotesis ..................................................................
1.5.1 Kerangka Pemikiran ................................................................................
1.5.2 Hipotesis .................................................................................................
1.6 Metodologi Penelitian ......................................................................................
1.7 Waktu dan Tempat Penelitian ...........................................................................
1
3
3
3
3
3
3
3
4
4
4
5
5
BAB II TINJAUAN PUSTAKA
2.1 Hematopoiesis .................................................................................................. 6
2.1.1 Periode Hematopoiesis pada manusia ....................................................... 6
2.1.2 Hematopoiesis Post Natal ......................................................................... 8
2.1.3 Organ-organ dan Faktor-faktor dalam Hematopoiesis ................................. 9
2.2 Eritropoiesis ..................................................................................................... 10
2.2.1 Tahapan Eritropoiesis............................................................................... 11
2.2.2 Eritropoietin dari Ginjal............................................................................ 11
2.3 Eritrosit atau Sel Darah Merah .......................................................................... 12
2.3.1 Fungsi dan Faktor yang Mendukung Eritrosit .......................................... 13
2.3.2 Normal Eritrosit dalam Tubuh .................................................................. 14
2.3.3 Destruksi Eritrosit .................................................................................... 14
2.4 Hemoglobin ...................................................................................................... 15
2.4.1 Struktur Hemoglobin ................................................................................ 15
2.4.2 Jenis-jenis Hemoglobin ............................................................................ 16
2.4.3 Fungsi Hemoglobin .................................................................................. 17
2.4.4 Kadar Hemoglobin .................................................................................. 17
ix
Universitas Kristen Maranatha
2.4.5 Faktor yang Memengaruhi Kadar Hemoglobin ......................................... 17
2.4.6 Sintesis Hemoglobin ................................................................................ 19
2.5 Hematokrit ....................................................................................................... 19
2.5.1 Faktor yang Memengaruhi Pemeriksaan Hematokrit ................................ 20
2.6 Anemia ............................................................................................................ 21
2.6.1 Definisi .................................................................................................... 21
2.6.2 Prevalensi................................................................................................. 21
2.6.3 Etiologi dan Klasifikasi ............................................................................ 22
2.6.4 Klasifikasi Anemia berdasarkan Berat-Ringannya .................................... 22
2.6.5 Mekanisme Terjadinya Anemia ............................................................... 22
2.6.6 Tanda dan Gejala Anemia ........................................................................ 23
2.6.7 Diagnosis Anemia ................................................................................... 24
2.7 Pemeriksaan Hemoglobin ................................................................................. 24
2.7.1 Cara Sahli ................................................................................................ 25
2.7.2 Cara Cyanmenthemoglobin ..................................................................... 25
2.7.3 Cara Tallqvist .......................................................................................... 26
2.7.4 Cara Sulfat .............................................................................................. 27
2.7.5 Kesalahan dalam Pemeriksaan Hemoglobin.............................................. 27
2.8 Pemeriksaan Hematokrit .................................................................................. 28
2.9 Hitung Jumlah Eritrosit .................................................................................... 29
2.9.1 Cara Manual ............................................................................................ 29
2.9.2 Cara Flow Cytometri ............................................................................... 29
2.10 Pemeriksaan Hemoglobin pada Penelitian ....................................................... 30
2.11 Kewaspadaan dan Ketelitian ........................................................................... 31
2.11.1 Faktor yang Memengaruhi Kewaspadaan dan Ketelitian ........................ 31
2.11.2 Susunan Saraf Pusat yang Mengatur Kewaspadaan dan Ketelitian ......... 32
2.11.3 Reticular Activating System .................................................................... 33
2.12 Pengaruh Anemia pada Kewaspadaan dan Ketelitian ...................................... 34
BAB III ALAT, BAHAN DAN METODE PENELITIAN
3.1 Alat dan Bahan Penelitian ................................................................................ 35
3.1.1 Alat Penelitian ......................................................................................... 35
3.1.2 Bahan Penelitian ...................................................................................... 35
3.2 Metode Penelitian ............................................................................................ 35
3.2.1 Tempat dan Waktu Penelitian .................................................................. 36
3.2.2 Populasi dan Sampel ................................................................................ 36
3.2.2.1 Populasi Penelitian .......................................................................... 36
3.2.2.2 Sampel Penelitian ........................................................................... 36
3.2.3 Kriteria Pemilihan Subjek .........................................................................36
3.2.3.1 Kriteria Inklusi ................................................................................ 36
3.2.3.2 Kriteria Eksklusi ............................................................................. 36
3.2.4 Cara Pemilihan Sampel ........................................................................... 37
3.2.5 Variabel dalam Penelitian ........................................................................ 37
3.2.6 Definisi Operasional Variabel .................................................................. 37
3.2.7 Tehnik Pengukuran/Prosedur Kerja dan Ukuran ....................................... 37
3.2.7.1 Prosedur Kerja Pengukuran Hemoglobin ........................................ 37
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Universitas Kristen Maranatha
3.2.7.2 Ukuran ............................................................................................ 38
3.2.7.3 Prosedur Kerja Tes Koran ............................................................... 38
3.2.7.4 Prosedur Kerja Johnson Pascal test ................................................ 39
3.2.7.5 Prosedur Penelitian ......................................................................... 39
3.2.8 Rencana Analisis ..................................................................................... 39
3.2.8.1 Analisis Data .................................................................................. 39
3.2.9 Hipotesis Statistik .................................................................................... 40
3.2.10 Kriteria Uji ............................................................................................ 40
3.2.11 Aspek Etik Penelitian ............................................................................ 40
BAB IV HASIL, PEMBAHASAN, DAN PENGUJIAN HIPOTESIS
PENELITIAN
4.1 Hasil Penelitian ................................................................................................ 41
4.2 Pembahasan Hasil Penelitian ............................................................................ 43
4.3 Pengujian Hipotesis Penelitian ......................................................................... 43
BAB V SIMPULAN DAN SARAN
5.1 Simpulan .......................................................................................................... 45
5.2 Saran ................................................................................................................ 45
DAFTAR PUSTAKA ........................................................................................... 46
LAMPIRAN .......................................................................................................... 49
RIWAYAT HIDUP............................................................................................... 57
xi
Universitas Kristen Maranatha
DAFTAR TABEL
Halaman
Batas Normal Kadar Hemoglobin........................................................... 17
Prevalensi Anemia di Dunia menurut WHO .......................................... 21
Klasifikasi Anemia Menurut Etiopatogenesis ......................................... 23
Hasil Pemeriksaan Kadar Hemoglobin ................................................... 41
Interpretasi Pemeriksaan Kadar Hemoglobin ......................................... 41
Waktu mengerjakan Johnson Pascal test pada kelompok Anemia dan
Non Anemia .......................................................................................... 42
Tabel 4.4 Hasil Additional test pada kelompok Anemia dan Non Anemia ............. 42
Tabel 2.1
Tabel 2.2
Tabel 2.3
Tabel 4.1
Tabel 4.2
Tabel 4.3
xii
Universitas Kristen Maranatha
DAFTAR GAMBAR
Halaman
Gambar 2.1 Diagram Hematopoiesis................................................................. 9
Gambar 2.2 Eritropoiesis .................................................................................. 12
Gambar 2.3 Struktur Eritrosit ........................................................................... 13
Gambar 2.4 Struktur Hemoglobin ..................................................................... 15
Gambar 2.5 Hemoglobimeter cara Sahli............................................................ 25
Gambar 2.6 Alat fotometer untuk cara cyanmethemoglobin .............................. 26
Gambar 2.7 Tallqvist Hemoglobin Scale ........................................................... 26
Gambar 2.8 Pemeriksaan Hemoglobin cara Sulfat ............................................ 27
Gambar 2.9 Penetapan nilai Hematokrit ............................................................ 28
Gambar 2.10 Hemoglobin Strip Test ................................................................. 30
xiii
Universitas Kristen Maranatha
DAFTAR LAMPIRAN
Halaman
Lampiran 1. Surat Keputusan Komisi Etik Penelitian .......................................
Lampiran 2. Surat Pernyataan Persetujuan Untuk Ikut Serta dalam Penelitian ...
Lampiran 3. Dokumentasi Penelitian (foto-foto) ..............................................
Lampiran 4. Output Hasil Pengujian Statistik....................................................
Lampiran 5. Contoh Additional test dan Johnson Pascal test.............................
Lampiran 6. Data Hasil Percobaan ....................................................................
49
50
51
52
54
56
xiv
Universitas Kristen Maranatha
LAMPIRAN
LAMPIRAN 1. SURAT KEPUTUSAN KOMISI ETIK PENELITIAN
Universitas Kristen Maranatha
LAMPIRAN 2. SURAT PERNYATAAN PERSETUJUAN UNTUK IKUT SERTA
DALAM PENELITIAN (INFORMED CONSENT)
KOMISI ETIK PENELITIAN
FAKULTAS KEDOKTERAN
UK MARANATHA - R.S. IMMANUEL
BANDUNG
SOP/008/01.0
Berlaku mulai:
Desember 2008
Email:
ethic.fkukmrsi@m
ed.maranatha.edu
Judul:
Formulir Protokol
SURAT PERNYATAAN PERSETUJUAN
UNTUK IKUT SERTA DALAM PENELITIAN
(INFORMED CONSENT)
Yang bertanda tangan dibawah ini:
Nama
:
Usia
:
Alamat
:
Pekerjaan
:
No. KTP/lainnya :
Dengan sesungguhnya menyatakan bahwa:
setelah mendapat keterangan sepenuhnya menyadari, mengerti, dan memahami tentang
tujuan, manfaat dan risiko yang mungkin timbul dalam penelitian, serta sewaktu-waktu
dapat mengundurkan diri dari keikut sertaannya, maka saya setuju ikut serta dalam
penelitian yang berjudul:
”Pengaruh Anemia terhadap Kewaspadaan dan Ketelitian pada Anak Usia
Sekolah”
Demikian surat pernyataan ini kami buat dengan sesungguhnya dan tanpa paksaan.
Mengetahui,
Penanggung jawab penelitian,
(
Christina Beatrice
)
Saksi-saksi:
1. …………………………… (
2. …………………………… (
Bandung,
Yang menyatakan
Peserta penelitian,
(
)
)
)
Universitas Kristen Maranatha
LAMPIRAN 3. DOKUMENTASI PENELITIAN
Subjek penelitian saat
mengerjakan tes yang diberikan
Stopwatch sebagai penanda waktu
mengerjakan Johnson Pascal test
Universitas Kristen Maranatha
Saat dilakukan pemeriksaan hemoglobin darah
LAMPIRAN 4.
OUTPUT HASIL PENGUJIAN STATISTIK
•
Johnson Pascal test
Group Statistics
kelompok
Johnson
N
Mean
Std. Deviation
Std. Error Mean
anemia
44
194.89
61.394
9.255
non
36
163.99
57.817
9.636
Independent Samples Test
Universitas Kristen Maranatha
Levene's
Test for
Equality of
Variances
t-test for Equality of Means
Sig.
F
Johnso
Equal
n
variances
Sig.
.994
t
(2-
Mean
Std. Error
Interval of the
tailed
Differenc
Differenc
Difference
)
e
e
df
.322 2.299
95% Confidence
Lower
Upper
78
.024
30.900
13.442
4.138
57.662
2.313 76.424
.023
30.900
13.361
4.292
57.509
assumed
Equal
variances
not
assumed
•
Additional test
Group Statistics
kelompok
Additional
N
Mean
Std. Deviation
Std. Error Mean
anemia
44
30.6477
8.06556
1.21593
non
36
34.6389
7.60884
1.26814
Independent Samples Test
Levene's
Test for
Equality of
Variances
t-test for Equality of Means
Universitas Kristen Maranatha
Additional
Equal
F
Sig.
t
.707
.403
-2.258
df
Std.
95% Confidence
Sig.
Mean
Error
Interval of the
(2-
Differenc
Differen
Difference
tailed)
e
ce
Lower
Upper
78
.027
-3.99116 1.76728
-7.50955
-.47278
-2.272 76.386
.026
-3.99116 1.75689
-7.49002
-.49230
variances
assumed
Equal
variances
not
assumed
Universitas Kristen Maranatha
LAMPIRAN 6. Hasil Percobaan
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
Hb
12,0
12,2
12,7
12,9
13,4
13,6
14,0
14,0
14,1
14,2
14,2
14,6
14,6
14,7
14,7
14,8
14,8
14,8
14,9
14,9
14,9
15,0
15,2
15,3
15,3
15,3
15,4
15,4
15,4
15,5
15,5
15,5
15,7
15,8
16,2
16,3
Non Anemia (>12 g/dL)
Add test
33.0
38.0
42.5
36.0
17.5
23.0
37.0
43.5
29.0
34.0
35.5
32.0
37.5
47.5
34.0
30.5
36.0
34.0
31.5
36.5
30.5
29.5
23.5
52.0
43.5
43.5
34.5
12.0
37.5
34.5
35.0
35.5
38.0
33.0
39.5
36.5
JP test
141.5
163.0
142.5
165.0
286.5
398.0
149.0
137.5
187.0
140.0
255.5
127.5
107.0
125.0
117.5
157.0
165.0
123.5
135.0
144.0
138.5
120.0
162.5
174.0
152.0
152.0
164.0
157.0
147.0
131.5
148.0
147.0
246.5
133.0
141.0
299.0
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
Hb
10,0
10,1
10,3
10,4
10,5
10,5
10,7
10,7
10,7
10,8
10,8
10,8
10,8
10,9
10,9
11,0
11,0
11,0
11,1
11,1
11,2
11,2
11,2
11,3
11,3
11,3
11,3
11,4
11,4
11,4
11,5
11,5
11,5
11,5
11,6
11,6
11,6
11,6
11,7
11,7
11,7
11,8
11,8
11,8
Anemia (
PENGARUH ANEMIA TERHADAP KEWASPADAAN DAN
KETELITIAN PADA ANAK USIA SEKOLAH DI SMP “X”
KABUPATEN JAWA BARAT
2011
Christina Beatrice, 2011
Pembimbing I : dr. Adrian Suhendra, Sp.PK., M.Kes
Pembimbing II: dr. Dani, M.Kes
Latar belakang : Setiap negara akan selalu mengadakan pembangunan nasional
dalam tujuannya untuk meningkatkan kualitas sumber daya manusianya. Di
Indonesia pembangunan kesehatan yang merupakan salah satu aspek dalam
pembangunan nasional masih terhambat berbagai masalah, antara lain masalah
kekurangan gizi seperti anemia. Angka kejadian anemia pada anak Indonesia
cukup tinggi, terutama di wilayah Jawa Barat. Dampak yang ditimbulkan anemia
pada anak antara lain meningkatkan angka kesakitan dan kematian, menghambat
pertumbuhan fisik, motorik dan mental, serta menurunkan daya tangkap belajar.
Keadaan ini tentu memprihatinkan bila menimpa anak-anak Indonesia yang akan
menjadi penerus pembangunan.
Tujuan : Mengetahui pengaruh anemia terhadap tingkat kewaspadaan dan
ketelitian pada anak usia sekolah.
Metode : Metode penelitiannya observational analitik dengan rancangan
penelitian case-control. Subjek penelitian diminta mengerjakan Additional test
serta Johnson Pascal test dan setelah itu akan dilakukan pemeriksaan kadar
hemoglobin darah melalui darah vena kapiler. Analisis data dilakukan dengan uji
T tidak berpasangan dengan α = 0.05.
Hasil : Rerata nilai Additional test pada kelompok anemia adalah sebesar 30,65
dan pada kelompok non anemia sebesar 34,64, sehingga didapat p-hitung 0,023.
Sedangkan hasil rerata waktu yang diperlukan dalam menyelesaikan Johnson
Pascal test pada kelompok anemia adalah 194,89 detik dan 163,99 detik yang
diperlukan pada kelompok non anemia, didapatkan p-hitung 0,026.
Simpulan : Anemia menurunkan kewaspadaan dan ketelitian pada anak usia
sekolah.
Kata kunci : anemia, anak sekolah, kewaspadaan, ketelitian
vii
Universitas Kristen Maranatha
ABSTRACT
THE EFFECT OF ANEMIA ON VIGILANCE AND THOROUGHNESS
IN THE SCHOOL-AGE CHILDREN AT THE “X” JUNIOR HIGH SCHOOL
DISTRICT IN WEST JAVA
2011
Christina Beatrice, 2011
Tutor I: dr. Adrian Suhendra, Sp.PK., M.Kes
Tutor II: dr. Dani, M.Kes
Backgrounds: Every country will always hold a national development in its
aim to improve the quality of human resources. Health development in Indonesia
which is one aspect of national development is still inhibited various
problems, including malnutrition such as anemia. The incidence of anemia in
Indonesian children is quite high, especially in West Java. Impact of anemia
especially in children among others increased morbidity and mortality, physical
growth, motor and mental are stunted and also learning comprehension is
decreased. This state of affairs is certainly sadden when it happens to the
Indonesian children who will be the successor of development.
Objectives: To find out whether anemia affects the level of vigilance and
thoroughness in the school-age children.
Methods: The method of this research is observational analysis with case-control
design. Research subjects are asked to do the Additional test and also the Johnson
Pascal test. After that, they will be measured the levels of blood hemoglobin by
venous blood capillaries. Data analysis was performed with independent-samples
T-test with α = 0.05.
Results: The mean value of anemia group on Additional test is 30.65 and nonanemic group at 34.64, so we get p= 0.023. While the average time required to
complete the Johnson Pascal test on the anemia group is 194,89 seconds and nonanemic group at 163,99 seconds, so p= 0.026.
Conclusions: Anemia reduce the level of vigilance and thoroughness in the
school-age children.
Key words: anemia, school-age children, vigilance, thoroughness
viii
Universitas Kristen Maranatha
DAFTAR ISI
Halaman
JUDUL ...............................................................................................................
i
LEMBAR PERSETUJUAN .............................................................................
ii
SURAT PERNYATAAN ................................................................................... iii
ABSTRAK........................................................................................................... iv
ABSTRACT........................................................................................................... v
KATA PENGANTAR.......................................................................................... vi
DAFTAR ISI ...................................................................................................... viii
DAFTAR TABEL ............................................................................................... xi
DAFTAR GAMBAR.......................................................................................... xii
DAFTAR LAMPIRAN ..................................................................................... xiii
BAB I PENDAHULUAN
1.1 Latar Belakang ..................................................................................................
1.2 Identifikasi Masalah.........................................................................................
1.3 Maksud dan Tujuan Penelitian .........................................................................
1.3.1 Maksud Penelitian ...................................................................................
1.3.2 Tujuan Penelitian.....................................................................................
1.4 Manfaat Penelitian ...........................................................................................
1.4.1 Manfaat Akademik ................................................................................
1.4.2 Manfaat Praktik.......................................................................................
1.5 Kerangka Pemikiran dan Hipotesis ..................................................................
1.5.1 Kerangka Pemikiran ................................................................................
1.5.2 Hipotesis .................................................................................................
1.6 Metodologi Penelitian ......................................................................................
1.7 Waktu dan Tempat Penelitian ...........................................................................
1
3
3
3
3
3
3
3
4
4
4
5
5
BAB II TINJAUAN PUSTAKA
2.1 Hematopoiesis .................................................................................................. 6
2.1.1 Periode Hematopoiesis pada manusia ....................................................... 6
2.1.2 Hematopoiesis Post Natal ......................................................................... 8
2.1.3 Organ-organ dan Faktor-faktor dalam Hematopoiesis ................................. 9
2.2 Eritropoiesis ..................................................................................................... 10
2.2.1 Tahapan Eritropoiesis............................................................................... 11
2.2.2 Eritropoietin dari Ginjal............................................................................ 11
2.3 Eritrosit atau Sel Darah Merah .......................................................................... 12
2.3.1 Fungsi dan Faktor yang Mendukung Eritrosit .......................................... 13
2.3.2 Normal Eritrosit dalam Tubuh .................................................................. 14
2.3.3 Destruksi Eritrosit .................................................................................... 14
2.4 Hemoglobin ...................................................................................................... 15
2.4.1 Struktur Hemoglobin ................................................................................ 15
2.4.2 Jenis-jenis Hemoglobin ............................................................................ 16
2.4.3 Fungsi Hemoglobin .................................................................................. 17
2.4.4 Kadar Hemoglobin .................................................................................. 17
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Universitas Kristen Maranatha
2.4.5 Faktor yang Memengaruhi Kadar Hemoglobin ......................................... 17
2.4.6 Sintesis Hemoglobin ................................................................................ 19
2.5 Hematokrit ....................................................................................................... 19
2.5.1 Faktor yang Memengaruhi Pemeriksaan Hematokrit ................................ 20
2.6 Anemia ............................................................................................................ 21
2.6.1 Definisi .................................................................................................... 21
2.6.2 Prevalensi................................................................................................. 21
2.6.3 Etiologi dan Klasifikasi ............................................................................ 22
2.6.4 Klasifikasi Anemia berdasarkan Berat-Ringannya .................................... 22
2.6.5 Mekanisme Terjadinya Anemia ............................................................... 22
2.6.6 Tanda dan Gejala Anemia ........................................................................ 23
2.6.7 Diagnosis Anemia ................................................................................... 24
2.7 Pemeriksaan Hemoglobin ................................................................................. 24
2.7.1 Cara Sahli ................................................................................................ 25
2.7.2 Cara Cyanmenthemoglobin ..................................................................... 25
2.7.3 Cara Tallqvist .......................................................................................... 26
2.7.4 Cara Sulfat .............................................................................................. 27
2.7.5 Kesalahan dalam Pemeriksaan Hemoglobin.............................................. 27
2.8 Pemeriksaan Hematokrit .................................................................................. 28
2.9 Hitung Jumlah Eritrosit .................................................................................... 29
2.9.1 Cara Manual ............................................................................................ 29
2.9.2 Cara Flow Cytometri ............................................................................... 29
2.10 Pemeriksaan Hemoglobin pada Penelitian ....................................................... 30
2.11 Kewaspadaan dan Ketelitian ........................................................................... 31
2.11.1 Faktor yang Memengaruhi Kewaspadaan dan Ketelitian ........................ 31
2.11.2 Susunan Saraf Pusat yang Mengatur Kewaspadaan dan Ketelitian ......... 32
2.11.3 Reticular Activating System .................................................................... 33
2.12 Pengaruh Anemia pada Kewaspadaan dan Ketelitian ...................................... 34
BAB III ALAT, BAHAN DAN METODE PENELITIAN
3.1 Alat dan Bahan Penelitian ................................................................................ 35
3.1.1 Alat Penelitian ......................................................................................... 35
3.1.2 Bahan Penelitian ...................................................................................... 35
3.2 Metode Penelitian ............................................................................................ 35
3.2.1 Tempat dan Waktu Penelitian .................................................................. 36
3.2.2 Populasi dan Sampel ................................................................................ 36
3.2.2.1 Populasi Penelitian .......................................................................... 36
3.2.2.2 Sampel Penelitian ........................................................................... 36
3.2.3 Kriteria Pemilihan Subjek .........................................................................36
3.2.3.1 Kriteria Inklusi ................................................................................ 36
3.2.3.2 Kriteria Eksklusi ............................................................................. 36
3.2.4 Cara Pemilihan Sampel ........................................................................... 37
3.2.5 Variabel dalam Penelitian ........................................................................ 37
3.2.6 Definisi Operasional Variabel .................................................................. 37
3.2.7 Tehnik Pengukuran/Prosedur Kerja dan Ukuran ....................................... 37
3.2.7.1 Prosedur Kerja Pengukuran Hemoglobin ........................................ 37
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3.2.7.2 Ukuran ............................................................................................ 38
3.2.7.3 Prosedur Kerja Tes Koran ............................................................... 38
3.2.7.4 Prosedur Kerja Johnson Pascal test ................................................ 39
3.2.7.5 Prosedur Penelitian ......................................................................... 39
3.2.8 Rencana Analisis ..................................................................................... 39
3.2.8.1 Analisis Data .................................................................................. 39
3.2.9 Hipotesis Statistik .................................................................................... 40
3.2.10 Kriteria Uji ............................................................................................ 40
3.2.11 Aspek Etik Penelitian ............................................................................ 40
BAB IV HASIL, PEMBAHASAN, DAN PENGUJIAN HIPOTESIS
PENELITIAN
4.1 Hasil Penelitian ................................................................................................ 41
4.2 Pembahasan Hasil Penelitian ............................................................................ 43
4.3 Pengujian Hipotesis Penelitian ......................................................................... 43
BAB V SIMPULAN DAN SARAN
5.1 Simpulan .......................................................................................................... 45
5.2 Saran ................................................................................................................ 45
DAFTAR PUSTAKA ........................................................................................... 46
LAMPIRAN .......................................................................................................... 49
RIWAYAT HIDUP............................................................................................... 57
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Universitas Kristen Maranatha
DAFTAR TABEL
Halaman
Batas Normal Kadar Hemoglobin........................................................... 17
Prevalensi Anemia di Dunia menurut WHO .......................................... 21
Klasifikasi Anemia Menurut Etiopatogenesis ......................................... 23
Hasil Pemeriksaan Kadar Hemoglobin ................................................... 41
Interpretasi Pemeriksaan Kadar Hemoglobin ......................................... 41
Waktu mengerjakan Johnson Pascal test pada kelompok Anemia dan
Non Anemia .......................................................................................... 42
Tabel 4.4 Hasil Additional test pada kelompok Anemia dan Non Anemia ............. 42
Tabel 2.1
Tabel 2.2
Tabel 2.3
Tabel 4.1
Tabel 4.2
Tabel 4.3
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DAFTAR GAMBAR
Halaman
Gambar 2.1 Diagram Hematopoiesis................................................................. 9
Gambar 2.2 Eritropoiesis .................................................................................. 12
Gambar 2.3 Struktur Eritrosit ........................................................................... 13
Gambar 2.4 Struktur Hemoglobin ..................................................................... 15
Gambar 2.5 Hemoglobimeter cara Sahli............................................................ 25
Gambar 2.6 Alat fotometer untuk cara cyanmethemoglobin .............................. 26
Gambar 2.7 Tallqvist Hemoglobin Scale ........................................................... 26
Gambar 2.8 Pemeriksaan Hemoglobin cara Sulfat ............................................ 27
Gambar 2.9 Penetapan nilai Hematokrit ............................................................ 28
Gambar 2.10 Hemoglobin Strip Test ................................................................. 30
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Universitas Kristen Maranatha
DAFTAR LAMPIRAN
Halaman
Lampiran 1. Surat Keputusan Komisi Etik Penelitian .......................................
Lampiran 2. Surat Pernyataan Persetujuan Untuk Ikut Serta dalam Penelitian ...
Lampiran 3. Dokumentasi Penelitian (foto-foto) ..............................................
Lampiran 4. Output Hasil Pengujian Statistik....................................................
Lampiran 5. Contoh Additional test dan Johnson Pascal test.............................
Lampiran 6. Data Hasil Percobaan ....................................................................
49
50
51
52
54
56
xiv
Universitas Kristen Maranatha
LAMPIRAN
LAMPIRAN 1. SURAT KEPUTUSAN KOMISI ETIK PENELITIAN
Universitas Kristen Maranatha
LAMPIRAN 2. SURAT PERNYATAAN PERSETUJUAN UNTUK IKUT SERTA
DALAM PENELITIAN (INFORMED CONSENT)
KOMISI ETIK PENELITIAN
FAKULTAS KEDOKTERAN
UK MARANATHA - R.S. IMMANUEL
BANDUNG
SOP/008/01.0
Berlaku mulai:
Desember 2008
Email:
ethic.fkukmrsi@m
ed.maranatha.edu
Judul:
Formulir Protokol
SURAT PERNYATAAN PERSETUJUAN
UNTUK IKUT SERTA DALAM PENELITIAN
(INFORMED CONSENT)
Yang bertanda tangan dibawah ini:
Nama
:
Usia
:
Alamat
:
Pekerjaan
:
No. KTP/lainnya :
Dengan sesungguhnya menyatakan bahwa:
setelah mendapat keterangan sepenuhnya menyadari, mengerti, dan memahami tentang
tujuan, manfaat dan risiko yang mungkin timbul dalam penelitian, serta sewaktu-waktu
dapat mengundurkan diri dari keikut sertaannya, maka saya setuju ikut serta dalam
penelitian yang berjudul:
”Pengaruh Anemia terhadap Kewaspadaan dan Ketelitian pada Anak Usia
Sekolah”
Demikian surat pernyataan ini kami buat dengan sesungguhnya dan tanpa paksaan.
Mengetahui,
Penanggung jawab penelitian,
(
Christina Beatrice
)
Saksi-saksi:
1. …………………………… (
2. …………………………… (
Bandung,
Yang menyatakan
Peserta penelitian,
(
)
)
)
Universitas Kristen Maranatha
LAMPIRAN 3. DOKUMENTASI PENELITIAN
Subjek penelitian saat
mengerjakan tes yang diberikan
Stopwatch sebagai penanda waktu
mengerjakan Johnson Pascal test
Universitas Kristen Maranatha
Saat dilakukan pemeriksaan hemoglobin darah
LAMPIRAN 4.
OUTPUT HASIL PENGUJIAN STATISTIK
•
Johnson Pascal test
Group Statistics
kelompok
Johnson
N
Mean
Std. Deviation
Std. Error Mean
anemia
44
194.89
61.394
9.255
non
36
163.99
57.817
9.636
Independent Samples Test
Universitas Kristen Maranatha
Levene's
Test for
Equality of
Variances
t-test for Equality of Means
Sig.
F
Johnso
Equal
n
variances
Sig.
.994
t
(2-
Mean
Std. Error
Interval of the
tailed
Differenc
Differenc
Difference
)
e
e
df
.322 2.299
95% Confidence
Lower
Upper
78
.024
30.900
13.442
4.138
57.662
2.313 76.424
.023
30.900
13.361
4.292
57.509
assumed
Equal
variances
not
assumed
•
Additional test
Group Statistics
kelompok
Additional
N
Mean
Std. Deviation
Std. Error Mean
anemia
44
30.6477
8.06556
1.21593
non
36
34.6389
7.60884
1.26814
Independent Samples Test
Levene's
Test for
Equality of
Variances
t-test for Equality of Means
Universitas Kristen Maranatha
Additional
Equal
F
Sig.
t
.707
.403
-2.258
df
Std.
95% Confidence
Sig.
Mean
Error
Interval of the
(2-
Differenc
Differen
Difference
tailed)
e
ce
Lower
Upper
78
.027
-3.99116 1.76728
-7.50955
-.47278
-2.272 76.386
.026
-3.99116 1.75689
-7.49002
-.49230
variances
assumed
Equal
variances
not
assumed
Universitas Kristen Maranatha
LAMPIRAN 6. Hasil Percobaan
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
Hb
12,0
12,2
12,7
12,9
13,4
13,6
14,0
14,0
14,1
14,2
14,2
14,6
14,6
14,7
14,7
14,8
14,8
14,8
14,9
14,9
14,9
15,0
15,2
15,3
15,3
15,3
15,4
15,4
15,4
15,5
15,5
15,5
15,7
15,8
16,2
16,3
Non Anemia (>12 g/dL)
Add test
33.0
38.0
42.5
36.0
17.5
23.0
37.0
43.5
29.0
34.0
35.5
32.0
37.5
47.5
34.0
30.5
36.0
34.0
31.5
36.5
30.5
29.5
23.5
52.0
43.5
43.5
34.5
12.0
37.5
34.5
35.0
35.5
38.0
33.0
39.5
36.5
JP test
141.5
163.0
142.5
165.0
286.5
398.0
149.0
137.5
187.0
140.0
255.5
127.5
107.0
125.0
117.5
157.0
165.0
123.5
135.0
144.0
138.5
120.0
162.5
174.0
152.0
152.0
164.0
157.0
147.0
131.5
148.0
147.0
246.5
133.0
141.0
299.0
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
Hb
10,0
10,1
10,3
10,4
10,5
10,5
10,7
10,7
10,7
10,8
10,8
10,8
10,8
10,9
10,9
11,0
11,0
11,0
11,1
11,1
11,2
11,2
11,2
11,3
11,3
11,3
11,3
11,4
11,4
11,4
11,5
11,5
11,5
11,5
11,6
11,6
11,6
11,6
11,7
11,7
11,7
11,8
11,8
11,8
Anemia (