Gambaran Penderita Anemia Hipokrom Mikrositer Di Rumah Sakit Immanuel.
ABSTRAK
KORELASI ANEMIA HIPOKROM MIKROSITER DENGAN USIA,
JENIS KELAMIN DAN INDEKS DARAH
Hendrik Budy, 2005. Pembimbing I : Dani Brataatmadja, dr, Sp.PK
Pembimbing II : Henki Pertamana,dr, Sp.PK
PendOOta anemia hipokrom mikrositer sering sekali sulit untuk didiagnosa
ketika kerusakannya sedang dalam tahap awal, sedang, atau fluctuating. Anemia
hipokrom mikrositer mempunyai prevalensi yang tinggi dan secara klinik sangat
penting. Dan terdeteksi pendOOta anemia mikrositer hipokrom kurang lebih 3%
dari semua pasien yang melakukan pengobatan di rumah sakit di Amerika.
Penelitian ini bertujuan untuk memberikan pengetahuan dan informasi
mengenai gambaran kasus anemia hipokrom mikrositer pOOapasien yang datang
ke Rumah Sakit lnunanuel pOOode bulan Agustus 2003 sampai September 2003
yang diharapkan dapat mendiagnosa dan memberikan tindakan medis yang cepat
dan tepat dalam pengendalian kasus anemia hipokrom mikrositer.
Karya tulis ini menggtUlakan metode survei deskripsi dari rekam medik.
Analisis
statistik
menggunakan
metode
box-plot,
sedangkan
untuk
membandingkan antara kelompok-kelompok variabel menggunakan metode one
way Anova. Pengambilan data dengan cara retrospektif dari instalasi laboratorium
pada Rumah Sakit lnunanuel Bandung. Data yang dipakai OOalah data dari
Agustus 2003- September 2003.
Gambaran dari 200 orang yang didapat dari rumah sakit Immanuel bulan
Agustus 2003 adalah sebagai bOOkut : Penderita anemia hipokrom mikrositik pria
dewasa 22 orang (11 %), anak laki-Iaki 6 orang (3%), wanita dewasa 32 orang
(16%), anak perempuan 5 orang (2.5%). Penderita anemia normokrom normositer
pria dewasa 43 orang (21.5%), anak laki-laki 19 orang (9.5%), wanita dewasa 50
orang (25%), anak perempuan 18 orang (9%). Penderita anemia makrositer pria
dewasa 2 omng (1%), anak laki-Iaki 0 orang (0%), wanita dewasa 3 orang (1.5%),
anak perempuan 0 orang (0%).
Dari 200 orang yang menderita anemia, 65 orang diantaranya menderita
anemia hipokrom mikrositer dengan jumlah yang paling banyak adalah pada
kelompok wanita dewasa sebanyak 32 orang (16%). Sedangkan menurut indeks
darah temyata HGB dan MCHC yang signifikan sedangkan HCT,MCY,MCH
tidak signifikan.
Diharapkan ada penelitian lebih lanjut dengan sampel yang lebih banyak dan
rentang waktu yang lebih panjang. Dan perlu dilakukan pemeriksaan lebih lanjut
pada pendOOta anemia hipokrom mikrositer sehingga kesalahan dalam diagnosis
dapat dihindarkan.
Kata kunei : Anemia Hipokrom Mikrositer
IV
ABSTRAC
THE DESCRIPTION
OF PATIENTS WITH HIPOCHROM
ANEMIA IN IMMANUEL HOSPITAL
MICROCYTIC
Hendrik Budy,2005. Tutor I : Oani Brataatmadja,dr,Sp.PK
Tutor II : Henki Pertamana,dr,Sp.PK
Most of patient with hipochrom microcytic anemia are difficult to be diagnosed
when the disease are on the early, moderate or fluctuating stage. The disease has
a high prevalency and clinically important. In some hospital in America, the
percentage of patients with hipochrom microcytic anemia detected was lower than
3%.
This experiment was done to learn the knowledge and information about
hipochrom microcytic anemia cases on patients visiting instalations Immanuel
hospital in August-September
2003 period so that it could be diagnosted and
given the patients get the early and effective therapy to control the disease.
The method used in this experiment is descriptive-survey
method taken from
medical records. Statistic analysis with box-plot method was used One way
Anova method was used to compare the variable group. The data was taken
retrospectivecally
from instalations laboratory in Immanuel Hospital Bandung
from August-September
2003 period
The descriptions of 200 pastients taken from instalations Immanuel ho~pital in
August 2003 period are follows: the adult patients (men) were 22 person (11%),
the child patients (men) were 6 persons (3%), the adult patients (women) were 32
person (16%), the child patient (women) were 5 person (2.5%) who sufferedfrom
hipochrom microcytic. The patients with normochrom normocytic anemia are as
follow: adult paients (men) were 43 person (21.5%), child patients (men) were 19
person (9.5%), adult patients (women) were 50 person (25%), child patients
(women) were 18 person (9%). The patients with macrocytic anemia are as follow
: adult patients (men) were 2 preson (1%), child patients (men) were 0 person
(0%), the adult patients (women) were 3 person (1.5%), the child patients
(women) were 0 person (0%).
Among 200 patients with anemia, 65 person of which suffered hipochrom
microcytic anemia with largest number onfemale adult patients group (32 person
or 16% of percentage).
Based on blood index show that HGB and MCHC are
statistically significant but HCr. MCVand MCH aren't.
It is suggested to do further researches using large sample and longger period.
Andfurther
examinations need to be done on patients with hipochrom microcytic
anemia so inaccurate diagnostic could be avoided.
Key Word: Hipochrom
Microcytic
Anemia
v
DAFT AR ISI
Halaman
LEMBAR PERSETUJUAN
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11
SURAT PERNYATAAN... ... ...
ABSTRAK...
III
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ABSTRACT...
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IV
v
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'"
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KATA PENGANTAR...
VI
DAFTAR ISI... ... ... ... ... ... ... ... ... ... ... .., ... ... ... ... ... ... ... ... ... ...
Vlll
DAFT AR T AS EL. .. .. . .. . .. . .. . .. . .. . . .. .. . .. . .. . . .. .. . .. . .. . .. . .. . .. . . .. . .. .. . ..
Xl
DAFTAR GAMBAR...
XIl
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... ... ... ...
DAFT AR LAMPIRAN
Xlll
DAFTAR DIAGRAM...
BAB(
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XIV
PENDAHULUAN
1.1 Latar Belakang. . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . .. . . . .
1
1.2 Identifikasi Masalah... ... ... ... ... ... ... ... ... ... ... ... ... ...
2
1.3 Maksud dan T1Uuan
2
...
1.4 Manfaat Karya Tulis Ilmiah... ... ... ... ... ... ... ... ... ... ...
2
1.5 Metodologi Penelitian...
3
1.6 Lokasi dan Waktll Penelitian
3
BAB n TINJAUAN PUST AKA
2.1 Eritrosit normal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 4
2.2 Anemia... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. 5
2.3 Gambaran klinis anemia... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
7
2.4 Gejala
8
2.5 Tanda... ... ... ... ... ... ... ... ... ... ... .., ... ... ... ... ... ... ... ... ... ...
8
2.6 KlasifikasidanLaboratorium
8
...
2.6.1 Indeks Sel Darah Merah
...
8
2.6.2 Klasifikasi Anemia Berdasarkan Penyebabnya
10
2.6.3 Pemeriksaan Laboratorium Lain Pada Anemia...
11
V111
2.7 Anemia Hipokrom Mikrositer
16
2.7.1 Anemia Defisiensi Besi
16
2.7.1.1 Aspek Gizi dan Metabolisme
16
2.7.1.2 Penyebaran Besi (Fe) Tubuh
16
2.7.1.3
Besi Makanan.
2.7.2 Penyerapan
Besi
2.7.3 Pengangkutan
2.7.4 Kebutuhan
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 17
18
Besi
... ...
19
19
Besi
2.7.5 Defisiensi Besi... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . 20
2.7.6 Hasil Laboratorium...
... ... .,. ... .,. ... ... ... ... ... ... ... ... ... ... .. 23
2.7.6.1 lndeks Sel Darah Merah dan SADT... ... ... ... ... ... ... 23
2.7.6.2 Serum Besi dan Kapasitas Total lkatan Besi (TIBC).. 23
2.7.6.3 Besi Sumsum Tulang
23
2.7.6.4 Serum Ferritin
24
2.7.6.5 Protoporfirin Eritrosit Bebas (FEP)...
24
2.7.7 Diagnosa
24
2.7.8 pengobatan... ... ...
... ... .., ... ... ... ... ... ... ... ... ... ...
25
2.7.9 Kelebihan Beban Besi (iron overload).. . .. . .. .. .. . .. ... ... .. . ... 27
2.8 Anemia pada Penyakit Kronis... ... ... ... ... ... ... ... .., ... ... ... .. . ... . 28
2.9 Anemia Sideroblastik... .. . .. . .. .. .. .. .. .. .. . .. . .. .. .. .. .. .. .. .. .. .. .. .
31
2.9.1 Anemia Sideroblastik-herediter,X-linked
32
2.9.2 Anemia Sideroblastik Didapat-Ideopatik
32
2.9.3 Anemia Sideroblastik Didapat-Seklmder...
2.9.4 Keracunan Timah Hitam... ...
... 33
... ...
. 34
2.9.5 Patogenesis Anemia Sideroblastik
34
2.9.6 Gangguan Sintesis Heme...
... ...
2.9.7 Terapi dan Diagnosis Anemia Sideroblastik
36
37
2.10 Sindrom Talasemia
2.10.1 Sindroma Talasemia-a
2.10.2 Sindroma Talasemia
2.10.3 Talasemia
37
~ Mayor...
Intermedia...
IX
... 35
... ...
...
38
. . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . ... 39
2.10.4 Trait ~-Talasemia (minor)... ... ...
... ... ... ...
39
2.10.5 Gambaran Klinis Talasemia Secara Umum
2.10.6 Diagnosis...
... ... ... ... ...
2. 10.7 Pengobatan...
2.11 Diagnosis
... ...
......
. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Diferensial
Anemia Hipokrom...
BAB III BAHAN DAN METODE
3.1 Bahan Penelitian...
... ...
40
40
... ... ... ... ... .., .,. ... ..
42
PENELITIAN
... ... ... ... ... ... ... ... ... ... ... .., ... ... ... ... ...
44
3.2 Metode Penelitian
44
3.3 Analisis
44
Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .
BAB IV HASIL DAN PEMBAHASAN
4.1 Hasil Penelitian dan Pembahasan
46
BAB V KESIMPULAN DAN SARAN
DAFTAR
5.1 Kesimpulan
56
5.2 Saran. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
PUSTAKA...
... ... ... ... ... ... ... ... ... .., ... ... ... ... ... ... ... ... ...
57
LAMPI RAN ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
59
RIW A Y AT HIDUP...
88
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ..
x
DAFTAR TABEL
Halaman
Tabel 2.1
Nilai-nilai Normal Sel Darah Merah Orang Dewasa
6
Tabel 2.2
Klasifikasi Anemia
9
Tabel2.3
Faktor yang Mengganggu Respon Retikulosit Terhadap
Anemia.
..............................................................
Tabel 2.4
Variasi Tipe Hb dan Arti Klinisnya... .. . .. . . .. .
Tabel 2.5
Distribusi Besi Tubuh
17
Tabel2.6
Penyerapan Besi
18
Tabel2.7
Perkiraan Kebutuhan Besi Setiap Hari (unit adalah mg/hari).
20
Tabel2.8
Sebab Defisiensi Besi
22
Tabel2.9
Ferritin Serum. unit ~lg/L
24
Tabel 2.10
Kegagalan Respon Terhadap Besi Oral
26
Tabel2.11
Kelebihan beban Besi (iron overload)
28
Tabel 2.12
Talasemia
38
Tabel 2.13
Beberapa Lesi Genetik yang Lebih Umum Bertanggung
Tabel2.14
.. . . .. .. . .. .
12
15
Jawab untuk P-Talasemia
39
Diagnosis Laboratorium Anemia Hipokrom
43
Tabel H-VI. 1 Jumlah dan Persentase Penderita Anemia Berdasarkan
Jenis Anemia dan Kelompok Penderita
46
Tabel H-VI.2 Hasil Pengamatan HGB, HCT, MCV, MCH dan MCHC
Dari 65 Penderita Anemia Hipokrom Mikrositer... . . . ... .
Xl
48
DAFTARGAMBAR
Halaman
Gambar L2.1
Anemia Defisiensi Besi 40x
77
Gambar L2.2
Anemia Defisiensi Besi lOx
77
Gambar L2.3
Kuku Koilonikia..
78
Gambar L2.4
Lidah Penderita Anemia Defisiensi Besi
78
Gambar L2.6
Mukosa Penderita Anemia Defisiensi Besi
79
Gambar L2.7
Sumsum Tulang Pada Anemia Defisiensi Besi
80
Gambar L3. 1
T alasemia.. . . . . .. . . .. . .. .. . . .. .. . .. .
81
Gambar L3.2
Peningkatan
Gambar L3.3
a Talasemia
82
Gambar L3.4
~ Talasemia
82
Gambar L3.5
Sumsum Tulang Penderita
Gambar L3.6
Sel Target Pada Penderita Talasemia
83
Gambar L4.1
Sumsum Tulang Pada Anemia Sideroblastik
84
Gambar L4.2
Sediaan Darah Tepi Anemia Sideroblastik
84
Gambar L5.1
Alat Hematology Analyzer Sysmex
85
Gambar L5.2
Hasil Hematology Analyzer Sysmex XT-1800
85
Gambar L5.3
Hasil Hematology Analyzer Sysmex XT-1800L
86
. . .. . .. . . . . . . . . .. .. . . . . . .. .
Besi Sumsum Tulang Pada Talasemia
xu
~ Talasemia
81
83
DAFT AR LAMPIRAN
Halaman
Lampiran I
Hasil Perhitungan Statistik. ..
.. . ..
..
. ... ...
Lampiran II
Gambar-Gambar Anemia Defisiensi Besi. . . .. . . . . . .. . . . .. ...
59
77
Lampiran III Gambar-Gambar Talasemia
81
Lampiran IV Gambar-Gambar Anemia Sideroblastik.. . ... . .. .. . . . . ...
84
Lampiran V
85
Gambar Alat-alat Serta Hasilnya
Lampiran VI Diagram Hasil
87
Xlll
DAFTAR
DIAGRAM
Halaman
L6. Diagram hasil... ... ... ... ... ... ... .,. ... .., ... ... ... ... ... ... ... ... ... ... ... ... ...
XlV
87
LAMPmAN I
BASIL PERHITUNGAN STATISTIK
OUTPUT PERHITUNGAN
MELALUI PERANGKAT LUNAK MEDCALC
Variable
HGB
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
95% CI for the median
Variance
Standard deviation
Relative standard deviation
Standard error of the mean
65
2.8000
14.0000
10.0262
9.5240 to 10.5283
10.0000
9.5070 to 10.6733
4.1063
2.0264
0.2021 (20.21%)
0.2513
Coefficient of Skewness
Coefficient of Kurtosis
-0.4594
1.5087
Kolmogorov-Smirnov test
for Normal distribution
accept
(P=0.1188)
(P=0.0443)
Normality
(P=0.699)
Percentiles
95% Confidence Interval
2.5
6.2250
to
7.0750
5
to
10
7.8000
6.3157 to 8.4995
25
8.9000
7.8810 to 9.8000
75
11.0750
10.6000 to 12.5190
90
13.0000
11.4000 to 13.6265
95
13.4250
to
97.5
13.7625
to
-----------------------------------------------------------Subgroup : KELOMPOK
PRIA ANAK
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
Variance
Standard deviation
Relative standard deviation
Standard error of the mean
6
9.3000
13.5000
10.9167
9.1601 to 12.6732
10.1500
2.8017
1.6738
0.1533 (15.33%)
0.6833
Coefficient of Skewness
Coefficient of Kurtosis
0.9609
-0.9501 (P=0.5243)
Kolmogorov-Smirnov test
for Normal distribution
accept
59
Normality
(P=0.437)
60
Percentiles
2.5
5
10
25
75
90
95
97.5
9.3600
9.9000
12.5000
13.4000
95% Confidence Interval
to
to
to
to
to
to
to
to
-----------------------------------------------------------Subgroup
: KELOMPOK = PRIA DEWASA
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
95% CI for the median
Variance
standard deviation
Relative standard deviation
Standard error of the mean
22
2.8000
14.0000
10.7455
9.5406 to 11.9503
11.1500
9.9000 to 12.9571
7.3845
2.7174
0.2529 (25.29%)
0.5794
Coefficient of Skewness
Coefficient of Kurtosis
-1.2894
2.2103
(P=0.0133)
(P=0.0609)
Kolmogorov-Smirnov test
for Normal distribution
accept
Percentiles
2.5
5
10
25
75
90
95
97.5
95% Confidence Interval
to
to
to
6.2856 to 11.1565
11.1435 to 13.7799
to
to
to
2.9700
4.8400
7.3900
9.9000
13.0000
13.5200
13.8800
13.9900
Normality
(P=0.420)
-----------------------------------------------------------: KELOMPOK
WANITA ANAK
Subgroup
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
Variance
Standard deviation
Relative standard deviation
Standard error of the mean
Coefficient of Skewness
Coefficient of Kurtosis
5
9.1000
11. 4000
10.4600
9.0673
to 11.8527
11.0000
1.2580
1.1216
0.1072
(10.72%)
0.5016
-0.5575
-3.0002
(P=0.1461)
Kolmogorov-Smirnov test
for Normal distribution
accept
Percentiles
2.5
5
95% Confidence Interval
to
to
Normality
(P=0.736)
61
10
25
75
90
95
97.5
to
to
to
to
to
to
9.1000
9.3250
11.4000
11. 4000
-----------------------------------------------------------: KELOMPOK = WANITA DEWASA
Subgroup
32
6.4000
11.6000
9.2969
8.8184 to 9.7753
9.2000
8.5415 to 10.1585
Sample size
Lowest value
Highest value
Arithmetic
mean
95% CI for the mean
Median
95% CI
Variance
Standard
Relative
Standard
for the median
1.7610
1.3270
deviation
standard deviation
error of the mean
Coefficient of Skewness
Coefficient of Kurtosis
Ko1mogorov-Smirnov test
for Normal distribution
Percentiles
2.5
5
10
25
75
90
95
97.5
0.1427 (14.27%)
0.2346
-0.2340
-0.9070
accept
(P=0.5521)
(P=0.2328)
Normality
(P=0.736)
95~; Confidence Interval
6.6700
7.3300
7.6700
8.0500
10.6000
10.8600
11.0000
11.4200
to
to
to
7.6678 to 9.1673
9.8109 to 10.8643
to
to
to
62
14
........................................
12
..............
.................................................................................-..............
10
..............
..-u..-
..
III
~
z
...
8
................--......
...
.........
o
............
4
.....
o
2
...
PRIAANAK
...
PRIA DEWASA
WANITAANAK
......
WANITADEWASA
KELOIo4POK
Data
Factor codes
HGB
KELOMPOK
Sample size
65
Source of variation
Sum of squares
D.F. Mean
------------------------------------------------------------Between groups
(influence factor)
within groups
(other fluctuations)
square
34.1010
3
11.3670
228.7046
61
3.7493
------------------------------------------------------------Total
262.8055
64
-------------------------------------------------------------
F-ratio
3.032
Significance level : P = 0.036
------------------------------------------------------------Student-Newrnan-Keuls
Factor
(1)
(2)
(3)
(4)
PRIA ANAK
PRIA DEWASA
WANITA ANAK
WANITA DEWASA
test
n
6
22
5
32
for all pairwise comparisons
Mean
Different
(P
KORELASI ANEMIA HIPOKROM MIKROSITER DENGAN USIA,
JENIS KELAMIN DAN INDEKS DARAH
Hendrik Budy, 2005. Pembimbing I : Dani Brataatmadja, dr, Sp.PK
Pembimbing II : Henki Pertamana,dr, Sp.PK
PendOOta anemia hipokrom mikrositer sering sekali sulit untuk didiagnosa
ketika kerusakannya sedang dalam tahap awal, sedang, atau fluctuating. Anemia
hipokrom mikrositer mempunyai prevalensi yang tinggi dan secara klinik sangat
penting. Dan terdeteksi pendOOta anemia mikrositer hipokrom kurang lebih 3%
dari semua pasien yang melakukan pengobatan di rumah sakit di Amerika.
Penelitian ini bertujuan untuk memberikan pengetahuan dan informasi
mengenai gambaran kasus anemia hipokrom mikrositer pOOapasien yang datang
ke Rumah Sakit lnunanuel pOOode bulan Agustus 2003 sampai September 2003
yang diharapkan dapat mendiagnosa dan memberikan tindakan medis yang cepat
dan tepat dalam pengendalian kasus anemia hipokrom mikrositer.
Karya tulis ini menggtUlakan metode survei deskripsi dari rekam medik.
Analisis
statistik
menggunakan
metode
box-plot,
sedangkan
untuk
membandingkan antara kelompok-kelompok variabel menggunakan metode one
way Anova. Pengambilan data dengan cara retrospektif dari instalasi laboratorium
pada Rumah Sakit lnunanuel Bandung. Data yang dipakai OOalah data dari
Agustus 2003- September 2003.
Gambaran dari 200 orang yang didapat dari rumah sakit Immanuel bulan
Agustus 2003 adalah sebagai bOOkut : Penderita anemia hipokrom mikrositik pria
dewasa 22 orang (11 %), anak laki-Iaki 6 orang (3%), wanita dewasa 32 orang
(16%), anak perempuan 5 orang (2.5%). Penderita anemia normokrom normositer
pria dewasa 43 orang (21.5%), anak laki-laki 19 orang (9.5%), wanita dewasa 50
orang (25%), anak perempuan 18 orang (9%). Penderita anemia makrositer pria
dewasa 2 omng (1%), anak laki-Iaki 0 orang (0%), wanita dewasa 3 orang (1.5%),
anak perempuan 0 orang (0%).
Dari 200 orang yang menderita anemia, 65 orang diantaranya menderita
anemia hipokrom mikrositer dengan jumlah yang paling banyak adalah pada
kelompok wanita dewasa sebanyak 32 orang (16%). Sedangkan menurut indeks
darah temyata HGB dan MCHC yang signifikan sedangkan HCT,MCY,MCH
tidak signifikan.
Diharapkan ada penelitian lebih lanjut dengan sampel yang lebih banyak dan
rentang waktu yang lebih panjang. Dan perlu dilakukan pemeriksaan lebih lanjut
pada pendOOta anemia hipokrom mikrositer sehingga kesalahan dalam diagnosis
dapat dihindarkan.
Kata kunei : Anemia Hipokrom Mikrositer
IV
ABSTRAC
THE DESCRIPTION
OF PATIENTS WITH HIPOCHROM
ANEMIA IN IMMANUEL HOSPITAL
MICROCYTIC
Hendrik Budy,2005. Tutor I : Oani Brataatmadja,dr,Sp.PK
Tutor II : Henki Pertamana,dr,Sp.PK
Most of patient with hipochrom microcytic anemia are difficult to be diagnosed
when the disease are on the early, moderate or fluctuating stage. The disease has
a high prevalency and clinically important. In some hospital in America, the
percentage of patients with hipochrom microcytic anemia detected was lower than
3%.
This experiment was done to learn the knowledge and information about
hipochrom microcytic anemia cases on patients visiting instalations Immanuel
hospital in August-September
2003 period so that it could be diagnosted and
given the patients get the early and effective therapy to control the disease.
The method used in this experiment is descriptive-survey
method taken from
medical records. Statistic analysis with box-plot method was used One way
Anova method was used to compare the variable group. The data was taken
retrospectivecally
from instalations laboratory in Immanuel Hospital Bandung
from August-September
2003 period
The descriptions of 200 pastients taken from instalations Immanuel ho~pital in
August 2003 period are follows: the adult patients (men) were 22 person (11%),
the child patients (men) were 6 persons (3%), the adult patients (women) were 32
person (16%), the child patient (women) were 5 person (2.5%) who sufferedfrom
hipochrom microcytic. The patients with normochrom normocytic anemia are as
follow: adult paients (men) were 43 person (21.5%), child patients (men) were 19
person (9.5%), adult patients (women) were 50 person (25%), child patients
(women) were 18 person (9%). The patients with macrocytic anemia are as follow
: adult patients (men) were 2 preson (1%), child patients (men) were 0 person
(0%), the adult patients (women) were 3 person (1.5%), the child patients
(women) were 0 person (0%).
Among 200 patients with anemia, 65 person of which suffered hipochrom
microcytic anemia with largest number onfemale adult patients group (32 person
or 16% of percentage).
Based on blood index show that HGB and MCHC are
statistically significant but HCr. MCVand MCH aren't.
It is suggested to do further researches using large sample and longger period.
Andfurther
examinations need to be done on patients with hipochrom microcytic
anemia so inaccurate diagnostic could be avoided.
Key Word: Hipochrom
Microcytic
Anemia
v
DAFT AR ISI
Halaman
LEMBAR PERSETUJUAN
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SURAT PERNYATAAN... ... ...
ABSTRAK...
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ABSTRACT...
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KATA PENGANTAR...
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DAFTAR ISI... ... ... ... ... ... ... ... ... ... ... .., ... ... ... ... ... ... ... ... ... ...
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DAFT AR T AS EL. .. .. . .. . .. . .. . .. . .. . . .. .. . .. . .. . . .. .. . .. . .. . .. . .. . .. . . .. . .. .. . ..
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DAFTAR GAMBAR...
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DAFT AR LAMPIRAN
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DAFTAR DIAGRAM...
BAB(
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PENDAHULUAN
1.1 Latar Belakang. . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . .. . . . .
1
1.2 Identifikasi Masalah... ... ... ... ... ... ... ... ... ... ... ... ... ...
2
1.3 Maksud dan T1Uuan
2
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1.4 Manfaat Karya Tulis Ilmiah... ... ... ... ... ... ... ... ... ... ...
2
1.5 Metodologi Penelitian...
3
1.6 Lokasi dan Waktll Penelitian
3
BAB n TINJAUAN PUST AKA
2.1 Eritrosit normal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 4
2.2 Anemia... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. 5
2.3 Gambaran klinis anemia... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
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2.4 Gejala
8
2.5 Tanda... ... ... ... ... ... ... ... ... ... ... .., ... ... ... ... ... ... ... ... ... ...
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2.6 KlasifikasidanLaboratorium
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2.6.1 Indeks Sel Darah Merah
...
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2.6.2 Klasifikasi Anemia Berdasarkan Penyebabnya
10
2.6.3 Pemeriksaan Laboratorium Lain Pada Anemia...
11
V111
2.7 Anemia Hipokrom Mikrositer
16
2.7.1 Anemia Defisiensi Besi
16
2.7.1.1 Aspek Gizi dan Metabolisme
16
2.7.1.2 Penyebaran Besi (Fe) Tubuh
16
2.7.1.3
Besi Makanan.
2.7.2 Penyerapan
Besi
2.7.3 Pengangkutan
2.7.4 Kebutuhan
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 17
18
Besi
... ...
19
19
Besi
2.7.5 Defisiensi Besi... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . 20
2.7.6 Hasil Laboratorium...
... ... .,. ... .,. ... ... ... ... ... ... ... ... ... ... .. 23
2.7.6.1 lndeks Sel Darah Merah dan SADT... ... ... ... ... ... ... 23
2.7.6.2 Serum Besi dan Kapasitas Total lkatan Besi (TIBC).. 23
2.7.6.3 Besi Sumsum Tulang
23
2.7.6.4 Serum Ferritin
24
2.7.6.5 Protoporfirin Eritrosit Bebas (FEP)...
24
2.7.7 Diagnosa
24
2.7.8 pengobatan... ... ...
... ... .., ... ... ... ... ... ... ... ... ... ...
25
2.7.9 Kelebihan Beban Besi (iron overload).. . .. . .. .. .. . .. ... ... .. . ... 27
2.8 Anemia pada Penyakit Kronis... ... ... ... ... ... ... ... .., ... ... ... .. . ... . 28
2.9 Anemia Sideroblastik... .. . .. . .. .. .. .. .. .. .. . .. . .. .. .. .. .. .. .. .. .. .. .. .
31
2.9.1 Anemia Sideroblastik-herediter,X-linked
32
2.9.2 Anemia Sideroblastik Didapat-Ideopatik
32
2.9.3 Anemia Sideroblastik Didapat-Seklmder...
2.9.4 Keracunan Timah Hitam... ...
... 33
... ...
. 34
2.9.5 Patogenesis Anemia Sideroblastik
34
2.9.6 Gangguan Sintesis Heme...
... ...
2.9.7 Terapi dan Diagnosis Anemia Sideroblastik
36
37
2.10 Sindrom Talasemia
2.10.1 Sindroma Talasemia-a
2.10.2 Sindroma Talasemia
2.10.3 Talasemia
37
~ Mayor...
Intermedia...
IX
... 35
... ...
...
38
. . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . ... 39
2.10.4 Trait ~-Talasemia (minor)... ... ...
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2.10.5 Gambaran Klinis Talasemia Secara Umum
2.10.6 Diagnosis...
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2. 10.7 Pengobatan...
2.11 Diagnosis
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. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Diferensial
Anemia Hipokrom...
BAB III BAHAN DAN METODE
3.1 Bahan Penelitian...
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PENELITIAN
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3.2 Metode Penelitian
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3.3 Analisis
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Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .
BAB IV HASIL DAN PEMBAHASAN
4.1 Hasil Penelitian dan Pembahasan
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BAB V KESIMPULAN DAN SARAN
DAFTAR
5.1 Kesimpulan
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5.2 Saran. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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PUSTAKA...
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LAMPI RAN ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
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RIW A Y AT HIDUP...
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DAFTAR TABEL
Halaman
Tabel 2.1
Nilai-nilai Normal Sel Darah Merah Orang Dewasa
6
Tabel 2.2
Klasifikasi Anemia
9
Tabel2.3
Faktor yang Mengganggu Respon Retikulosit Terhadap
Anemia.
..............................................................
Tabel 2.4
Variasi Tipe Hb dan Arti Klinisnya... .. . .. . . .. .
Tabel 2.5
Distribusi Besi Tubuh
17
Tabel2.6
Penyerapan Besi
18
Tabel2.7
Perkiraan Kebutuhan Besi Setiap Hari (unit adalah mg/hari).
20
Tabel2.8
Sebab Defisiensi Besi
22
Tabel2.9
Ferritin Serum. unit ~lg/L
24
Tabel 2.10
Kegagalan Respon Terhadap Besi Oral
26
Tabel2.11
Kelebihan beban Besi (iron overload)
28
Tabel 2.12
Talasemia
38
Tabel 2.13
Beberapa Lesi Genetik yang Lebih Umum Bertanggung
Tabel2.14
.. . . .. .. . .. .
12
15
Jawab untuk P-Talasemia
39
Diagnosis Laboratorium Anemia Hipokrom
43
Tabel H-VI. 1 Jumlah dan Persentase Penderita Anemia Berdasarkan
Jenis Anemia dan Kelompok Penderita
46
Tabel H-VI.2 Hasil Pengamatan HGB, HCT, MCV, MCH dan MCHC
Dari 65 Penderita Anemia Hipokrom Mikrositer... . . . ... .
Xl
48
DAFTARGAMBAR
Halaman
Gambar L2.1
Anemia Defisiensi Besi 40x
77
Gambar L2.2
Anemia Defisiensi Besi lOx
77
Gambar L2.3
Kuku Koilonikia..
78
Gambar L2.4
Lidah Penderita Anemia Defisiensi Besi
78
Gambar L2.6
Mukosa Penderita Anemia Defisiensi Besi
79
Gambar L2.7
Sumsum Tulang Pada Anemia Defisiensi Besi
80
Gambar L3. 1
T alasemia.. . . . . .. . . .. . .. .. . . .. .. . .. .
81
Gambar L3.2
Peningkatan
Gambar L3.3
a Talasemia
82
Gambar L3.4
~ Talasemia
82
Gambar L3.5
Sumsum Tulang Penderita
Gambar L3.6
Sel Target Pada Penderita Talasemia
83
Gambar L4.1
Sumsum Tulang Pada Anemia Sideroblastik
84
Gambar L4.2
Sediaan Darah Tepi Anemia Sideroblastik
84
Gambar L5.1
Alat Hematology Analyzer Sysmex
85
Gambar L5.2
Hasil Hematology Analyzer Sysmex XT-1800
85
Gambar L5.3
Hasil Hematology Analyzer Sysmex XT-1800L
86
. . .. . .. . . . . . . . . .. .. . . . . . .. .
Besi Sumsum Tulang Pada Talasemia
xu
~ Talasemia
81
83
DAFT AR LAMPIRAN
Halaman
Lampiran I
Hasil Perhitungan Statistik. ..
.. . ..
..
. ... ...
Lampiran II
Gambar-Gambar Anemia Defisiensi Besi. . . .. . . . . . .. . . . .. ...
59
77
Lampiran III Gambar-Gambar Talasemia
81
Lampiran IV Gambar-Gambar Anemia Sideroblastik.. . ... . .. .. . . . . ...
84
Lampiran V
85
Gambar Alat-alat Serta Hasilnya
Lampiran VI Diagram Hasil
87
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DAFTAR
DIAGRAM
Halaman
L6. Diagram hasil... ... ... ... ... ... ... .,. ... .., ... ... ... ... ... ... ... ... ... ... ... ... ...
XlV
87
LAMPmAN I
BASIL PERHITUNGAN STATISTIK
OUTPUT PERHITUNGAN
MELALUI PERANGKAT LUNAK MEDCALC
Variable
HGB
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
95% CI for the median
Variance
Standard deviation
Relative standard deviation
Standard error of the mean
65
2.8000
14.0000
10.0262
9.5240 to 10.5283
10.0000
9.5070 to 10.6733
4.1063
2.0264
0.2021 (20.21%)
0.2513
Coefficient of Skewness
Coefficient of Kurtosis
-0.4594
1.5087
Kolmogorov-Smirnov test
for Normal distribution
accept
(P=0.1188)
(P=0.0443)
Normality
(P=0.699)
Percentiles
95% Confidence Interval
2.5
6.2250
to
7.0750
5
to
10
7.8000
6.3157 to 8.4995
25
8.9000
7.8810 to 9.8000
75
11.0750
10.6000 to 12.5190
90
13.0000
11.4000 to 13.6265
95
13.4250
to
97.5
13.7625
to
-----------------------------------------------------------Subgroup : KELOMPOK
PRIA ANAK
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
Variance
Standard deviation
Relative standard deviation
Standard error of the mean
6
9.3000
13.5000
10.9167
9.1601 to 12.6732
10.1500
2.8017
1.6738
0.1533 (15.33%)
0.6833
Coefficient of Skewness
Coefficient of Kurtosis
0.9609
-0.9501 (P=0.5243)
Kolmogorov-Smirnov test
for Normal distribution
accept
59
Normality
(P=0.437)
60
Percentiles
2.5
5
10
25
75
90
95
97.5
9.3600
9.9000
12.5000
13.4000
95% Confidence Interval
to
to
to
to
to
to
to
to
-----------------------------------------------------------Subgroup
: KELOMPOK = PRIA DEWASA
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
95% CI for the median
Variance
standard deviation
Relative standard deviation
Standard error of the mean
22
2.8000
14.0000
10.7455
9.5406 to 11.9503
11.1500
9.9000 to 12.9571
7.3845
2.7174
0.2529 (25.29%)
0.5794
Coefficient of Skewness
Coefficient of Kurtosis
-1.2894
2.2103
(P=0.0133)
(P=0.0609)
Kolmogorov-Smirnov test
for Normal distribution
accept
Percentiles
2.5
5
10
25
75
90
95
97.5
95% Confidence Interval
to
to
to
6.2856 to 11.1565
11.1435 to 13.7799
to
to
to
2.9700
4.8400
7.3900
9.9000
13.0000
13.5200
13.8800
13.9900
Normality
(P=0.420)
-----------------------------------------------------------: KELOMPOK
WANITA ANAK
Subgroup
Sample size
Lowest value
Highest value
Arithmetic mean
95% CI for the mean
Median
Variance
Standard deviation
Relative standard deviation
Standard error of the mean
Coefficient of Skewness
Coefficient of Kurtosis
5
9.1000
11. 4000
10.4600
9.0673
to 11.8527
11.0000
1.2580
1.1216
0.1072
(10.72%)
0.5016
-0.5575
-3.0002
(P=0.1461)
Kolmogorov-Smirnov test
for Normal distribution
accept
Percentiles
2.5
5
95% Confidence Interval
to
to
Normality
(P=0.736)
61
10
25
75
90
95
97.5
to
to
to
to
to
to
9.1000
9.3250
11.4000
11. 4000
-----------------------------------------------------------: KELOMPOK = WANITA DEWASA
Subgroup
32
6.4000
11.6000
9.2969
8.8184 to 9.7753
9.2000
8.5415 to 10.1585
Sample size
Lowest value
Highest value
Arithmetic
mean
95% CI for the mean
Median
95% CI
Variance
Standard
Relative
Standard
for the median
1.7610
1.3270
deviation
standard deviation
error of the mean
Coefficient of Skewness
Coefficient of Kurtosis
Ko1mogorov-Smirnov test
for Normal distribution
Percentiles
2.5
5
10
25
75
90
95
97.5
0.1427 (14.27%)
0.2346
-0.2340
-0.9070
accept
(P=0.5521)
(P=0.2328)
Normality
(P=0.736)
95~; Confidence Interval
6.6700
7.3300
7.6700
8.0500
10.6000
10.8600
11.0000
11.4200
to
to
to
7.6678 to 9.1673
9.8109 to 10.8643
to
to
to
62
14
........................................
12
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10
..............
..-u..-
..
III
~
z
...
8
................--......
...
.........
o
............
4
.....
o
2
...
PRIAANAK
...
PRIA DEWASA
WANITAANAK
......
WANITADEWASA
KELOIo4POK
Data
Factor codes
HGB
KELOMPOK
Sample size
65
Source of variation
Sum of squares
D.F. Mean
------------------------------------------------------------Between groups
(influence factor)
within groups
(other fluctuations)
square
34.1010
3
11.3670
228.7046
61
3.7493
------------------------------------------------------------Total
262.8055
64
-------------------------------------------------------------
F-ratio
3.032
Significance level : P = 0.036
------------------------------------------------------------Student-Newrnan-Keuls
Factor
(1)
(2)
(3)
(4)
PRIA ANAK
PRIA DEWASA
WANITA ANAK
WANITA DEWASA
test
n
6
22
5
32
for all pairwise comparisons
Mean
Different
(P