KORELASI PARAMETER HEMATOLOGIANEMIA DEFISIENSI BESI DENGAN KADAR HbA1CSEBAGAI PENANDA DIABETES MELLITUSKajian pada Wanita Usia Subur

KUSUMASTUTI, dr. Tri Ratnaningsih, M.Kes, SpPK-K

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Hemoglobin A1c (HbA1c) adalah hasil glikasi non-enzimatik irreversibel pada satu atau kedua N-terminal valine dari rantai β-hemoglobin. Jumlah totalnya tergantung pada konsentrasi glukosa 2-3 bulan sebelum pemeriksaan. Di samping kadar glukosa darah, beberapa faktor juga mempengaruhi kadar HbA1c. Salah satunya adalah anemia defisiensi besi (ADB). Wanita usia subur berpotensi untuk menderita ADB karena kehamilan, melahirkan, menstruasi reguler dan diet. Penelitian ini ditujukan untuk melihat perbedaan kadar HbA1c antara kelompok ADB dan non-ADB serta melihat korelasi parameter hematologi ADB dengan kadar HbA1c pada wanita usia subur. Penelitian menggunakan desain potong lintang. Subyek penelitian adalah 28 wanita usia subur dengan ADB dan 36 wanita usia subur non-ADB. Kriteria inklusi meliputi : wanita usia 15- 49 tahun, masih menstruasi teratur, tidak ada riwayat histerektomi, tidak sedang terapi obat hematinik, tidak ada riwayat DM atau penggunaan obat anti diabetik. Kriteria eksklusi meliputi : hamil, perdarahan, gangguan fungsi ginjal, sirosis hepatis, anemia hemolitik, hemoglobinopathy dan defisiensi asam folat, tidak datang ke ILK RS DR Sardjito selama periode penelitian, kelompok anemia yang tidak masuk kriteria ADB berdasarkan parameter CRP dan ferritin dan mempunyai kadar glukosa darah puasa ≥100 mg%. Semua subyek diperiksa darah lengkap dan HbA1c kemudian diuji beda rerata kadar HbA1c pada subyek ADB dan non-ADB serta dilihat korelasi antara parameter hematologi ADB dengan HbA1c. Rerata kadar HbA1c pada kelompok ADB 5,51±0,31% lebih tinggi secara signifikan dibanding kelompok non-ADB 5,34±0,04% (p=0,017). Terdapat korelasi negatif antara kadar HbA1c dengan Hb, hematokrit, MCV, MCH dan korelasi positif dengan RDW. Perhatian perlu ditekankan pada wanita usia subur yang mempunyai Hb rendah ketika menginterpretasi hasil pemeriksaan HbA1c. Skrining ADB perlu dilakukan untuk memastikan interpretasi pemeriksaan parameter HbA1c, terutama untuk diagnosis pre-DM.

Hemoglobin A1c (HbA1c) is a product of irreversible non-enzymatic process on one or both of N-terminal valine of β-hemoglobin chain. Besides plasma glucose levels, some conditions can affect the level of HbA1c. One of them is iron deficiency anemia (IDA). Women of childbearing age have more risks to undergo IDA because of pregnancy, birth, regular menstruation, and diet. The aims of this study was to determine the difference of HbA1c levels in women of childbearing age with IDA and without IDA and to determine the correlation between the hematologic parameters of IDA and HbA1c levels. This study design is cross-sectional. Twenty-eight women of childbearing age with IDA and 36 healhty women were included in the study. The inclusion criteria included woman age 15-49 years old, still menstruate regularly, no history of histerectomy, no use of hematinic drugs, no history of DM or the use of anti diabetic drugs. The exclusion criteria were : pregnancy, bleeding, impaired renal function, hepatic cirrhosis, hemolytic anemia, hemoglobinopathy, folic acid deficiency, did not attend to DR Sardjito General Hospital Clinical Laboratory during study period in February-March 2012, anemia with etiology other than iron deficieny based on CRP and ferritin status, and fasting blood glucose levels >100 mg/dL. All subjects were tested for complete blood count and HbA1c. Subsequently mean difference test was conducted to HbA1c levels on IDA group versus non-IDA group. Correlation was also sought on hematologic parameters and HbA1c levels. The mean of HbA1c levels in IDA group is 5,51+0,31% which is significantly higher than non-IDA group mean of 5,34+0,04% (p=0,017). There is a negative correlation between HbA1c with hemoglobin, hematocrit, MCV, MCH and a positive correlation with RDW. Concern should be given on women of childbearing age with low hemoglobin levels when interpretated HbA1c results. Screening for IDA is deemed necessary to ensure interpretation of HbA1c determination especially to diagnose pre-diabetic state.

Kata Kunci : Anemia Defisiensi Besi-Wanita Usia Subur-HbA1c-korelasi-pre-DM