Laporkan Masalah

Karakteristik red cell distribution width dan gambaran morfologi eritrosit pada penderita talasemia, anemia defisiensi besi, dan populasi normal

WIJAYA, Rusmiyati, Prof. dr. Budi Mulyono, SpPK(K), MM

2009 | Tesis | S2 PPDS 1-Patologi Klinik

Red cell Distribution Width (RDW) merupakan parameter yang dapat dipakai untuk membedakan diagnosis anemia defisiensi besi (ADB) dari talasemia minor. Gambaran nilai RDW pasien talasemia yang sudah mendapat transfusi belum pernah dilaporkan sebelumnya, maka tujuan penelitian ini yaitu untuk menemukan karakteristik RDW dan melihat adakah perbedaan RDW dan morfologi eritrosit, serta hubungan RDW dengan MCV di antara pasien talasemia, ADB dan populasi normal dan korelasi antara RDW dan MCV dengan indeks England & Frazer pada ADB dan talasemia minor. Penelitian ini dilakukan secara cross sectional pada 30 kasus talasemia, yang terdiri dari 12 talasemia mayor (± 40 hari setelah transfusi packed red cell), 5 talasemia intermedia (± 3 bulan setelah transfusi) dan 13 talasemia trait/minor, kelompok normal sebagai kontrol 20 orang; dan 20 kasus ADB diambil secara retrospektif. Red cell distribution width pada talasemia mayor (yang telah mendapat transfusi packed red cell (± 40 hari setelah transfusi), intermedia (± 3 bulan setelah transfusi), minor/trait dan ADB semuanya berbeda bermakna dengan RDW populasi normal (12,71 ± 0,77) (p<0,01). Pada pasien ADB, talasemia mayor dan talasemia intermedia tersebut, semua RDW-nya berbeda bermakna dengan RDW talasemia minor (P<0,01). Rerata RDW intermedia (33.84 ± 6,0) berada pada nilai tertinggi di antara semua subyek penelitian dan berbeda bermakna terhadap rerata RDW talasemia mayor. Tear drops, sel target, fragmentosit dan basophiilic stippling terdapat pada talasemia mayor dan intermedia tersebut dan pada talasemia minor, dengan jumlah persentase basophilic stippling yang terendah. Red cell distribution width pada talasemia mayor, intermedia dan minor tak ada korelasi dengan fragmentosit-nya, koefisien korelasi masing-masing r = 0.285; r = 0,061 dan r = -0,309 (p>0,05). RDW pada talasemia intermedia, talasemia minor, ADB dan populasi normal tidak ada korelasi dengan MCV-nya (p>0,05), sedangkan pada talasemia mayor tersebut, mempunyai korelasi terbalik “r”= -0,607 (p<0,05). MCV tidak ada korelasi dengan indeks England & Frazer pada talasemia minor dan ADB. Mengenai korelasi antara RDW dengan penghitungan indeks England & Frazer, pada ADB didapatkan korelasi, r = 0,518 (p<0,05). Pada talasemia minor tidak terdapat korelasi, r = 0,213 (P>0,05). RDW talasemia minor berkisar dari 11,5 -17,8%; RDW 14,5 – 17,8% bisa talasemia minor atau ADB atau gabungan talasemia minor dengan ADB; RDW >17,8% diduga kuat ADB

Red cell distribution width (RDW) is one of the parameters which can be used to differentiate the diagnosis between iron deficiency anemia (IDA) and thalassemia minor. Since the levels or patterns of RDW of the varies kinds of transfused thalassemia patients have not yet ever been reported before, the purpose of this study is to find out the characteristics of the RDW of thalassemias, IDA and of normal subjects as well as the morphology of erythrocytes to see if there are some differences among them. Also to see the correlation of RDW with schistocytes in thalassemia and the correlation of RDW with MCV in thallasemia, IDA and normal pupulaltion. As well as to reveal the correlation between RDW or MCV and index of England & Frazer in IDA and thalassemia minor. In this study, samples of thirty clinically diagnosed thalassemia patients consist of 12 cases of about 40-days transfused with packed red cell thalassemia mayor, 5 cases of about 3-months transfused with packed red cell thalassemia intermedia, and 13 cases of thalassemia minor. There were 20 cases of IDA and 20 normal persons as control. Tear drops, target cells, fragmentocytes and basophillic stippling were encountered in the thalassemia major, the intermedia and minor/trait with the percentage of basophilic stippling at the lowest level. The means of Red cell distribution width of the thalasemia major, the intermedia, minor/trait and IDA all were significantly different from that of the control (12.71±0.77) p<0,01 with the highest mean RDW of the intermedia (p<0.01). The means RDW of the thalassemia major, intermedia and IDA were significantly different from that of the thalasemia minor/trait (p<0.01). There were no correlation between RDW and schistocytes in the thalassemia major, the intermedia and minor (p>0.05). There were no correlation of RDW with MCV among the thalassemia intermedia, thalassemia minor, IDA and normal population (p>0.05), except that of the thalassemia major, which has inversed correlation, r = -0.607 (p<0,05). In IDA, there was correlation between RDW and index England & Frazer, r = 0.518 (P<0.05) but index England & Frazer no correlation with MCV; whereas in thalassemia minor there were no any correlations among them, r = 0.213 and r = 0.526 (p>0.05) respectively. The RDW of thalassemia minor ranged from 11.5 – 17.8 %; RDW of 14.5 -17.8 % could be either thalassemia minor or IDA or both thalassemia minor and IDA; and RDW>17.8% strongly suggests IDA.

Kata Kunci : Red cell distribution width,Talasemia,Sel target,Tear drop, Red cell Distribution Width, thalassemia, target cell, tear drop, basophilic stippling, schistocytes


    Tidak tersedia file untuk ditampilkan ke publik.