PERBEDAAN KADAR HbA1C PADA WANITA USIA SUBUR DENGAN ANEMIA DEFISIENSI BESI DAN TANPA ANEMIA DEFISIENSI BESI

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

2012 | Tesis | S2 Ilmu Patologi Klinik

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 (WUS) berpotensi untuk menderita ADB karena kehamilan, melahirkan, menstruasi reguler dan diet. Penelitian ini ditujukan untuk melihat pengaruh ADB terhadap kadar HbA1c dan melihat korelasi parameter pemeriksaan ADB terhadap kadar HbA1c pada WUS. Penelitian menggunakan desain potong lintang. Subyek penelitian adalah 30 WUS dengan ADB dan 30 WUS non-ADB. Kriteria inklusi meliputi : wanita, 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 : kadar glukosa darah puasa ≥126 mg/dL, hamil, perdarahan, gangguan fungsi ginjal, sirosis hepatis, anemia hemolitik, hemoglobinopathy dan defisiensi asam folat. Parameter yang diperiksa adalah complete blood count (CBC), morfologi darah tepi (MDT), kadar ferritin serum, kadar glukosa puasa, C-reaktif protein (CRP) dan kadar HbA1c. Dikatakan ADB bila didapatkan Hb < 12 mg% dan kadar ferritin < 12 ng/dL untuk CRP < 5 mg/L. Jika CRP ≥ 5 mg/L diagnosis ADB ditegakkan dengan Hb < 12 mg% dan kadar ferritin ≤ 100 ng/dL. Independent t-test digunakan untuk membandingkan data kontinu terdistribusi normal. Jika distribusi data tidak normal digunakan Mannwhitney test. Data HbA1c diubah menjadi skala katagorik untuk melihat Odds Ratio (OR) dengan cut-off point 5,5%. Untuk melihat hubungan antara parameter diagnosis ADB dengan kadar HbA1c digunakan Pearson atau Spearman Correlation

Hemoglobin A1c (HbA1c) is a product of irreversible non-enzymatic process on one or both of N-terminal valine 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 effect of IDA on the HbA1c levels in women of childbearing age and to determine the correlation between the diagnostic parameters of IDA and HbA1c levels. This study design is cross-sectional. Thirty women of childbearing age with IDA and 30 healhty women were included in the study. The inclusion criteria included woman, age 15-49 years, 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, fasting blood glucose levels ≥ 126 mg / dL, impaired renal function, hepatic cirrhosis, hemolytic anemia, hemoglobinopathy, and folic acid deficiency. The parameters examined were complete blood count (CBC), blood smear, serum ferritin levels, C-reaktif protein (CRP), fasting blood glucose and HbA1c levels. Iron deficiency anemia was defined if the Hb levels < 12 mg% and ferritin levels < 12 ng/dL for CRP levels < 5 mg/L. If CRP levels ≥ 5 mg/L diagnosis of IDA based on Hb levels < 12 mg% and ferritin levels ≤ 100 ng/dL. Independent t-test was used to compare normally distributed continuous data. Mann-whitney test were used if the distribution of the data was not normal. The data of HbA1c was changed to categorical scale to determine the Odd’s Ratio (OR) with cutt of point 5,5%. Pearson or Spearman corellation were used to determine the relationship between diagnostic parameters of IDA with HbA1c levels.

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