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PERBEDAAN KADAR HEMOGLOBIN PADA 6 JAM DAN 24 JAM SETELAH TRANSFUSI PACKED RED CELLS (PRC) PASIEN KEGANASAN HEMATOLOGI DI RSUP DR. SARDJITO YOGYAKARTA

MARINI TASLIMA, Dr. dr. Usi Sukorini, M.Kes., Sp.PK(K)

2022 | Tesis-Spesialis | PATOLOGI KLINIK

Latar belakang: Keganasan hematologi merupakan penyakit neoplastik jaringan hematopoietik dan limfoid. Anemia merupakan salah satu komplikasi yang sering ditemui pada pasien keganasan hematologi. Salah satu tata laksana anemia yang sering diberikan adalah transfusi packed red cell (PRC) karena memiliki keunggulan yaitu dapat meningkatkan kadar hemoglobin dan hematokrit dengan cepat. Sampai saat ini masih terdapat perbedaan pendapat mengenai waktu yang tepat untuk memantau kadar hemoglobin setelah transfusi PRC. Pemeriksaan hemoglobin yang umum dilakukan di RSUP Dr. Sardjito Yogyakarta yaitu pada 6 jam setelah transfusi PRC, namun belum ada standar kebijakan mengenai hal tersebut, sedangkan pada beberapa laporan penelitian, pemeriksaan kadar hemoglobin dilakukan pada waktu 24 jam setelah transfusi PRC. Tujuan: Untuk mengetahui rerata peningkatan kadar hemoglobin pada 6 jam dan 24 jam setelah transfusi PRC, dan menguji perbedaan delta kadar hemoglobin 6 jam dan 24 jam setelah transfusi PRC, masing-masing dibandingkan dengan hemoglobin awal pada pasien keganasan hematologi. Metode: Penelitian ini merupakan penelitian observasional analitik prospektif dengan melakukan pemeriksaan kadar hemoglobin menggunakan alat hematologi Sysmex XN-1000 pada 6 jam dan 24 jam setelah transfusi PRC. Data karakteristik subjek penelitian ditampilkan secara deskriptif dalam rerata dan simpang baku serta median dan nilai minimum-maksimum. Normalitas data subjek penelitian dilakukan menggunakan uji Kolmogorov-Smirnov. Uji beda antara delta kadar hemoglobin 6 jam setelah transfusi PRC dibanding hemoglobin awal, dan delta kadar hemoglobin 24 jam setelah transfusi PRC dibanding kadar hemoglobin awal, dianalisis menggunakan paired t test. Uji beda delta kadar hemoglobin 6 jam dan 24 jam setelah transfusi PRC pada setiap diagnosis dianalisis menggunakan Kruskal-Wallis. Analisis data penelitian menggunakan SPSS versi 20. Hasil: Dari 32 subjek penelitian yang memenuhi kriteria inklusi dan eksklusi, didapatkan rerata + SB kadar hemoglobin awal, kadar hemoglobin 6 jam setelah transfusi PRC dan kadar hemoglobin 24 jam setelah transfusi PRC secara berurutan adalah 7,40 + 1,76 g/dL; 9,11 + 1,75 g/dL; 9,22 + 1,72 g/dL. Delta kadar hemoglobin 6 jam setelah transfusi PRC dibanding kadar hemoglobin awal adalah 1,71 + 0,98 g/dL, delta kadar hemoglobin 24 jam setelah transfusi PRC dibanding kadar hemoglobin awal adalah 1,81 + 0,94 g/dL. Berdasarkan kriteria derajat keparahan anemia oleh National Cancer Institute (NCI) dapat dikatakan bahwa delta kadar hemoglobin tersebut tidak memiliki perbedaan klinis yang bermakna. Hal tersebut didukung dengan adanya kemiripan antara hasil kadar hemoglobin 6 jam dengan kadar hemoglobin 24 jam setelah transfusi PRC yang ditunjukkan dengan noktah yang berhimpit. Simpulan: Didapatkan perbedaan delta kadar hemoglobin 6 jam dan 24 jam setelah transfusi PRC, masing-masing dibandingkan dengan kadar hemoglobin awal pada pasien keganasan hematologi, yang bermakna secara statistik, namun tidak bermakna secara klinis.

Background: Hematologic malignancy is a neoplastic disease of hematopoietic and lymphoid tissue. Anemia is one of the complications that are often encountered in patients with hematological malignancies. One of the anemia treatments that is often given is packed red cell (PRC) transfusion because it has advantages over other anemia therapies, namely it can increase hemoglobin and hematocrit levels quickly. Until now there are still differences of opinion regarding the appropriate time to monitor hemoglobin levels after PRC transfusion. Hemoglobin examination is commonly done at Dr. RSUP. Sardjito Yogyakarta at 6 hours after PRC transfusion, but there was no standard policy regarding this matter, while in several research reports, hemoglobin examination was carried out within 24 hours after PRC transfusion. Objective: To determine the mean increase in hemoglobin levels at 6 hours and 24 hours after PRC transfusion, and to examine the difference in hemoglobin levels 6 hours and 24 hours after PRC transfusion, respectively, compared with initial hemoglobin in patients with hematological malignancies. Method: This study was a prospective analytic observational study by examining hemoglobin using a Sysmex XN-1000 hematology device at 6 hours and 24 hours after PRC transfusion. Characteristic data of research subjects were displayed descriptively in the mean and standard deviation or median and the minimum-maximum value. The normality of the research subject data was carried out using the Kolmogorov-Smirnov test. The difference test between the difference in hemoglobin levels 6 hours after the PRC transfusion compared to the initial hemoglobin, and the difference in hemoglobin levels 24 hours after the PRC transfusion compared to the initial hemoglobin, were analyzed using paired t test. The delta test of hemoglobin levels 6 hours and 24 hours after PRC transfusion for each hematologic malignancy was analyzed using Kruskal-Wallis. Analysis of research data using SPSS version 20. Result: Of the 32 study subjects who met the inclusion and exclusion criteria, the mean ���± SB baseline hemoglobin levels, hemoglobin 6 hours after PRC transfusion and hemoglobin 24 hours after PRC transfusion respectively were 7.40 ���± 1.76 g/dL; 9.11 ���± 1.75 g/dL; 9.22 ���± 1.72 g/dL. Similar results were seen between hemoglobin levels 6 hours and hemoglobin 24 hours after PRC transfusion. The result of the difference in hemoglobin levels 6 hours after PRC transfusion compared to the initial hemoglobin was 1.71 ���± 0.98 g/dL and the difference in hemoglobin levels 24 hours after PRC transfusion compared to the initial hemoglobin was 1.81 ���± 0.94 g/dL, based on the NCI criteria for the severity of anemia, it can be said that the difference in hemoglobin is not clinically significant. This is supported by the similarity of the results between hemoglobin levels at 6 hours and hemoglobin 24 hours after PRC transfusion as indicated by coincide dots. Conclusion: There were delta differences in hemoglobin levels 6 hours and 24 hours after PRC transfusion, respectively, compared with baseline hemoglobin in patients with haematological malignancies, which were statistically significant, but not clinically significant.

Kata Kunci : Keganasan hematologi, anemia, hemoglobin, transfusi, PRC.

  1. S2-2022-420575-abstract.pdf  
  2. S2-2022-420575-bibliography.pdf  
  3. S2-2022-420575-tableofcontent.pdf  
  4. S2-2022-420575-title.pdf