KORELASI ANTARA PERSENTASE TROMBOSIT YANG MENGEKSPRESIKAN P-SELECTIN DAN NILAI CORRECTED COUNT INCREMENT (CCI) PASCA TRANSFUSI TROMBOSIT PADA PASIEN ANAK DENGAN KEGANASAN

FUAD ANSHORI, Dr. dr. Teguh Triyono, M. Kes., Sp. PK(K); Dr. dr. Tri Ratnaningsih, M. Kes., Sp. PK(K)

2019 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Latar belakang: Manipulasi trombosit selama penyimpanan menimbulkan platelet storage lesion (PSL) yang berdampak pada peningkatan jumlah trombosit yang aktif dan mengekspresikan P-selectin. Peningkatan ekspresi molekul ini dapat menyebabkan peningkatan bersihan trombosit pasca transfusi sehingga menurunkan efikasi transfusi trombosit yang dinilai dengan corrected count increment (CCI). Namun demikian, beberapa penelitian masih belum dapat membuktikan hubungan trombosit yang mengekspresikan P-selectin dengan nilai CCI. Tujuan: Mengetahui korelasi antara persentase trombosit yang mengekspresikan P-selectin dan nilai CCI pasca transfusi trombosit pada pasien anak dengan keganasan. Metode: Penelitian analitik observasional prospektif ini melibatkan pasien trombositopenia di ruang rawat hematologi-onkologi anak, RSUP Dr. Sardjito selama periode 2 bulan. Setiap TC diukur persentase trombosit yang mengekspresikan P-selectin dan 1 jam setelahnya dilakukan perhitungan CCI. Karakteristik subjek dan TC yang ditransfusikan disajikan sesuai jenis datanya dan diperbandingkan berdasarkan nilai CCI <7500 dan >/=7500. Uji korelasi dilakukan antara CCI dengan persentase trombosit yang mengekspresikan P-selectin dan variabel lainnya. Hasil: Penelitian ini melibatkan 43 subjek penelitian dengan 29 subjek (67,4%) diantaranya memiliki nilai CCI >/=7500. Persentase trombosit yang mengekspresikan P-selectin pada TC yang ditransfusikan pada kelompok subjek dengan CCI <7500 ditemukan lebih tinggi daripada kelompok CCI >/=7500 (20,55% vs. 13,45%; p<0,05). Peningkatan persentase trombosit yang mengekspresikan P-selectin berkorelasi terhadap penurunan CCI (r=0,404; p<0,05) akan tetapi pada penelitian ini, tidak ditemukan korelasi antara data klinis subjek dan karakteristik TC dengan CCI. Kesimpulan: Pada penelitian ini ditemukan korelasi dengan kekuatan sedang dan bernilai negatif antara persentase trombosit yang mengekspresikan P-selectin dan dan nilai CCI pasca transfusi trombosit pada pasien anak dengan keganasan.

Background: Platelet manipulation during storage raises results in platelet sorage lesion (PSL) which in turn may increase the level of activated and P-selectin expressing platelets. Increased expression of these molecules may lead to increased platelet clearance post-transfusion thereby reducing the efficacy of platelet transfusions as assessed by corrected count increments (CCI). Nevertheless, some studies still unable to prove the association between the percentage of platelets those expressing P-selectin with CCI value. Objective: To investigate the correlation between the percentage of platelets expressing P-selectin and CCI values after platelet transfusion in pediatric patients with malignancy. Method: A prospective observational analytical study was performed on thrombocytopenic patients in the pediatric hematology-oncology ward, Dr. Sardjito hospital for a period of 2 months. For each TC, the percentage of platelets expressing P-selectin was measured and 1 hour afterward the CCI calculation was performed. Subject characteristics and transfused TC are presented in accordance to the type of data and were compared based on CCI values <7500 and >/=7500. The correlation between CCI and the percentage of platelets expressing P-selectin and other variables were tested. Results: This study involved 43 subjects with 29 subjects (67.4 %) of whom had a CCI value of >/=7500. The mean percentage of platelets expressing P-selectin in the TC transfused in the CCI <7500 group was higher than the CCI ≥7500 group (20.55 % vs. 13.45%; p <0.05). The increased percentage of platelets expressing P-selectin had correlation with decreased CCI (r = 0.404; p <0.05) however, no correlation was found between the subjects clinical data and TC characteristics with CCI. Conclusion: we found a moderate inverse correlation between the percentage of platelets expressing P-selectin and CCI level after platelet transfusion among pediatric patients with malignancy

Kata Kunci : transfusi trombosit, platelet storage lesion, P-selectin, CCI