PERBANDINGAN DELTA INTERLEUKIN-6 PASCATRANSFUSI PACKED RED CELL (PRC) LEUKODEPLESI DENGAN NON-LEUKODEPLESI PADA PASIEN DEWASA DENGAN KEGANASAN

DANI AMALIA ARIFIN, Dr. dr. Teguh Triyono, M.Kes., Sp.PK (K) ; dr. Windarwat, M.Sc., Sp. PK (K)

2021 | Tesis-Spesialis | PATOLOGI KLINIK

Latar belakang: Interleukin-6 (IL-6) memiliki peranan penting dalam etiopatogenesis anemia pada keganasan. Terapi anemia pada pasien dengan keganasan adalah transfusi PRC. Akumulasi IL-6 yang dihasilkan oleh leukosit dalam PRC dapat terjadi selama proses penyimpanan dan meningkatkan risiko terjadinya reaksi transfusi. Leukodeplesi merupakan proses untuk menurunkan jumlah leukosit kontaminan sehingga diharapkan dapat menurunkan akumulasi IL-6 dalam PRC dan meminimalisasi reaksi transfusi. Tujuan: Menganalisis perbedaan rerata delta kadar IL-6 pascatransfusi PRC leukodeplesi dibandingkan non-leukodeplesi pada pasien dewasa dengan keganasan. Metode: Desain penelitian ini adalah quasi experimental. Subjek penelitian adalah pasien dewasa dengan keganasan di Instalansi Kanker Terpadu TULIP RSUP Dr. Sardjito Yogyakarta yang mendapatkan transfusi PRC leukodeplesi atau non-leukodeplesi dan memenuhi kriteria inklusi. Dilakukan pemeriksaan darah lengkap dan pemeriksaan kadar IL-6 yang diambil pra dan satu jam pascatransfusi PRC leukodeplesi atau non-leukodeplesi. Kadar IL-6 diukur menggunakan metode ELISA sandwich. Rerata delta kadar IL-6 dihitung dari selisih antara kadar IL-6 pratransfusi dan pascatransfusi. Perbedaan rerata delta kadar IL-6 kelompok transfusi PRC leukodeplesi dibandingkan dengan non-leukodeplesi, dan dianalisis menggunakan uji Mann-Whitney. Hasil : Median kadar IL-6 pascatransfusi lebih rendah secara bermakna pada kelompok leukodeplesi dibandingkan dengan non-leukodeplesi (1,9 pg/mL versus 3,4 pg/mL; p=0,035). Median delta kadar IL-6 lebih rendah secara bermakna pada kelompok leukodeplesi dibandingkan non-leukodeplesi (-0,3 versus - 0,1; p=0,047). Didapatkan perbedaan bermakna delta kadar IL-6 berdasarkan lama simpan PRC pada kelompok leukodeplesi (p=0,002) dan non-leukodeplesi (p=0,043), dan ditemukan peningkatan delta IL-6 semakin tinggi dengan semakin lama simpan produk PRC. Simpulan : Median delta kadar IL-6 pascatransfusi PRC leukodeplesi lebih rendah secara bermakna dibandingkan non-leukodeplesi.

Background: Interleukin-6 (IL-6), have an important role in the etiopathogenesis of anemia in malignancies. Treatment of anemia in patients with malignancy is PRC transfusion. Accumulation of IL-6 produced by leucocytes in PRC can occur during the storage process and increase the risk of transfusion reactions. Leukodepletion is a process to reduce the number of contaminant leucocytes so that it is expected to reduce the accumulation of IL-6 in PRC and minimize transfusion reactions. Objective: This study aimed to analyze differences in mean delta levels of IL-6 posttransfusion PRC leukodepleted compared non-leukodepleted in adult patients with malignancy Method:This was a quasi experimental study. Subjects were adult patients with malignancy at TULIP Integrated Cancer Institute RSUP Dr. Sardjito Yogyakarta, who received leukodepleted or non-leukodepleted PRC transfusion and met the inclusion criteria. The examination for complete blood count and IL-6 levels were performed pre and one hour post PRC's transfusion. IL-6 levels were measured using the sandwich ELISA method. Mean delta levels of IL-6 was calculated from the difference between pre and post transfusion IL-6 levels. The differences in mean delta levels of IL-6 in the leukodepleted PRC transfusion group were compared with non-leukodepleted group, and were analyzed using the Mann-Whitney test. Results :The median post transfusion IL-6 levels were significantly lower in leukodepleted group than non-leukodepleted group (1,9 pg/mL versus 3,4 pg/mL; p=0,035). Median delta levels of IL-6 were significantly lower in leukodepleted group compared to non-leukodepleted group (-0,3 versus -0,1; p=0,047). There was significant differences in delta IL-6 levels based on the long storage period PRC in the leukodepleted groups (p=0,002) and non-leukodepleted (p=0,043), and it was found that the increase in delta IL-6 was higher with the longer the PRC product was stored. Conclusion : Median delta levels of IL-6 posttransfusion in leukodepleted group were significantly lower compared to non-leukodepleted group.

Kata Kunci : delta interleukin-6, anemia pada keganasan, transfusi, packed red cell, leukodeplesi