KKorelasi Indeks Trombosit Donor Dengan Corrected Count Increment (CCI) Pasca Transfusi Thrombopheresis Pasien Keganasan Hematologi Dewasa

Ahmad Khoirul Anwar, Dr.dr. Teguh Triyono M.Kes. Sp.PK-K; Dr.dr.Andaru Dahesihdewi M.Kes. Sp.PK-K

2024 | Tesis-Spesialis | S2 Ilmu Patologi Klinik

Latar belakang : Trombositopenia merupakan komplikasi keganasan hematologi yang sering membutuhkan transfusi profilkasis atau terapi, diantaranya dengan komponen thrombopheresis. Pada skrining donor thrombopheresis dilakukan pemeriksaan jumlah trombosit dan indeks trombosit yang meliputi Mean Platelet Volume (MPV), Platelet Distribution WIdth (PDW), Platelet Large Cell Ratio (PLCR), Plateletcrit (PCT), namun aplikasinya belum banyak diketahui. Donor thrombopheresis dengan jumlah trombosit berukuran besar lebih banyak tercermin dalam pemeriksaan indeks trombosit sesaat sebelum donasi, secara teori dapat meningkatkan keberhasilan transfusi, diukur dengan Corrected Count Increment (CCI) 1 jam pasca transfusi.

Tujuan : Mengevaluasi korelasi indeks trombosit (MPV,PDW,PLCR,PCT) donor thrombopheresis dengan CCI 1 jam pasca transfusi trombosit pada pasien keganasanhematologi dewasa

Metode : Desain penelitian obeservasional analitik, pendekatan potong lintang dilakukan di ruang rawat pasien keganasan hematologi dewasa non intensif, Unit Pelayanan Transfusi Darah dan Instalasi Laboratorium Terpadu RSUP Dr.Sardjito Yogyakarta bulan Nopember 2020 sampai Juli 2021. Pemeriksaan jumlah trombosit dan indeks trombosit dengan hematology analyzer Sysmex XN 550 dilakukan pada subjek donor thrombopheresis sebelum donasi. Jumlah trombosit diperiksa pada subjek pasien pra-transfusi dan 1 jam pasca transfusi. Penghitungan CCI dilakukan dengan kalkulasi menggunakan rumus CCI. Uji korelasi menggunakan Spearman, uji normalitas mengunakan Saphiro Wilk. Nilai p<0>

Hasil : Sebanyak 45 subjek donor diikutkan dalam penelitian dengan semua jenis kelamin adalah laki-laki yang memiliki median usia 36(22-61), MPV 10,2(7,5-13,1)fL, PDW 12(8,4-20,3) fL, PCT 0,25(0,12-0,42)% serta rerata nilai PLCR adalah 28,47+_6,9%. Sejumlah 45 subjek pasien diikutkan dalam penelitian ini dengan rincian 29(64,4%) pasien laki-laki dan 16(35,6%) perempuan dengan median usia 50(18-68) tahun. Terdapat korelasi positif yang lemah namun bermakna secara statistik antara PLCR donor dan CCI pasien 1 jam pasca transfusi thrombopheresis (r=0,427;p=0,028). TIdak ditemukan korelasi antara indeks trombosit (MPV,PDW,PCT) dan CCI 1 jam pasca transfusi thrombopheresis.

SImpulan : Nilai PLCR berkorelasi positif secara signifikan dengan CCI 1 jam pasca transfusi thrombopheresis pasien keganasan hematologi dewasa. TIdak ditemukan korelasi antara nilai CCI ini dengan indeks trombosit lain.

Background: Thrombocytopenia is a complication of hematological malignancies that often requires prophylactic transfusion or therapy, including thrombopheresis component. In donor thrombopheresis screening, the platelet count and platelet indeks are examined, including Mean Platelet VOlume (MPV), Platelet DIstribution WIdth (PDW), Platelet Large Cell Ratio (PLCR), Plateletcrit (PCT), but their application is not widely known. Thrombopheresis donors with greater number of large platelets, reflected in the platelet index examination immediately before donation, can theoretically increase the success of the transfusion, measured by the Corrected Count Increment (CCI) 1 hour post transfusion.

Objective : To evaluate the correlation of platelet indices (MPV, PDW, PLCR, PCT) of donor thrombopheresis with CCI 1 hour post transfusion in adult hematological malignancy patients

Methods :The research design was analytical observational research design with cross sectional approach carried out in the ward for patients with non intensive adult hematological malignancies, the Blood Transfusion Service Unit and the Integrated Laboratory Intallation of Dr. Sardjtio General Hospital Yogyakarta from Nopember 2020 until Jly 2021. The examination of platelet and platelet indices carried by Sysmex Xn 550 hematology analyzer on donor subject before donation.Platelet counts were checked in patient subjects pre transfusion and 1 hour post transfusion. CCI calculation use the CCI formula. Corelation test using Spearman, normality test using Saphiro Wilk. The p value <0>

Result : A total of 45 donor subjects were included in the study, all were males with median age of 36(22-61), MPV 10,2(7,5-13,1)fL, PDW 12(8,4-20,3)fL, PCT 0,25(0,12-0,42)% and the acerage PLCR value was 28,47+-6,9%. A total of 45 patient subjects were included in the study, with details of 29(64,4%) male patients and 16(35,6%) female patients also with median age 50(18-68) years. There was a weak but statistically significant positive correlation between donor PLCR and patient CCI 1 hour after thrombopheresis transfusion (r=0,327;p=0,028). No correlation was found between platelet indices (MPV,PDW,PCT) and CCI 1 hour after thrombopheresis transfusion.

Conclusion : The PLCR value is significantly positively correlated with CCI 1 hour after thrombopheresis transfusin in adult hematological malignancy patients. No correlation was found between this CCI value and other platelet indices.

Kata Kunci : keganasan hematologi, donor thrombopheresis, PLCR, CCI