KORELASI CONTENT HEMOGLOBIN RETICULOCYTE (CHr)DAN STATUS BESI BIOKIMIA PADA IBU HAMIL ATERM

Dwi Ferniawanti, dr. Tri Ratnaningsih, M.Kes., Sp.PK(K).; Prof. dr. Budi Mulyono, MM, Sp.PK(K)

2016 | Tesis | S2 Ilmu Kedokteran Klinik

Defisiensi besi merupakan masalah gizi ibu hamil dengan prevalensi cukup tinggi di Indonesia bahkan di Yogyakarta. Ibu hamil aterm berisiko tinggi defisiensi besi akibat peningkatan tertinggi kebutuhan besi pada trimester ketiga dan risiko perdarahan saat melahirkan, sehingga saat memasuki periode laktasi dapat terjadi gangguan kesehatan ibu dan periode emas tumbuh kembang bayi. Baku emas diagnosis defisiensi besi dengan penilaian langsung cadangan besi sumsum tulang bersifat invasif, pemeriksaan tidak langsung dengan parameter hematologi konvensional hanya dapat mendeteksi tahap lanjut, sedangkan parameter biokimia mampu mendeteksi tahap awal tetapi kurang praktis, nilainya dipengaruhi banyak faktor, biaya relatif mahal dan ketersediaaan terbatas. Alat Advia 120 mampu mengukur kandungan hemoglobin dalam retikulosit (Content Hemoglobin Reticulocyte / CHr) yang dilepas sumsum tulang 24-48 jam ke sirkulasi, sehingga dinilai lebih aktual menggambarkan status besi sumsum tulang. Tujuan penelitian ini adalah untuk mengetahui korelasi CHr dan status besi biokimia (feritin, besi serum dan saturasi transferin)pada ibu hamil aterm. Penelitian ini dilakukan dengan disain potong lintang, subyek penelitian melibatkan ibu hamil aterm yang datang untuk melahirkan di RS PKU Muhammadiyah Bantul. Sampel darah diambil 7mL. Dua mL sampel darah dimasukkan dalam tabung EDTA untuk diperiksa darah lengkap otomatik dan CHr dengan alat hematology analyzer Advia 120 (Bayer). Lima mL sampel darah diambil serumnya untuk diperiksa status besi biokimia, yakni : besi serum/serum iron (SI) dan Total Iron Binding Capacity (TIBC)untuk memperoleh nilai saturasi transferin (Tsat) menggunakan Cobas analyzer C 501 (Roche Diagnostics, Germany) dan feritin serum (SF)menggunakan alat mini Vidas. Serum juga diperiksa CRP secara kualitatif dengan Avitex. Subyek penelitian yang memenuhi kriteria inklusi dan eksklusi sebanyak 73 ibu hamil aterm dengan umur (mean+-SD) 29,4+-5,61 tahun, kadar hemoglobin 12,36+-1,01 g/dL, CHr 32,15+-1,86 pg, feritin ((median (min-maks)) 19,83 (6,26-92,51)mcg/dL, besi serum 70 (37-207)mcg/dL, dan saturasi transferin 16 (6-49) %. Didapatkan 27 subyek (37%) dari total 73 subyek mengalami defisiensi besi, dan terdapat perbedaan bermakna pada nilai rerata hemoglobin, CHr, feritin, besi serum, dan saturasi transferin. Dilakukan analisis uji korelasi Spearman dan didapatkan korelasi positif antara CHr dengan status besi biokimia, yakni dengan feritin (r=0,381, p<0,001), besi serum (r=0,272, p<0,02)dan saturasi transferin (r=0,365, p<0,001). Terdapat korelasi positif yang signifikan antara CHr dengan status besi biokimia (feritin, besi serum, dan saturasi transferin) pada ibu hamil aterm.

Iron deficiency is a nutritional problem of pregnant women with high prevalence in Indonesia, even in Yogyakarta. Pregnant women at term had a higher risk of iron deficiency due to highest iron needs in the third trimester and risk of hemorrage during labour, so when entering the lactation period, there is potentially serious disruption on maternal health and the golden period of growth and development of babies born. Gold standard diagnosis of iron deficiency is a direct assessment iron reserves of bone marrow which are invasive, indirect examination by conventional hematological parameters can only detect advanced stages, whereas biochemical parameters able to detect the early stages but less practical, influenced many factors, relatively high cost and limited avaibility. The Advia 120 is capable of displaying a new parameter Content Hemoglobin Reticulocyte (CHr) which measures the hemoglobin content of reticulocytes in the bone marrow is removed 24-48 hours in circulation, so it is considered more actual in describing the iron status of the bone marrow. The purpose of this study is to determine the correlation of CHr and biochemical iron status (ferritin, serum iron, and transferrin saturation) in pregnant women at term. This study was a cross-sectional design, that involved pregnant women at term who came in PKU Muhammadiyah Bantul Hospital. Seven mL of blood sample were collected through the cubital vein. Two mL of the blood sample is inserted into EDTA tubes for routine hematology and CHr by means of automated hematology instrument Advia 120 (Bayer). The serum of the remaining 5 mL of the sample was collected for the examination of biochemical iron status, there are: serum iron (SI) and Total Iron Binding Capacity (TIBC)to obtain the value of transferrin saturation (TSat) using Cobas analyzer C 501 (Roche Diagnostics, Germany), serum ferritin (SF) using Minividas. The serum also examined CRP qualitatively using Avitex. The subjects of this study who meet the inclusion and exclusion criteria were 73 pregnant women at term, the age (mean+-SD) 29,4+-5,61 years, hemoglobin levels 12,36+-1,01 g/dL, CHr levels 32,15+-1,86 pg, SF levels ((median (min-max)) 19,83 (6,26-92,51)mcg/dL, SI levels 70 (37-207)mcg/dL, dan TSat levels 16 (6-49) %. Twenty seven subjects obtained from a total of 73 subjects with iron deficiency, and there are significant differences in the mean value hemoglobin, CHr, ferritin, serum iron, and transferrin saturation. Correlation test using Spearmans and positive correlations were found between CHr and biochemical iron status, there are ferritin (r=0,381, p=0,001), SI (r=0,272, p=0,02) and Tsat (r=0,365, p=0,001). There is a significant positive correlation between CHr and biochemical iron status (ferritin, SI, and TSat) in pregnant women at term.

Kata Kunci : correlation, CHr, biochemical iron status, pregnant women at term