Diagnosis Laboratorium Anemia Mh Lengkappptx

8/16/2019 Diagnosis Laboratorium Anemia Mh Lengkappptx

1/65

DIAGNOSISLABORATORIUM

ANEMIA

Dr. Endah Purnamasari, SpPK


2/65

Defnisi

Ke!ida"#u"upan massa eri!r$si! di da%amdarah &an' men'a"i(a!"an !ida" ade"ua!n&ahan!aran $"si'en "e )arin'an peri*er.

+ in!r$(e-s #%ini#a% hema!$%$'& / !h edi!i$n,001

ANEMIA


3/65

Pemeri"saan %a($ra!$rium un!u" mende!e"si anemia

1. Hemoglobin (Hb)

Sua!u pr$!ein !er"$n)u'asi &an' (er*un'si da%am!ransp$r! $"si'en dan "ar($ndi$"sida.

Pr$!ein ini merupa"an "$mp$nen u!ama eri!r$si!.

Se!iap 'ram 2( dapa! men'andun' ,34 mL O5Kadar 2( !er'an!un' umur, )enis "e%amin, 'e$'raf,

*a"!$r s$sia%6e"$n$mi, ras


4/65

Umur Hemoglobin (g/dL)Ne$na!us 7!a%i pusa!8 3,9 : 0,9 : 3 hari 7darah "api%er8 4,9 : 55,9/,9 : 5 !ahun /,9 : 3,9

5 : ; !ahun ,9 : 3,9; : 5 !ahun ,9 : 9,95 : 1 !ahun 7pria8 3,/ : ;,/5 : 1 !ahun 7


5/65

5. 2ema!$"ri! 72!8Men''am(ar"an $%ume eri!r$si! per $%ume darah

N$rma% = 4/ : 41, @ 3C645

3. Sediaan apus darah !epi 7SADT8 Dapa! meni%ai unsur6unsur se% darah !epi seper!i

eri!r$si!, %eu"$si!, !r$m($si!.

Pen!in' se"a%i mem(ua! sediaan apus &an' (ai"a'ar mendapa!"an in*$rmasi ma"sima%.


6/65

4. Re!i"u%$si!

Merupa"an eri!r$si! muda &an' masih mempun&ai sisa

RNA pada si!$p%asma. N$rma% /,9 6,9 759./// : C9.///?L8

2i!un' re!i"u%$si! dapa! di'una"an un!u" meni%aipenin'"a!an eri!r$p$iesis, *un'si sumsum !u%an', danresp$n !erhadap !erapi.

9. Inde"s eri!r$si!Di'una"an un!u" men'e!ahui u"uran eri!r$si! dan

"andun'an 2( da%am eri!r$si!

MF 7Mean Corpuscular Volume?F$%ume Eri!r$si! Ra!a6

ra!a8 M2 7Mean Corpuscular Haemoglobin?2( Eri!r$si! Ra!a6

ra!a8

M2 7Mean Corpuscular HaemoglobinConcentration?K$nsen!rasi 2( Eri!r$si! Ra!a6ra!a8


7/65

K%asif"asi Anemia• Anemia dapat diklasifikasikan atas :

1. Morfologi

2. Penyebab (etiologi)


8/65

• K%asif"asi Anemia (erdasar"an M$r*$%$'i

1. Anemia Mikrositik Hipokrom2. Anemia Normositik Normokrom

3. Anemia Makrositik


9/65

• K%asif"asi anemia (erdasar"an e!i$%$'i

. Kehi%an'an darah 7a"u!, "r$nis8

5. Gan''uan pem(en!u"an eri!r$si!

a. Insufcient eritropoiesis 7eri!r$p$iesis !ida"

#u"up8

(. Ineective eritropoiesis 7eri!r$p$iesis !ida"

e*e"!i*8

3. Ber"uran'n&a masa hidup eri!r$si!

a. "e%ainan "$n'eni!a% mem(ran, enim,

"e%ainan 2(

(. "e%ainan didapa! ma%aria, $(a!, in*e"si,

pr$ses imun$%$'is


10/65

Tahapan dasar Dia'n$sis Anemia

. Ea%uasi in*$rmasi "%inis dari ri


11/65

• Pemeri"saan fsi"

• Pu#a!, %emah, %esu

• Or'an$me'a%i 7ha!i, %impa, KGB8

• Kunin'?i"!erus anemia hem$%i!i"

• U%"us "a"i pada anemia 2(S

• K$i%$ni"ia, an'u%ar #hei%$sis anemia defsiensi

(esi• Ke%ainan neur$%$'is anemia defsiensi i! B5


12/65

5. Ea%uasi pemeri"saan %a($ra!$rium hema!$%$'i

dasar dan "husus

a. Kadar 2(, 2!, re!i"u%$si!, SADT, MF, M2,

M2, LED, )um%ah %eu"$si!, !r$m($si!.

(. Pemeri"saan "husus SI, TIB, Jeri!in, G;PD !es,d%%

#. Pemeri"saan sumsum !u%an'


13/65

ANEMIA DEJISIENSI BESI


14/65

Jisi$%$'is si"%us (esi !u(uh

In!a"e (esi 65 m' ? hari, dia(s$r(sien!er$si! du$denum, "emudian disir"u%asi (eri"a!an den'an!rans*erin.

Pen''unaan (esi mem(en!u" m&$'%$(in 7;8,mem(en!u" hem$'%$(in 7;98,se(a'ai (a'ian enimperna*asan 7si!$"r$m "a!a%ase,

dan per$"sidase8

Pen&impanan Besi (en!u" *eri!in a!au hem$siderindi se% RES ha!i, %impa, KGB, dansumsum !u%an' 7598.

Andrew NC. Disorder of Iron Metabolism. New England Journal of Medicine. December 23,

ANEMIA DEJISIENSI BESI


15/65

Tetbook in Medi!al P"ysiology And Pat"op"ysiology Essentials and clinical problems.Copenhagen Medical Publishers 1999 – 2000.

http://www.mi.!u.d!/ppaule"/chapter22/!ap#2022.htm


16/65

. Ke(u!uhan menin'"a!• (a&i dan ana" un!u" per!um(uhan,•


17/65

3. Kehi%an'an (esi da%am (en!u" 2(6uria,hem$siderinuria a!au

hema!uria.

• misa%n&a pada mens!ruasi, perdarahan sa%.#erna7hem$r$id, u%"us pep!i"um, hernia, "e'anasan,

"$%i!is u%sera!ia d%%8, perdarahan sa%. na*as7idi$pa!hi# pu%m$nar& hem$sider$sis8.

2 Hoffbrand A#$ Petit T%$ Moss PAH. %ssential Haematology &t" ed. 'ondon : la!kell *!ientifi!

P+bli!ation. 2,,1- 1/0.


18/65

Pa!$fsi$%$'i

a. Ke'a'a%an sin!esis hem$'%$(in

(. Ber"uran'n&a masa hidup eri!r$si!, (iasan&apada anemia (era!

&ee '(, Iron De)cienc* and Iron$De)cienc* Anemia. In+ &ee '( et al.

eds-. introbe/s clinical 0ematolog*. !0iladel0ia + &eeebiger.1+ 4$1515.


19/65

a. Ke'a'a%an Sin!esis 2em$'%$(in

esi Protoporfirin

Heme lobin

Hemoglobin

Defiensi Fe

Inflamasi kronik

Keganasan

Anemia Sideroblastik

Thalasemia (α,β)

Hoffbrand A#$ Petit T%$ Moss PAH. %ssential Haematology &t" ed. 'ondon : la!kell *!ientifi! P+bli!ation.2,,1- 1/0.


20/65

(. Ber"uran'n&a masa hidup eri!r$si!

• Ke"uran'an (esi

2( !urun

adan&apenurunan *$rma(i%i!as dan e"si(i%i!asmem(ran mudah dides!ru"si $%eh %impa se% pensi%, $a%$si!, se% !ar'e!

• Ben!u" dan e"si(i%i!as mem(ran eri!r$si!diper!ahan"an $%eh O5 dan $5.


21/65

. Pemeri"saan Darah Tepi Len'"ap

• 2(, 2!, MF, M2, dan M2• Kadar (esi !u(uh 7Serum ir$n, TIB, Sa!urasi Trans*erin8,

"adar *eri!in serum, sT*R 7s$%u(%e Trans*erin Resep!$r8

• N serum Ir$n C/61/ m'?d% dan TIB 59/64// m'?d%.

• Sa!urasi Trans*erin SI ? TIB //• N$rma% 5964/ Anemia de*. (esi 9

• N "adar *eri!in serum


22/65

5. Ea%uasi Sediaan 2apus Darah Tepi

Eri!r$si!• mikrositik hipokrom

anisopoikilositosis: se% pensi%, se% !ar'e!, dan$a%$si!?e%ip!$si!

• Mikrositik ringan

2! 34 a!au 2( / '?d%.

• Mikrositik hipokrom

2! 5C a!au 2( 0 '?d%.


23/65

"ttp:.o+p.!om+kor!bin/0,1/45/&55,1st+dent!asespage6,/."tm


24/65

Lekosit

• Jumlahnya biasanya normal

Trombosit

• Normal atau meningkat

• Jumlah trombosit yang meningkat pada anemiadefisiensi besi karena perdarahan.


25/65

3. Pemeri"saan dan ea%uasi sumsum !u%an'• Hiperseluler den'an eri!r$p$iesis &an'

hipera"!i*,

• 2em$siderin sumsum !u%an' (er"uran'.

4. Pemeri"saan "husus un!u" men#ari e!i$%$'i

misa%n&a ana%isa ma"anan, !um$r mar"er,

pemeri"saan !in)a un!u" men#ari darah samar danparasi!, ser!a pemeri"saan !erhadap adan&a

hem$'%$(inuria dan hem$siderinuria.

&ee '(, Iron De)cienc* and Iron$De)cienc* Anemia. In+ &ee '( et al.eds-. introbe/s clinical 0ematolog*. !0iladel0ia + &eeebiger.


26/65

Hoffbrand A#$ Petit T%$ Moss PAH. %ssential Haematology & t" ed. 'ondon : la!kell *!ientifi! P+bli!ation.

2,,1- 1/0.

Kesimpu%an Dia'n$sis La($ra!$rium AnemiaDefsiensi Besi

• Kadar 2em$'%$(in 5 'r? dL

• MFM2 Menurun se(andin' den'an (era! anemia

• SADT mi"r$si!i" hip$"r$m, !er'an!un' s!adium

• Besi Serum Menurun

• TIB Menin'"a!

• sT*R Menurun

• Jerri!in serum Menurun

• adan'an Je sum.!%' Tida" ada• Besi eri!r$(%asTida" ada

• E%e"!r$*$resis 2B N$rma%


27/65


28/65

ANEMIA PENAKIT MENA2UN7 ANEMIA OF CHRONIC I!EA!E8


29/65

Definisi

Anemia &an' (erhu(un'an den'an in*e"si"r$ni", inamasi "r$ni" a!au pen&a"i!"e'anasan (u"an di"arena"an perdarahan,hem$%isis, a!aupun pen''an!ian )arin'ansumsum !u%an' $%eh se% !um$r

Tida" !ermasu" anemia &' (erhu( d' "e%ainan 'in)a% End$"rin Pen&a"i! ha!i

•Iron deficiency and hypochromic anemias. In: Hoffbrand A! "etit J#! $oss "! ed. #ssential haematology. % th ed.

&'ford: (lack)ell science limited* +,,-. p. %/0

• Anemia of defecti1e heme synthesis. In : $c2en3ie! 4(. Te'tbook of Hematology. +nd ed. 5illiams 6 5ilkins* -778.p.

-7/%,

• Anemias of abnormal iron metabolism and hemochromatosis. In: 4tiene/$artin A! Lotspeich/4teininger 9A! 2oepke J!

eds. 9linical haematology principles! procedures! correlations. +nd ed. "hiladelphia: Lippincott* -77. p. --.


30/65

Kara"!eris!i"

/ h&p$*erremia 7SI rendah8

/ *eri!in N 7#adan'an (esi !u(uh ade"ua!8

•Iron deficiency and hypochromic anemias. In: Hoffbrand A! "etit J#! $oss "! ed. #ssential haematology. % th ed.



-7/%,




31/65

Etiologi

Infeksi kronik

"eny. "aru : T(9! pneumonia

Subacute bacterial endocarditis

"I;

"eny.


32/65

Epidemiologi

• Anemia !er(an&a" pada pasien ra


33/65

Pa!$'enesis Pa!$fsi$%$'i

. Adan&a 'an''uan pe%epasan (esi dari ma"r$*a'

Makrofag/monosit teraktivasi IL-1

Stimulasi sintesis apoferitin dlm makrofag

Besi (feritin) yg berikatan dg apoferitin

terperangkap dlm makrofag

Apoferitin

e di sirkulasi

!elepasan e dari sumsum tulang

eritin " /

Serum Iron

Anemias of abnormal iron metabolism and hemochromatosis. In: 4tiene/$artin A! Lotspeich/4teininger 9A! 2oepke J!



34/65


35/65

5. Gan''uan resp$ns sumsum !u%an'

6 Adan&a si!$"in &an' men'ham(a! pr$du"si a"!ii!as

EPO pada s!em #e%% IL6 TNJ6Q8#espon imun $ proses inflamasi

(pasien dg inf% &ronik' inflm% &ronik' keganasan

!roduksi IL-1 $ "-

!roduksi $ aktivitas *!+


-7/%,


36/65

3. Ke!ahanan hidup eri!r$si! &an' memende" 7(e%um di"e!ahui )e%as8, didu'a

a"!iasi ma"r$*a' ne$si!$%isis

Adan&a !$"sin (a"!eri hem$%isis eri!r$si!

Ja"!$r hem$%isis &' (erhu( d' !um$r


-7/%,

•$eans! =T. Anemia 4econdary to 9hronic ;isease and 4ystemic ;isorders. In 5introbe>s 9linical Hematology. #dited

by : ?reer! J"! @oerster J! Lukens J$! =odgers ?$! "araske1as @! ?lader (. Lippincott*+,,%. p. -%%8/


37/65

*ryt,royte survival

.angguanmetabolisme e

=espon

sumsum tulang

inadekuat#espons *!+

-

-

ACD

Sekresi/produksi*!+ -


38/65

Diagnosiseiss .' .oodnoug, L% Anemia of ,roni disease%" *ngl 0 Med 2234 5361211-5


39/65

Diagnosis• Terdapa! pen&. In*e"si "r$ni", Inamasi "r$ni",

"e'anasan &' mendasari "e%ainan anemia.

• Anemia !ida" dise(a("an "rn perdarahan,hem$%isis, "e%ainan 'in)a%, pen&. 2a!i,end$"rin

• La(

a. 2ema!$%$'i 2( (iasan&a rin'an6sedan'765 '?dL di(a


40/65

Laboratorium•Iron deficiency and hypochromic anemias. In: Hoffbrand A! "etit J#! $oss "! ed. #ssential haematology. % th ed.



-7/%,



Sediaan apus Darah Tepi mi"r$si!i" hip$"r$ma!au n$rm$si!i" n$rm$"r$m.

Sumsum !u%an' hem$siderin 7#adan'an (esi8d%m ma"r$*a'. Tida" menun)u""an hiperp%asiaeri!r$id mes"ipun !dp! anemia 7resp$nseri!r$p$iesis !umpu%8

(. Kimia

Serum Ir$n , TIB , Jeri!in N?, sT*R n$rma%,

pr$!$p$rfrin (e(as , Ureum , a%(umin dan!rans*erin

#. Imun$%$'i

Pr$!ein Jase a"u! 7TNJ6Q, Ji(rin$'en,eru%$p%asmin, 2ap!$'%$(in, RP, Pr$!einAm&%$id8


41/65

Perbandingan data laboratoriumantara AC dan anemia de! "e


42/65

DIAGNOSIS LABORATORIUMANEMIA MAKROSITIK

#A$%&'#'

M*+ / M*% ↑


43/65

LA&A*&#UMA%+M#AMA,&'#*#, Sediaan hapus darah tepi: makrositik

Th/ Folat & B12

Retikulosit N / ↓Retikulosit ↑

MDS

nemia

hemolitik

ates 7. Approa!" to t"e diagnosis and !lassifi!ation of blood diseases. 7n: 'eis *M$ ain 8$ ates 7$ editors. 9a!ie and 'eis pra!ti!al

"aematolo . /t" ed. P"iladel "ia: "+r!ill li;in stone else;ier 2,,1. . 42

!erdarahan

akut

Non"me#alo$lastik Me#alo$lastik

Diseritropoietik Normo$lastik

%ipotiroid

!en'( %ati krn alkohol

Respon thdth/ Folat

Respon thdth/ B12

De)( Folat

De)( B12

Retikulosit

Mor)olo#i ss tulan#


44/65

e-nisi

• $egaloblasB #hrlich : istilah untuk prekursor

eritrosit abnormal pada penderita anemia pernisiosa.-

• Anemia megaloblas ter


45/65

• #tiologi :

defisiensi asam folat! (-+! obat yg menghambat sintesis ;NA

2elainan kongenital


46/65

-. ?lacer (. Anemia: ?eneral 9onsiderations. In: ?reer J! @oerster J! Lukens J! =odgers ?! "araske1as @! ?lader

(! editors. 5introbeCs 9linical Hematology. "hiladelphia: Lippincott 5illiams 6 5ilkins* +,,%. p. 700.

+. http:EEetd.fcla.eduED@ED@#,,,,0E@olicF$odule.pdf


47/65

,lasi-kasi

-. ;efisiensi it (-+ : ;efisiensi dari asupan G


48/65

,lasi-kasi

+. ;efisiensi asam folat : Asupan kurang 2ebutuhan yg meningkat

2ehamilan

bayi

Anemia hemolitik kronik

Alkoholisme

$alabsorbsi kongenital

&bat yg menginduksi defisiensi asam folat =eseksi usus halus yg ekstensif! reseksi yeyunum

?lacer (. Anemia: ?eneral 9onsiderations. In: ?reer J! @oerster J! Lukens J! =odgers ?! "araske1as @! ?lader (!

editors. 5introbeCs 9linical Hematology. "hiladelphia: Lippincott 5illiams 6 5ilkins* +,,%. p. 700.


49/65

,lasi-kasi

. ;efisiensi it (-+ 6 asam folat : Tropical sprue ?luten/sensiti1 enteropathy

%. ?angguan sintesis ;NA yg diturunkan :

&rotic aciduria Lesch/Nyhan syndrome Anemia megaloblastik yg responsif thd tiamin $ethyl/tetrahydrofolate reductase

@ormiminotransferase ;ihydrofolate reductase ;efisiensi Transcobalamin II

Homocystinuria 6 $ethylmalonic aciduria




50/65

,lasi-kasi

0. &bat 6 Toksin yg menginduksi gangguansintesis ;NA : Antagonis folat Gmethotre'ate Antagonis purin G 8/mercaptopurine antagonis pirimidin Gcystosine arabinoside

Alkylating agents Gcyclophosphamide ido1udineGAT! cyclophosphamide Trimethoprim 2ontrasepsi oral

Nitrous o'ide Arsenic 9hlordane #rythroleukemia




51/65

• Defsiensi asam *$%a!• aran' di!emu"an "arena sum(er *$%a! didapa!"an

dari sa&uran, daun6daunan, (i)i6(i)ian, "a#an' (an&a" di Ind$nesia.

• Dapa! dise(a("an $%eh sir$sis ha!i ,(er"ai!an d'n#adan'an *$%a! (er"uran'

• Defsiensi i!amin B5• )aran' di!emu"an di Ind$nesia


52/65

!olat7sia 8ietary olate *9uivalent olat dari

suplemen

(:g/,r);(:g/,r) (:g/kg)

Bayi 2-< bln=-1 bln

2

? @%? >%>

Anak 1-5 t,n-> t,n

13222

52222

Laki-laki $!erempuan

@-15 t,n1-1> t,n

52222

22

% $ anita C 1@ t,n 22 1222

Damil 1-1> t,n

1@-32 t,n

t,n

1@-32 t,n322322

>221222

Biesalski D&' .rimm !% ,e "utrients% In6 !oket Atlas of "utrition% "eE Fork6 ,ieme4 223% p% 1@-21

; : 1 :g folat makanan setara dengan 2'3 :g suplemen


53/65

,andungan !olat

Biesalski D&' .rimm !% ,e "utrients% In6 !oket Atlas of "utrition% "eE Fork6 ,ieme4 223% p% 1@-21


54/65

"ungsi asam !olat

• Asam folat koen3im yg dibutuhkan pd berbagaireaksi metabolik:

4intesis ;NA4intesis asam aminoGpolyamine

2on1ersi homosistein men


55/65


56/65

8o9brand 2551

Dasar bio:imiawi anemia megaloblasti:

iagnosis anemia


57/65

iagnosis anemiamegaloblastik

-. Anamnesis:

• 2onsumsi makanan

K konsumsi sayuran hi


58/65

+. ?e


59/65

,lasi-kasi %*


60/65

@rias JL! (ailey L(. @olic acid guide for physicians. 9ited July +0 th +,,. A1ailable from : http:EEetd.fcla.eduED@ED@#,,,,0E@olicF$odule.pdf

Anensefali *pina ifida

%n!ep"alo!ele

3. La($ra!$rium


61/65

a. 2ema!$%$'i

Anemia ma"r$si!i" MF 70C 8 d'n re!i"u%$si!$penia

Pansi!$penia

Sediaan hapus darah !epi Eri!r$si! ma"r$si!i", An (era! p$i"i%$si!$sis, !ear

dr$p #e%%, eri!r$si! (erin!i, 2$


62/65

4umsum tulang :

Hiperselularitas

#ritropoiesis hiperaktif banyak sel megaloblastik! dominasi

prorubrisit! dissosiasi inti/sitoplasmik

• 2romatin inti seperti menghilang kondensasi terhambat

• 2romosom abnormal centromere spreading

9armel! =. Anemia: ?eneral 9onsiderations. In: ?reer J! @oerster J! Lukens J! =odgers ?! "araske1as @! ?lader(! editors. 5introbeCs 9linical Hematology. "hiladelphia: Lippincott 5illiams 6 5ilkins* +,,%. p. -/%.


63/65

?ranulopoiesis hiperaktif tampak kelainan

berupa ?iant stab! giant metamielosit

Trombopoiesis hiperaktif bentuk kelainan inti dismorfik! tdk ada pembentukan trombosit


64/65

(. Kimia Darah LD2

As. Ura!

Bi%iru(in indire"

De*. B5 Serum B5 serum T2J N?

De*. *$%a! B5 N T2J

De*. J$%a! B5 B5 T2J

Serum Ir$n N?, Jerri!in N?

9armel! =. Anemia: ?eneral 9onsiderations. In: ?reer J! @oerster J! Lukens J! =odgers ?! "araske1as @! ?lader

(! editors. 5introbeCs 9linical Hematology. "hiladelphia: Lippincott 5illiams 6 5ilkins* +,,%. p. -/%

(ila HbK -, gEdL


65/65

Selamat Belaar

Diagnosis Laboratorium Anemia Mh Lengkappptx

Documents

Transcript of Diagnosis Laboratorium Anemia Mh Lengkappptx