EVALUASI PARAMETER RETICULOCYTE HEMOGLOBIN EQUIVALENT (Ret-He) SEBAGAI UJI SKRINING DEFISIENSI BESI PADA IBU HAMIL ATERM DALAM PERSALINAN
| Main Authors: | , Dinne Fitriya, , dr. Tri Ratnaningsih, M.Kes, SpPK-K |
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| Format: | Thesis NonPeerReviewed |
| Terbitan: |
[Yogyakarta] : Universitas Gadjah Mada
, 2014
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| Subjects: | |
| Online Access: |
https://repository.ugm.ac.id/130894/ http://etd.ugm.ac.id/index.php?mod=penelitian_detail&sub=PenelitianDetail&act=view&typ=html&buku_id=71327 |
Daftar Isi:
- Iron deficiency is a nutritional problem of pregnant women with high prevalence in Indonesia, even in Yogyakarta. At term pregnancy 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 Sysmex XT-2000i is capable of displaying a new parameter reticulocyte hemoglobin equivalent (RET-He) 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 but there is no global agreement about the cut-off. This study aims to determine to the cutoff value of Ret-He who has the optimal sensitivity and specificity for screening for iron deficiency at term pregnancy who will delivery in Yogyakarta, This diagnostic study with a cross-sectional design, using the gold standard ferritin cut-off value of <15 ng / ml with negative results of C-Reactive Protein (CRP). The study involved women at term pregnancy who came in PKU Muhammadiyah Bantul Hospital and then undergo a complete blood count and RET-He test using automatic hematology analyzer Sysmex XT-2000i with flowcytometry method, measurement of ferritin serum using a mini vidas (enzyme linked fluorescence assay method/ ELFA) and CRP qualitatively using Avitex. This study was followed by 189 subjects, only 97 subjects meet the inclusion and exclusion criteria with age range 20-43 year. Based on feritin serum, there are 50 subjects with iron deficiency, no difference subject characteristics between two grups, but there are significant lower mean values in the of hemoglobin concentration, hematocrit, MCV, MCH, and RET-He and higher mean RDW-CV in iron deficiency group. Using ROC curve, we found that Ret He had Area under curve (AUC) value of 0.71 which shows that the RET-He has good enough as a diagnostic tools to detecting iron deficiency. The optimal cutoff value as a screening test of iron deficiency at term pregnancy in labour was <35.5 pg obtained in the range from 30.69 to 36.17 pg, has 68%, sensitivity, 66% specificity, with Positive predictive value (PPV), 66% Negative Predictive Value (NPV), positive likelihood ratio (LR) 2.00, negative LR 0.49. Further research is needed to assess the role of Ret-he as a iron deficiency screening test at maternal involving subjects from various trimesters of pregnancy by comparing various parameters as a gold standard (eg, transferrin saturation, or ferritin with different cut-off values ). Keywords : iron deficiency, Ret-He, screening, at term pregnancy