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All Journal Buletin Udayana Mengabdi E-Jurnal Medika Udayana Health Science Journal of Indonesia E-Jurnal Udayana Medica The Indonesian Biomedical Journal Indonesian Journal of Cardiology Indonesian Journal of Medicine ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Archives of The Medicine and Case Reports Journal of Global Pharma Technology
Anak Agung Wiradewi Lestari
Departemen Patologi Klinik, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Hydatidiform Mole Pregnancy with Hyperthyroidism: A Case Report Dewi, Ni Made Ratih Purnama; Gotera, Wira; Lestari, Anak Agung Wiradewi; Herawati, Sianny; Wande, I Nyoman; Mulyantari, Ni Kadek; Sudana, I Nyoman Gde; Prabawa, I Putu Yuda
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 3 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i3.2243

Abstract

Hyperthyroidism is a condition with excess biosynthesis and hormone secretion by the thyroid gland. One of the secondary causes of hyperthyroidism is hydatidiform mole pregnancy, which is included in Gestational Trophoblastic Disease (GTD). Hyperthyroidism in hydatidiform mole pregnancies occurs due to increased beta-Human Chorionic Gonadotropin (beta-hCG).  Increasing beta-hCG level affects stimulation of the thyroid gland, increasing thyroid hormone levels in the serum, which causes thyrotoxicosis. This case is such a rare case. A 22-years-old female, G1P0A0, came complaining of amenorrhea accompanied by vaginal bleeding with abdominal pain, nausea, vomiting and palpitations.accompanied by vaginal bleeding with abdominal pain, nausea, vomiting and palpitations. Physical examination showed tachycardia with a pulse rate of 120 beats per minute. Ultrasound examination of the abdomen showed an anteflexed uterus with a honeycomb appearance. Based on a series of tests, the patient has a hydatidiform mole pregnancy with a risk of impending thyroid storm, indicated by TSH suppression with increased fT4. Beta-hCG can cause hyperthyroidism through cross-reaction with TSH receptors. In patients with hyperthyroidism due to GTD, it is not characterized by the characteristic features often found in Graves' disease. Evacuation with curettage and medication was performed to reduce thyroid hormone and serum beta-hCG levels. Hyperthyroidism is an abnormality that can be found in hydatidiform mole pregnancies. It is important to carry out early detection by examining thyroid function in GTD, proper management, and regular monitoring of thyroid function and beta-hCG in pregnant female to provide comprehensive management and prevent complications that can be caused by hyperthyroidism.      
Mapping of Donor Blood Antigens and Development of Panel Cell Reagents in Bali Province Mulyantari, Ni Kadek; Lestari, Anak Agung Wiradewi; Herawati, Sianny
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 3 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i3.2351

Abstract

Examination of other blood groups' antigens, such as Rhesus (d, C, c, E, e), Kell, Duffy, Kidd, and others, is not routinely carried out in blood services. This study aimed to determine the type of blood group antigen and the composition of the antigens of panel cell reagents for antibody screening and identification in Bali. The subjects were 120 voluntary donors who regularly donate blood. Blood group antigen examination was carried out with a column agglutination test. The antigen mapping was analyzed to determine the possible development of panel cell reagents. Among 120 research subjects, 76.67% were male. Rhesus antigen mapping showed 73.3% DCe phenotype, 3.33% DcE, 3.33% Dce, 19.17% DCE. MNS system, 22.5% M-N+, 35.83% M+N+, 85% S-s+, 14.17% S+s+ and 0.83% S+s-. For the Kell system, no donor with phenotype K+k-, 5.83% K+k+, 94.17% K-k+. No donor with Kpa antigen and 100% with Kpb antigen. Based on Duffy system, 74.17% Fy (a+b), 23.33% Fy(a+b+), 1.7% Fy(a-b+), 0.8% Fy(a-b-). For Kidd system 36.67% Jk(a+b-), 45.83% Jk(a+b+), 17.5% (Jk(a-b+) and no donor with Jk(a-b-). The screening analysis of donor antigens allows the development of panel cell reagents using two types of panel cells. Most donors have a Rhesus DCe phenotype with other dominant antigens, M+N+, S-s+, K-k+, Kpb, Fy(a+b-), and Jk(a+b+). The development of panel cell reagents can be done with the antigen composition of R1R1 (D, C, e, M, S, k, Kpb, Fya, Jka) and R2R2 (D, c, E, M, N, s, K,k, Kpb, Fya, Fyb, Jka, Jkb).  
Cerebral Malaria from a Plasmodium falciparum and Plasmodium malariae Co-Infection: A Case Report on a Diagnostic Challenge Vera Akmilia; Anak Agung Ayu Yuli Gayatri; Anak Agung Wiradewi Lestari
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.779

Abstract

Severe malaria, primarily caused by Plasmodium falciparum, is a life-threatening medical emergency. Its diagnosis can be significantly complicated by mixed-species infections, where the presence of a less virulent Plasmodium species may mask the true etiological agent of the severe disease, leading to potential delays in appropriate therapy. This report details a case of cerebral malaria where such a diagnostic challenge occurred. An 18-year-old male with a recent travel history to a malaria-endemic area in Indonesia presented with a one-day history of decreased consciousness (Glasgow Coma Scale score of 9) following a week-long febrile illness. The clinical presentation met the World Health Organization's criteria for severe malaria, specifically cerebral malaria. Initial microscopic examination of a peripheral blood smear exclusively identified Plasmodium malariae. However, a concurrently performed rapid diagnostic test (RDT) was positive for both the pan-malarial antigen and the P. falciparum-specific histidine-rich protein 2 (HRP-2) antigen. This critical discordance prompted treatment for severe falciparum malaria with intravenous artesunate and triggered an expert re-evaluation of the blood smears. Subsequent analysis confirmed a co-infection with both P. falciparum and P. malariae. The patient showed significant clinical improvement within three days of initiating appropriate therapy. In conclusion, this case underscores the peril of diagnostic anchoring in severe malaria. Clinical severity must supersede laboratory findings that are incongruent with the patient's condition. The presence of a Plasmodium species other than falciparum on an initial smear does not rule it out as the cause of a severe syndrome. Discordant results between microscopy and RDTs are a critical red flag for mixed infections and mandate immediate, expert parasitological re-evaluation to ensure timely, life-saving treatment.
The Concordance of Platelet Counts on Hematology Analyzer with Thrombocytopenia Sample with Platelet Clump Prabawa, I Putu Yuda; Lestari, Anak Agung Wiradewi; Wande, I Nyoman; Mahartini, Ni Nyoman; Herawati, Sianny; Cong, Tzeto Han
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 32 No. 1 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v32i1.2437

Abstract

Pseudo-thrombocytopenia is a pre-analytical issue commonly observed in clinical laboratory settings due to platelet aggregation or clumps. In cases of thrombocytopenia, it is essential to conduct a platelet count via Peripheral Blood Smear (PBS) to identify clumping and subsequently re-evaluate the platelet count. The examination of platelets can now be carried out through different methodologies offered by Hematology Analyzers, such as PLT-I, PLT-O, and PLT-F. The primary objective of this research was to evaluate the correlation and agreement of platelet count findings (PLT-I, PLT-O, and PLT-F) in samples displaying flagged platelet clumps between a Hematology Analyzer and PBS at Prof. dr. I.G.N.G. Ngoerah General Hospital, Bali. An analytical cross-sectional observational study was conducted on 71 samples of thrombocytopenia with platelet clump flagging on the Sysmex® XN-1000 Series Hematology Analyzer at Prof. dr. I. G. N. G. Ngoerah Hospital. SPSS version 26.0 and MedCalc were used to conduct statistical analysis. There was a significant difference in the PLT clump Fluorescence index (p = 0.001) between the sample groups with and without the clump, and there was a strong positive correlation of the PLT count results between the Hematology Analyzer (p <0.001) and PBS in the sample groups with and without the clump. The Bland-Altman mean bias was lowest in the sample group without clumps against PLT-I (0.39x103/ml; 95% LOA: -57.05-57.83) and highest in the sample group with a clump to PLT-F (105.38x103/ml; 95% LOA: -14.7-225.46). There is a strong positive correlation and concordance of platelet count results between the Hematology Analyzer and PBS. However, there is no concordance between the platelet count results from the Hematology Analyzer and PBS in the clump group.
The Correlation between HbA1c and MCP-1 Levels in Diabetic Retinopathy Patients Lestari, Anak Agung Wiradewi; Nabu, Ekarini Katharina Yunarti; Triningrat, Anak Agung Mas Putrawati; Wande, I Nyoman; Wirawati, Ida Ayu Putri; Mahartini, Ni Nyoman; Cong, Tzeto Han; Prabawa, I Putu Yuda
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 32 No. 1 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v32i1.2678

Abstract

Diabetic Retinopathy (DR) is a common microvascular complication of diabetes mellitus and a leading cause of vision loss. Persistent hyperglycemia plays a central role in the pathogenesis of DR by promoting chronic inflammation. Monocyte Chemoattractant Protein-1 (MCP-1), a key pro-inflammatory chemokine, is believed to mediate this process. This study aimed to investigate the correlation between glycemic control, as reflected by glycated hemoglobin (HbA1c) levels, and serum MCP-1 concentrations in patients with DR. A cross-sectional analysis was conducted involving 45 DR patients at Prof. dr. I. G. N. G. Ngoerah General Hospital. HbA1c levels were assessed enzymatically and reported in NGSP units, while serum MCP-1 concentrations were measured through ELISA and expressed in pg/mL. The correlation between the two parameters was evaluated using Spearman's rank correlation test, with significance determined at p <0.05.The participants consisted of 64.4% males and 35.6% females, with a mean age of 55.0±6.6 years. The median HbA1c was 9.5% (range: 5.9–12.3%), and the median MCP-1 level was 320.57 pg/mL (range: 32.34–605.41 pg/mL). A moderate positive correlation was identified between HbA1c and MCP-1 levels r = 0.45; p = 0.007). These findings indicate that increased blood glucose levels may coincide with elevated MCP-1, suggesting an ongoing inflammatory response contributing to DR progression. This study demonstrates a significant moderate positive correlation between HbA1c and serum MCP-1 in DR patients, suggesting that elevated blood glucose levels may contribute to increased MCP-1 expression. These findings support the potential role of MCP-1 as a biomarker of both poor glycemic regulation and inflammation in the progression of diabetic retinopathy.
Co-Authors Aakash Aakash Airin Que Anak Agung Ayu Lydia Prawita Anak Agung Ayu Yuli Gayatri Anak Agung Gde Bisma Sanjaya Anak Agung Ngurah Subawa Anak Agung Putri Satwika Aryana, I Gusti Ngurah Wien Aryati Aryati Bagus Anom Sudiada Bagus Ari Pradnyana Dwi Sutanegara Budi Santosa Budi Santosa Cong, Tzeto Han Desak Gde Diah Dharma Santhi Dewi, Ni Made Ratih Purnama Dharayani, Luh Anandita Diah Pradnya Paramita Edward Kurnia Setiawan Limijadi, Edward Kurnia Setiawan Eka Wiratnaya Ekarini Katharina Yunarti Nabu Ekarini Katharina Yunarti Nabu Endrawati KJ Felim, Jethro Gde Ary Putra Kamajaya Gede Wira Mahadita Giri, Kadek Gede Bakta Haneetha Yogarajah I A Putri Wirawati I Gde Raka Widiana I Gst Agung Dwi Mahasurya I Gusti Ngurah Wien Aryana I Gusti Putu Suka Aryana I Kadek Arya Candra I Ketut Suyasa I Nyoman Astika I Nyoman Hery Sumertayasa I Nyoman Indrawan Mataram I Nyoman Santa Wijaya I Nyoman Wande I Nyoman Wande I Putu Sidhi Rastu Karyana I Putu Yuda Prabawa I Wayan Agus Surya Pradnyana I Wayan Putu Sutirta Yasa I Wayan Suryanto Dusak I.A. Putri Wirawati Ida Ayu Ari Utami Ida Bagus Putu Putrawan Indrayani, Pande Kadek Putri Rahayu Intan Astariani Ketut Gede Mulyadi Ridia Ketut Siki Kawiyana Ketut Suega Komang Agus Widhy Utama Putra Komang Septian Sandiwidayat Krisna Yoga Pratama Made Ayu Widyaningsih Made Dyah Khrisnadewi Made Kris Budiman Made Wirabhawa Mahartini, Ni Nyoman Mardiyah Hayati Michael Ferdinand Milaviwanda, Luh Komang Ayu Nabu, Ekarini Katharina Yunarti Ni Gusti Ayu Putu Lestari Santika Dewi Ni Kadek Mulyantari Ni Ketut Rai Purnami Ni Komang Krisnawati Ni Luh Gede Yoni Komalasari Ni Luh Putu Pranena Sastri Ni Made Stithaprajna Pawestri Prabawa, I Putu Yuda Putu Astawa Putu Ayu Krisna Cahyaning Putri Putu Gde Hari Wangsa Putu Putri Titamia Saraswati Putu Ugi Sugandha R. A.T. Kuswardhani Sagung Novita Widyaningrat Sianny Herawati Sianny Herawati Sri Darmawati Sudana, I Nyoman Gde Sudewa Djelantik Teguh Triyono Thaha .. Tjok Gde Oka Tjokorda Gede Oka Triningrat, Anak Agung Mas Putrawati Usi Sukorini Vera Akmilia Wande IN Wayan Aryadana Wayan Giri Putra Wijaya Kusuma Wira Gotera Wirawati, Ida Ayu Putri Yenny Kandarini