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All Journal Jurnal Kedokteran Syiah Kuala Biomolecular and Health Science Journal Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Indian Journal of Forensic Medicine & Toxicology
Arifoel Hajat
Department Of Clinical Pathology, Faculty Of Medicine, Airlangga University, Surabaya
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Diagnostic Value of Determination Blast Cell Population Lineage Using WPC Scattergram Hematology Analyzer Nina Ratnasari; Arifoel Hajat; S. Ugroseno Yudho Bintoro
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 26 No. 3 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i3.1585

Abstract

The diagnosis of hematology malignancies requires examination that includes morphology, immunophenotyping, and cytogenetics. Immunophenotyping is the most trusted examination in determining hematology malignancies lineage, but it is only available in large hospitals and the costs are relatively expensive, so the determination of lineage depends on bone marrow aspiration examination. Therefore it is necessary to have an easier and more reliable alternative to assist BMA morphology. White Precursor Cell (WPC) scattergram Sysmex XN-1000 has the capability to differentiate malignancy lineage. The purpose of this study was to determine the diagnostic value of determining lineage generated by WPC scattergram compared to the lineage from BMA examination. BMA blood samples were simultaneously examined by BMA morphology interpretation using microscope and WPC scattergram Sysmex XN-1000 examination. The hematology malignancies lineage resulting from BMA and WPC scattergram examination was then analyzed statistically to determine the suitability, sensitivity, and specificity. The results of determining the lineage of blast cell population based on WPC scattergram resulted in a suitability with a sensitivity of 93.75% and specificity of 94.74% for determining the hematological malignancy of myeloid lineage and 94.74% and 93.75% for lymphoid lineage, with a diagnostic accuracy of 94.91%. Based on this study it can be concluded that the WPC scattergram can determine the lineage of hematological malignancies with a suitability and high diagnostic value of lineage based on BMA morphology.
TEG's Utility to Detect Hypercoagulability in Adult Patients at Post-Cardiac Surgery Using Cardiopulmonary Bypass in ICU Hildegardis Dyna Dumilah; Hartono Kahar; Arifoel Hajat; Philia Setiawan; Heroe Soebroto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 1 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i1.1615

Abstract

The use of Cardiopulmonary Bypass (CPB) in adult patients of cardiac surgery disrupts the coagulation system. The most common complication of the coagulation system is bleeding; however, that does not rule out the possibility of a dangerous hypercoagulation condition. A quick and precise coagulation test can provide clues for clinicians to predict future hemostatic disorders or determine interventional therapy. aPTT and PT are standard laboratory tests, which are limited to detect a deficiency of coagulation factors. Thromboelastography (TEG) test (R time, K time, α angle, MA, and LY30) provides an overview of the entire coagulation and fibrinolysis process with faster results. A 2.7 mL citrate blood sample was taken and tested in a TEG®5000 device, then centrifuged. The plasma was then tested for aPTT and PT using the Sysmex CS-2100i device. Bleeding volume was measured from chest drain 1-2 hours in the ICU after chest closure in the operating room. Bleeding criteria were as follows: > 1.5 mL/kg/hour for 6 hours consecutively in 24 hours or > 100 mL/hour. The results showed 30 patients with no clinically significant bleeding. A significant correlation was found between PT and bleeding volume at IV hour (p=0.008, r= 0.472). There was no correlation between aPTT and TEG (R time, K time, α angle, MA, and LY30) with the bleeding volume at I, II, III, and IV hours. There was a hypercoagulation indication of the TEG test of 56.7%, which showed clinical importance for the patient. PT can be used to analyze changes in bleeding volume at IV hour and TEG is more superior to detect hypercoagulability of adult patients after cardiac surgery with CPB.  
Pancytopenia and Progressive Splenomegaly in Patient with Disseminated Histoplasmosis Paulus Budiono Notopuro; Arifoel Hajat; Made Putra Sedana
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 2 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i2.1621

Abstract

Disseminated histoplasmosis is a severe manifestation of fungal infection caused by Histoplasma capsulatum. It usually occurs in a patient with an immunodeficiency state. With the increase of HIV infection and the use of immunosuppressant drugs lately, its prevalence also increases. A case of 43 years old female with prolonged fever, pancytopenia, and massive progressive splenomegaly. The diagnosis of disseminated histoplasmosis and the secondary hemophagocytic syndrome was made based on bone marrow examination that showed increased hemophagocytic processes and multipleintracytoplasmic H.capsulatum. She had been treated with Itraconazole 200 mg for three months. In the first month's evaluation, her complete blood count improved without any transfusions, and the size of her spleen size decreased. She had been fully recovered after the completion of 3-month treatment.
Difference Expressions CD34 in Acute Myeloid Leukemia Cell Culture in the Administration of Cytarabine-Daunorubicine Dose Standards Muhammad Saiful Rahman; Paulus Budiono Notopuro; Suprapto Ma'at; Made Putra Sedana; Arifoel Hajat
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 2 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i2.1623

Abstract

The cure rate for patients with Acute Myeloid Leukemia (AML) is 20-75%. Standard-dose cytarabine + (SDAC)-daunorubicine gives a remission rate of ± 60%, and the case of relapse is frequently found. In-vivo CD34 expression is a reliable and straightforward test that must evaluate AML patients' response to predict the response of chemotherapy + induction phase accurately. Differences in in-vitro CD34 expression are expected to be able to predict chemosensitivity in AML patients. An experimental post-test-only control group study was conducted from May to December 2019, and 8 AML subjects were found. Peripheral Blood Mononuclear Cells (PBMC) were isolated from peripheral blood samples of patients with AML collected in EDTA tubes. The PBMC isolated from peripheral blood were divided into two groups, and each group contained 106 PBMC cells in culture media. The control group (without treatment) and the SDAC-daunorubicine group were 0 + incubated for 4 hours at 37 C with a 5% CO2 atmosphere. The expression of CD34 was measured using FACSCaliburâ„¢, while + CD34+ percentage was calculated with CellQuestâ„¢ software. The percentage of CD34 in the control, SDAC + DNR, showed a significant difference with p < 0.001. This study showed a significant difference between the control group and the group + administered with the standard dose of cytarabine-daunorubicine with p < 0.001. The average CD34 expression in the + SDAC-DNR treatment group was higher than in the control group. CD34 markers cannot be used as predictors of chemosensitivity in the administration of chemotherapy.
Hairy Cell Leukemia (Morphologic and Immunophenotypic Profile) Anindita Novia Damayanti; Arifoel Hajat
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 3 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i3.1712

Abstract

Hairy Cell Leukemia (HCL) is a lymphoproliferative B cell abnormality dominated by mature lymphocytes with cytoplasmic projections and often misunderstood as Chronic Lymphocytic Leukemia (CLL). Misdiagnosis can be caused by errors in the preparation of peripheral Blood Smear Evaluation (BSE). Immunophenotyping is an option to differentiate HCL from CLL. A 56-year-old female presented with complaints of weakness. Physical examination showed conjunctival anemia 3 3 and hepatosplenomegaly. Hematological test results were as follows: Hb 7.4 g/dL; WBC 131.24x10 /uL; and Plt 61x10 /uL. BSE And Bone Marrow Aspiration (BMA) showed predominantly mature lymphocytes with cytoplasmic projections and suspected CLL with HCL as the differential diagnosis. Immunophenotyping with peripheral blood samples showed CD19+, CD20+, CD79a+, HLA-DR+, CD5-, and CD7- suggesting an increasing mature lymphocytes population (74.16%) that expressed B lymphoid lineage. White Precursor Cell (WPC) channel test showed an abnormal lymphocytes population. The differential diagnosis of patients with dominant mature lymphocytes BSE with cytoplasmic projections was CLL and HCL. Immunophenotyping of CLL showed positive results on B cell markers (CD19, CD20, CD79a, and HLA-DR) with aberrant CD5. However, in such an HCL case like this, there were strongly positive results on B cell markers but the absence of aberrant CD5. This study was supported by the presence of abnormal lymphocytes population in the WPC test. The diagnosis of HCL in this patient was based on interpretation of BSE and immunophenotyping, supported by the WPC test.
Determining Acute Leukemia Lineage Using Mie Map Red Blood Cell Nelly Zuroidah; Arifoel Hajat; Paulus Budiono Notopuro
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 1 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i1.1747

Abstract

The determination of myeloid and lymphoid lineage is essential for the diagnosis and therapy of acute leukemia. Immunophenotyping is the gold standard to determine the lineage of acute leukemia, but it is still constrained and relatively expensive. Mie Map RBC in the ADVIA 2120i is a parameter that can give additional information about myeloid and lymphoid lineage but has never been studied before. It is expected that Mie Map RBC can be used to differentiate the lineage of acute myeloid and lymphoid leukemia if immunophenotyping is not present. This study aimed to analyze the diagnostic value of Mie Map RBC with ADVIA 2120i towards immunophenotyping in determining myeloid and lymphoid lineage in acute leukemia. Child and adult patients diagnosed with acute leukemia (n=30) that had peripheral blood smear and bone marrow aspiration with blasts > 20% were examined using ADVIA 2120i. The Mie Map RBC lineage results were compared to the lineage of immunophenotyping. The sensitivity and specificity of the Mie Map RBC myeloid series are respectively 60.00%, 93.33%. The sensitivity and specificity of the Mie Map RBC lymphoid series are respectively 93.33% and 60.00%. The diagnostic accuracy value of Mie Map RBC is 76.67%. The determination of acute leukemia myeloid series lineage has high specificity. If there is no population outside the matrix of Mie Map RBC, it highly suggests myeloid series. On the other hand, the determination of acute leukemia lymphoid series lineage has a relatively low specificity meaning that the population outside the matrix of Mie Map RBC does not always suggest a lymphoid lineage
CHRONIC MYELOGENEOUS LEUKEMIA TRANSFORMATION INTO ACUTE LYMPHOBLASTIC LEUKEMIA Endah Indriastuti; Arifoel Hajat
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1395

Abstract

Chronic Myelogenous Leukemia (CML) is a myeloproliferative neoplasm that can progress into various conditions. Transformation of CML into Acute Lymphoblastic Leukemia (ALL) is rare. A 22-year-old male with a history of CML since 2014 and positive BCR-ABL p210 in 2017 came with the complaint of weakness. Physical examination showed hepatosplenomegaly. Complete Blood Count (CBC) showed Hb 7.1 g/dL, WBC 290,620 /uL, platelet 434,000 /uL.Blood Smear Evaluation (BSE) suggested CML blastic crisis with DD of AML-M5. Patient’s condition got worse and the CBC result showed WBC 96,770/uL and platelet 7,000/uL in 2 weeks. Blood smear evaluation was dominated by mononuclear cells with scanty blue cytoplasm, no granules, no Auer rods, loose chromatin, and indistinct nucleoli, suggesting lymphoblasts with a proportion of 60%. The BMA result was dominated by lymphoblast, consistent with ALL. The immunophenotyping result was CD10+, CD34+(0.99%), CD79a+, HLA-DR+, and CD20+. Molecular examination showed positive RUNX1 and NRAS while FLT3, NPM1 and del(5q) was negative.  BCR-ABL gene can be found both in CML and ALL. CML transformation into ALL had been reported to be related with deletion of a transcription gene. Diagnosis of ALL can be established by BMA and immunophenotyping. CD34+ expression of lymphoblast in ALL can be varied and found to be minimal in this case. Patient with history of CML showed an ALL picture based on BSE, BMA, and immunophenotyping suggesting CML transformation into ALL although CD34+ expression was minimal.    
Co-Authors Angela Dinaria Kemala Swary Anindita Novia Damayanti Aryati Aryati Aryati Aryati Betty Agustina Tambunan Bintoro, Siprianus Ugroseno Yudho Dian W Astuti Dwi Ajeng Roosanti Ersa Bayung Maulidan Fery H. Soedewo Hartono Kahar, Hartono Hildegardis Dyna Dumilah Indriastuti, Endah Johanis Johanis Made Putra Sedana Merylin Ranoko Mia Ratwita Andarsini Muhammad Saiful Rahman Nelly Zuroidah Ni Made Rindra Hermawathi Ni Made Rindra Hermawathi Nina Ratnasari Notopuro, Paulus Budiono Prillye Deasy Octaviantie Puspitasari, Yessy Semedi, Bambang Pujo Setiawan, Philia Sidarti Soehita Siti Nurul Hapsari Soebroto, Heroe Sony Wibisono Sri Purwaningsih Suprapto Ma&#039;at Suprapto Ma'at Trinil Sulamit Veithzal Rivai Zainal Widodo Widodo Yetti Hernaningsih