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Endang Windiastuti
Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Iron profiles of preterm infants at two months of chronological age Henny Adriani Puspitasari; Endang Windiastuti; Aryono Hendarto
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (258.931 KB) | DOI: 10.14238/pi56.5.2016.277-84

Abstract

Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the body’s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements. Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA). Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed. Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers >20 years of age (93%). Subjects’ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 µg/dL, TIBC 329µg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5). Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.
Using iron profiles to identify anemia of chronic disease in anemic children with tuberculosis Reni Wigati; Endang Windiastuti; Badriul Hegar
Paediatrica Indonesiana Vol 51 No 4 (2011): July 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.4.2011.217-22

Abstract

Background Anemia of chronic disease (ACD) is commonly found in patients with chronic inflammation or infection. By examining soluble transferrin receptor or bone marrow iron, ACD was found in 80% of anemic adult tuberculosis (TB) patients. Iron profile, another tool to differentiate ACD from iron deficiency anemia (IDA), is both less expensive and less invasive. Few studies have been reported on iron profiles of anemic children with TB in Indonesia.Objective We aimed to use iron profiles to determine the proportion of ACD in anemic children with tuberculosis.Methods A cross-sectional study on anemic children with TB who came to Cipto Mangunkusumo Hospital and Tebet Puskesmas (community health center) was performed in September-November 2010. Iron profiles included the measurements of serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TF), and serum ferritin (SF).Results Our study comprised of 66 subjects, with a median age of 3.8 years (6 months–18 years). Most subjects had normal SI (85%), normal TIBC (71%), low transferrin saturation (51%), and normal SF (71%). Only 10 children had iron homeostasis disorder and 6 of these were diagnosed as having ACD. Thus, iron profiles failed to prove that iron metabolism was disturbed. The profile of children with organ-specific TB was more consistent with ACD compared to the profile of childhood TB. [SI 29.1 (11-83) vs 44 (10-151) μg/dL; TIBC 239.3 (100.80) vs 299.0 (58.51) μg/dL; TF 18.3 (4-100) vs 15 (1-53) %; and SF 154 (34.9-655) vs 36.1 (2.5-213.4) μg/L].Conclusion The proportion of ACD (9%) diagnosed by using iron profiles was not as high as previously reported. Further research using newer techniques is needed to detect ACD in anemic children with TB. [
The proportion of bone mineral density in children with high risk acute lymphoblastic leukemia after 6- and 12-month chemotherapy maintenance phase Mira Christiyani Santoso; Endang Windiastuti; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 50 No 6 (2010): November 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (121.074 KB) | DOI: 10.14238/pi50.6.2010.365-70

Abstract

Background Low bone mineral density (BMD) value is one of the current concerns in acute lymphoblastic leukemia (ALL) patients. Some risk factors including use of chemotherapeutic drugs, nutritional status, phy sical activities, and progression of disease are suspected as the predisposing factors for development of osteopenia and osteoporosis.Objectives To obtain the proportion of BMD z-score, level of calcium ions, and 25 (OH)D3 in children 'With high risk ALL after 6 and 12 months chemotherapy maintenance phase.Methods We conducted a cross-sectional comparative study from May 2008 to May 2010. Subjects were high risk ALL patients aged 5-18 years old who had completed the 6 or 12 months chemotherapy maintenance phase. We measured 25 (OH) D3 level, calcium ion level, and BMD using electro chemi-luminescence immunoassay, ion selective electrode, and dual x-ray absorptiometry, respectively.Results There were 40 subjects who enrolled this study. The incidence of hypocalcemia and vitamin D deficiency were 33/40 and 40/40, respectively. The mean calcium ion levels, 25 (OH)D3 level, and BMD z􀁏score values in six months groups were 1.1 (0.1 SD) mmol/L, 21.3 (2 SD) ng/L, -0.7 (0.8 SD), respectively, while in the 12 months group, the values were 1.1 (0.0 SD) mmol/L, 21(2.2 SD) ng/L, -1.7 (0.6 SD), respectively (P=0.478). Body mass index (BMI) and corticosteroid cumulative dose is correlated \\lith the low BMD values in L1-L4.Conclusion The bone mineral metabolism disorder marked with the low levels of calcium, 25 (OH)D3 and osteopenia was observed in ALL patients who underwent chemotherapy. The proportion of the BMD z-score value, calcium ion level, and 25 (OH) D3 in the two groups were not statistically significant.
Clinical features and survival pattern of central nervous system leukemia in children with acute lymphoblastic leukemia Hardiono D. Pusponegoro; Moeslichan M. Z.; Risma K. Kaban; Rulina Suradi; Endang Windiastuti
Paediatrica Indonesiana Vol 41 No 9-10 (2001): September 2001
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (300.834 KB) | DOI: 10.14238/pi41.5.2001.247-52

Abstract

Infiltration of leukemic cells into the central nervous system (CNS) is one of the causes of neurological disorders in patients with acute lymphoblastic leukemia (ALL) that worsen the prognosis. This retrospective cohort study aimed to review the clinical manifestations of children with CNS leukemia, their survival pattern and the role of early CNS leukemial. The survival curve was developed by Kaplan-Meier method, while the comparison of survival curves was done with log-rank test. Among 128 new ALL patients, 23 (18.0%) patients suffered from CNS leukemia, while 13 (10.2%) suffered from early CNS leukemia and 10 (7.8%) suffered from relapsing CNS leukemia. CNS leukemia was more common in male, in those aged less than 2 years, in those with white blood cell (WBC) count above 50,000/ìl, and in patients type FAB-L2 ALL. The clinical manifestations most commonly found were decrease of consciousness (61%), vomiting (48%), cranial nerve palsy (44%), seizures (39%), and headache (26%). Relapsing CNS leukemia was more common in high risk (12.5%) compared with standard risk leukemia (5.7%). Patients with early CNS leukemia had a lower survival rate than those without early CNS leukemia (p = 0.0005). The percentage of patients with early CNS leukemia surviving up to 3 years was 26%. We conclude that early CNS leukemia could cause low survival ALL patients.
Co-Authors Alan R. Tumbelaka Aryono Hendarto Badriul Hegar Hardiono D. Pusponegoro Henny Adriani Puspitasari Mira Christiyani Santoso Moeslichan M. Z. Reni Wigati Risma K. Kaban Rulina Suradi