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Systemic lupus erythematosus in a 9-year-old patient with beta-thalassemia trait. A case report Ninik Sukartini, Ninik Sukartini
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 36, No 3 (2004)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (126.06 KB)

We reported a case of lupus nephritis in a 9-year-old patient with beta-thalassemia trait who was treated in Cipto Mangunkusumo Hospital. The patient presented with bicytopenia, hepatosplenomegaly and lymphadenopathy. Laboratory results revealed hematologic disorder, i.e. hemolytic anemia with positive Coombs test and thrombocytopenia, positive ANA and antibody to double-stranded DNA, and proteinuria of 1230 mg/24 hrs, which fulfilled 4 criteria of ACR for the diagnosis of systemic lupus erythematosus ISLE). Signs of pericarditis was not found. In the follow up, the patient showed microcytic hypochromic anemia with high transferrin saturation level, leading to hemoglobin analysis which revealed beta thalassemia trait. This case is interesting because this patient didnt present with characteristic clinical features, and because SLE is seldom diagnosed before 16 years of age. Moreover, this patient also suffered from beta thalassemia trait, which is known to be associated with rheumatoid arthritis, another autoimmune disorder.Key words: SLE, lupus nephritis, beta thalassemia trait, childhood age

EVALUATION OF BLOOD GLUCOSE TESTING USING CONTOUR® PLUS GLUCOMETER Beauty, Venny; Sukartini, Ninik
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 3 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i3.1340

The use of glucometers has been widely recommended to help patients in controlling their blood glucose level. This study compared the blood glucose level measured by Contour® Plus glucometer and Cobas c501 chemistry analyzer, as the reference method. The study design was cross-sectional and conducted in the Dr. Cipto Mangunkusumo Hospital in April 2017. Study materials were 120 capillary blood examined by Contour® Plus glucometer and plasma analyzed by Cobas c501 chemistry analyzer. Precision, correlation, accuracy, and clinical accuracy tests were performed based on ISO 15197:2013, using Parkes error grid analysis. Contour® Plus glucometer yielded a CV of 1.56-2.2%, following the recommendation of the American Diabetes Association, of <5%, there was a strong positive correlation between the glucose level of capillary blood and plasma (r=0.997). Accuracy test based on ISO 15197:2013 showed that 100% of capillary blood glucose deviations were within the ±15 mg/dL range for glucose level <100 mg/dL and ±15% range for glucose level ≥100 mg/dL. Clinical accuracy test with Parkes error grid showed 100% of results were in zone A. Contour® Plus glucometer test results met the ISO 15197:2013 criteria, so the results were proportional to the reference method’s results and clinically acceptable. Contour® Plus glucometer is safe to be used in blood glucose monitoring, as long as careful attention is given to the device specifications.

Comparison of the Profile and TSH Levels from Several Types of Blood Collection Tubes Putra, Gunawan Eka; Sukartini, Ninik; Immanuel, Suzanna; Henrika, Fify; Indrasari, Nuri Dyah
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 26, No 2 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i2.1475

Thyroid-Stimulating Hormone (TSH) is an important parameter in diagnosing thyroid disease which uses serumaccording to the World Health Organization's (WHO) recommendations. The use of plasma can help improve the TurnAround Time (TAT); however, the discrepancy with serum is unknown. A cross-sectional study using 89 blood samples wasperformed to compare TSH levels using serum tubes with clot activator (Tube I), plasma tubes with heparin (Tube II), andplasma tubes with heparin-gel separator (Tube III); and to overview of TSH levels according to gender and age. The medianof TSH levels in Tubes I, II, and III were 1.380 (0.032-7.420) μIU/mL, 1.380 (0.030-7.480) μIU/mL, and 1.360 (0.030-7.460)μIU/mL, respectively. There were no statistically significant differences in TSH levels of the three tubes. The median TSHlevels differences of Tubes II and III compared to the tube I were -0.9% (-7.2-2.2) and -1.7% (-8.0-1.6), respectively.Measurement bias observed in this study was following the specified desirable bias according to Ricos. The median TSHlevels of the male and female groups were 1.500 (0.032-4.250) μIU/mL and 1.345 (0.058-7.420) μIU/mL, respectively. MedianTSH levels of 31-40 years old age group and >61 years old age group were 1.190 (0.609-3.240) μIU/mL and 1.730 (0.088-5.760) μIU/mL, respectively. Specimens from three tubes could be used to examine TSH levels. Measurement of TSH levelsshowed a higher median in the male and older group.

Evaluasi Pemeriksaan Imunoglobulin E Spesifik Menggunakan Immunoblot Assay dengan Baku Emas Skin Prick Test -, Yudhistira; Sukartini, Ninik; Immanuel, Suzanna; Rengganis, Iris
Cermin Dunia Kedokteran Vol 46, No 2 (2019): Penyakit Dalam
Publisher : PT. Kalbe Farma Tbk.

Pendahuluan. Skin Prick Test (SPT) merupakan baku emas diagnosis alergi, tetapi tidak dapat dilakukan pada kondisi tertentu seperti dermatografisme, hamil, tidak dapat lepas obat antialergi, sehingga pemeriksaan IgE spesifik menjadi pilihan. Di Indonesia belum ada data perbandingan pemeriksaan IgE spesifik dengan SPT. Penelitian ini dilakukan untuk menentukan sensitivitas, spesifisitas, PPV, NPV, LR+ dan LR- pemeriksaan IgE spesifik menggunakan analisis immunoblot. Metode. Penelitian menggunakan desain potong lintang. Subjek penelitian adalah pasien poliklinik alergi imunologi. Pengambilan sampel dengan metode non-probability sampling dengan teknik consecutive sampling. Analisis dilakukan terhadap alergen tungau debu rumah (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis) dan kecoa. Hasil. Seratus subjek yang memenuhi kiteria masukan dan tolakan (76% perempuan, rerata usia 38.9 tahun) ikut serta dalam penelitian ini. Sensitivitas empat alergen bervariasi dengan rentang 32.4%-76.8%, spesifisitas 68.0%-85.7%, PPV 54.5%-94.5%, NPV 46.2%-65.3%, LR+ 1.8-5.0, dan LR- 0.3-0.8.Sensitivitas pemeriksaan IgE spesifik cukup baik pada tiga tungau debu rumah tetapi rendah pada kecoa; spesifisitas dan PPV bervariasi cukup sampai baik; NPV cukup baik. Simpulan dan Saran. Uji diagnostik IgE spesifik tungau debu rumah menunjukkan hasil cukup baik. Pemeriksaan IgE spesifik tidak dapat digunakan untuk skrining alergi kecoa.Background. Skin Prick Test (SPT) is considered as gold standard for diagnosis of allergy, but cannot be performed in some conditions such as dermatographism, pregnancy, and unable to abstain from antiallergy drugs. In these conditions, specific-IgE test is a test of choice. But there is no comparison data on specific IgE test with SPT in Indonesia. This study was to investigate sensitivity, specificity, PPV, NPV, LR+, and LR- of specific-IgE test of immunoblot assay kit. Method. The study was cross-sectional. Subjects were patients from allergy-immunology clinic who fulfilled inclusion and exclusion criteria. Sampling was performed using non-probability sampling method with consecutive technique. Analysis was performed for house dust mite allergen (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis) and cockroach. Result. Hundred subjects (76% was female, average age of 38.9 years) were involved. Sensitivity of four allergens were varied with range 32.4%-76.8%, specificity 68.0%-85.7%, PPV 54.5%-94.5%, NPV 46.2%-65.3%, LR+ 1.8-5.0, and LR- 0.3-0.8. Sensitivities of specific-IgE for three species of house dust mite were moderate, but low for cockroach; specificities and PPVs were moderate to high; NPVs were moderate. Conclusion. Diagnostic test of specific-IgE with house dust mite allergen shows adequate result. Specific IgE test cannot be utilized for screening of cockroach allergy.Â

Systemic lupus erythematosus in a 9-year-old patient with beta-thalassemia trait. A case report Ninik Sukartini Ninik Sukartini
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 36, No 3 (2004)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (126.06 KB)

We reported a case of lupus nephritis in a 9-year-old patient with beta-thalassemia trait who was treated in Cipto Mangunkusumo Hospital. The patient presented with bicytopenia, hepatosplenomegaly and lymphadenopathy. Laboratory results revealed hematologic disorder, i.e. hemolytic anemia with positive Coombs' test and thrombocytopenia, positive ANA and antibody to double-stranded DNA, and proteinuria of 1230 mg/24 hrs, which fulfilled 4 criteria of ACR for the diagnosis of systemic lupus erythematosus ISLE). Signs of pericarditis was not found. In the follow up, the patient showed microcytic hypochromic anemia with high transferrin saturation level, leading to hemoglobin analysis which revealed beta thalassemia trait. This case is interesting because this patient didn't present with characteristic clinical features, and because SLE is seldom diagnosed before 16 years of age. Moreover, this patient also suffered from beta thalassemia trait, which is known to be associated with rheumatoid arthritis, another autoimmune disorder.Key words: SLE, lupus nephritis, beta thalassemia trait, childhood age

KELEBIHAN ZAT BESI SEKUNDER BERKAITAN DENGAN SATURASI TRANSFERIN DAN FERITIN Isabella Valentina; Ninik Sukartini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 20, No 1 (2013)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v20i1.447

Iron overload disorder is a condition due to an excessive rate of iron acquisition compared to the rate of body iron loss that happens constantly. The clinical manifestations vary depending on the location of the damaged organs. Consequently, the symptoms of iron overload may mimic many diseases such as cirrhosis, diabetes mellitus, arthropathy, and skin pigmentation. The laboratory results which may point to iron overload are as follows: transferrin saturation >45%, serum ferritin level >300 ng/ml in men and >200 ng/ml in women. It is thus imperative that the molecular mechanism of iron metabolism and pathogenesis of iron overload are well understood in order to correct the interpretation of the laboratory results for iron overload. The standard management is blood removal by phlebotomy to maintain the level of the serum ferritin at 50 ng/mL in order to prevent irreversible hepatic cirrhosis

COMPARISON OF AUTOMATIC STARRSED RS ERYTHROCYTE SEDIMENTATION RATE WITH MANUAL WESTERGREN METHOD Ninik Sukartini; Siskawati Suparmin
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1302

This study aimed to compare the results of ESR measurements using Starrsed RS (30- and 60-minute mode) and manual Westergren method. We also investigate the effect of high leukocytes and haematocrit (Ht) on Starrsed RS ESR measurements. A cross-sectional study using K3EDTA anticoagulated blood samples from 140 subjects were conducted. A total of 21 samples with leukocytes count >50 000/µl were examined. The effect of Ht was studied using data from comparative study subjects. The 60-minute mode Starrsed RS correlated very strongly [r = 0.98 (95%CI 0.97 to 0.98), p <0.0001], had good agreement [mean bias -0.4 mm (95%CI -1.46 to 0.74)], and gave no significant different results with manual Westergren method. The 30-minute mode Starrsed RS also has a very strong correlation [r = 0.97 (95%CI 0.96 to 0.98), p<0.0001] and good agreement [mean bias-2.9 mm (95%CI -4.23 to -1.58)], but has systematic difference with manual Westergren method. There was significant difference between manual method and Starrsed RS in samples with high leukocytes (p = 0.0208). There were no significant differences of ESR results measured by Starrsed RS dan manual Westergren method in the group of Ht≤35% and >35%. The ESR on the Starrsed RS should still be read at 60 minute. Leukocytes>50 000/µl may affect ESR measurements on Starrsed but no effect of haematocrit was observed.

KEKURANGAN ZAT BESI DI PEREMPUAN HAMIL MENGGUNAKAN HEMOGLOBIN RETIKULOSIT (RET-HE) Petriana Primiastanti; Ninik Sukartini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 19, No 3 (2013)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v19i3.414

Iron deficiency is the most common nutrional deficiency in the world, mostly in developing and industrial countries. Population with highest risk of iron deficiency generally are reproductive-age women. In Indonesia, the prevalence of iron deficiency anemia in pregnant women is about 50.5%. Anemia due to iron deficiency in pregnancy can affect both mother as well as the foetus. In order to prevent permanent systemic complication, it is important to do early detection before iron deficiency anaemia developes. In the early phase of iron deficiency prior to anaemia, additional tests of ferritin, serum iron and saturation index are needed besides the complete blood count. A new parameter named reticulocyte hemoglobin equivalent (RET-He) has been developed to detect the level of hemoglobin in an immature erythrocyte or reticulocyte. Reticulocytes will be present in the peripheral circulation for only 24−48 hours, so the RET-He will give more appropriate information about the condition of bone marrow iron. When the bone marrow iron is depleted, the RET-He will show a decrease. In several hematology analyzers, for example Advia 2120 and Sysmex XE 2100, this parameter can be tested together with CBC, so no additional blood sample is needed. The aim of this study is to know iron deficiency in healthy first and second trimester pregnant women by screening using RET-He and compare the result to other parameters that are now available, such as: hemoglobin, ferritin, transferrin saturation. Those parameters can develop RET-He cut-off with optimal sensitivity and specificity. The study comprised 100 healthy pregnant women from I and II trimester who did not develop anemia yet during their last pregnancy. The subjects were divided into three (3) groups based on ferritin and transferrin saturation: 67 women (67%) without iron deficiency, 17 women (17%) with iron deficiency stage I, and 16 women (16%) with iron deficiency stage II. Hemoglobin, RET-He, and transferrin saturation showed a mean±SD of 12.35±1.02 g/dL, 33.60±1.88 pg and 28.63±1.07%, respectively. Median ferritin (min-max) was 40.10 (6.24–191.30)ng/mL. By using receiver operating curve (ROC) in this study RET-He point was found at 33.65 pg as an optimal cut-off point to differentiate iron deficiency with sensitivity and specificity of 67% and 64.18% respectively. From cross tabs table of RET-He with ferritin as the gold standard and 33.65 pg as the cut-off point results were 47.8% positive predictive value (PPV), 79.6% negative predictive value (NPV), positive likelihood ratio (LR) 1.86 and negative likelihood ratio (LR) 0.52. In this study, significant differences between non iron deficiency and the iron deficiency stage II groups and between iron deficiency stage I and iron deficiency stage II groups were found. There was no difference between the non iron deficiency and iron deficiency stage I groups.

ERYTHROCYTE INDICES TO DIFFERENTIATE IRON DEFICIENCY ANEMIA FROM β TRAIT THALASSEMIA (Indeks Eritrosit untuk Membedakan Anemia Defisiensi Besi dengan Thalassemia β Trait) Yohanes Salim; Ninik Sukartini; Arini Setiawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 23, No 1 (2016)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v23i1.1184

Anemia defisiensi zat besi dan thalassemia β trait merupakan penyebab tersering anemia mikrositik hipokrom di Indonesia. Keduapenyakit tersebut sulit dibedakan hanya dengan pemeriksaan hematologi, oleh karena itu diperlukan pemeriksaan tambahan sepertiferitin dan analisis hemoglobin. Banyak penelitian yang membedakan kedua penyakit tersebut dengan indeks eritrosit. Berbagai indekseritrosit memiliki nilai diagnostik yang berbeda di setiap negara dan belum ada data di Indonesia. Penelitian ini melakukan uji diagnostikIndeks Mentzer, RDW, Green-King, Sirdah dan mencari nilai cut-off baru yang dapat memberikan nilai diagnostik lebih baik. Penelitianterdiri dari 98 subjek definitif anemia defisiensi besi dan 80 subjek thalassemia β trait. Indeks Mentzer didapatkan kepekaan 83,6%,kekhasan 66,2%, NPP 75,2%, NPN 76,8% dan Indeks RDW mempunyai kepekaan 91,8%, kekhasan 75%, NPP 81,8%, NPN 88,2%. Nilaidiagnostik Indeks Green-King didapat kepekaan 96,9%, kekhasan 67,5%, NPP 78,5%, NPN 94,7%, sedangkan Indeks Sirdah adalahkepekaan 92,8%, kekhasan 58,7%, NPP 73,3%, NPN 87,0%. Nilai cut-off baru Indeks Mentzer adalah 13,44, RDWI 233,4, Green-King75,06 dan Sirdah 32,52. Keempat Indeks eritrosit dapat diterapkan untuk orang Indonesia dengan Indeks Green-King sebagai indeksyang terbaik.

Evaluasi Pemeriksaan Imunoglobulin E Spesifik Menggunakan Immunoblot Assay dengan Baku Emas Skin Prick Test Yudhistira -; Ninik Sukartini; Suzanna Immanuel; Iris Rengganis
Cermin Dunia Kedokteran Vol 46, No 2 (2019): Penyakit Dalam
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v46i2.517

Pendahuluan. Skin Prick Test (SPT) merupakan baku emas diagnosis alergi, tetapi tidak dapat dilakukan pada kondisi tertentu seperti dermatografisme, hamil, tidak dapat lepas obat antialergi, sehingga pemeriksaan IgE spesifik menjadi pilihan. Di Indonesia belum ada data perbandingan pemeriksaan IgE spesifik dengan SPT. Penelitian ini dilakukan untuk menentukan sensitivitas, spesifisitas, PPV, NPV, LR+ dan LR- pemeriksaan IgE spesifik menggunakan analisis immunoblot. Metode. Penelitian menggunakan desain potong lintang. Subjek penelitian adalah pasien poliklinik alergi imunologi. Pengambilan sampel dengan metode non-probability sampling dengan teknik consecutive sampling. Analisis dilakukan terhadap alergen tungau debu rumah (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis) dan kecoa. Hasil. Seratus subjek yang memenuhi kiteria masukan dan tolakan (76% perempuan, rerata usia 38.9 tahun) ikut serta dalam penelitian ini. Sensitivitas empat alergen bervariasi dengan rentang 32.4%-76.8%, spesifisitas 68.0%-85.7%, PPV 54.5%-94.5%, NPV 46.2%-65.3%, LR+ 1.8-5.0, dan LR- 0.3-0.8.Sensitivitas pemeriksaan IgE spesifik cukup baik pada tiga tungau debu rumah tetapi rendah pada kecoa; spesifisitas dan PPV bervariasi cukup sampai baik; NPV cukup baik. Simpulan dan Saran. Uji diagnostik IgE spesifik tungau debu rumah menunjukkan hasil cukup baik. Pemeriksaan IgE spesifik tidak dapat digunakan untuk skrining alergi kecoa.Background. Skin Prick Test (SPT) is considered as gold standard for diagnosis of allergy, but cannot be performed in some conditions such as dermatographism, pregnancy, and unable to abstain from antiallergy drugs. In these conditions, specific-IgE test is a test of choice. But there is no comparison data on specific IgE test with SPT in Indonesia. This study was to investigate sensitivity, specificity, PPV, NPV, LR+, and LR- of specific-IgE test of immunoblot assay kit. Method. The study was cross-sectional. Subjects were patients from allergy-immunology clinic who fulfilled inclusion and exclusion criteria. Sampling was performed using non-probability sampling method with consecutive technique. Analysis was performed for house dust mite allergen (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis) and cockroach. Result. Hundred subjects (76% was female, average age of 38.9 years) were involved. Sensitivity of four allergens were varied with range 32.4%-76.8%, specificity 68.0%-85.7%, PPV 54.5%-94.5%, NPV 46.2%-65.3%, LR+ 1.8-5.0, and LR- 0.3-0.8. Sensitivities of specific-IgE for three species of house dust mite were moderate, but low for cockroach; specificities and PPVs were moderate to high; NPVs were moderate. Conclusion. Diagnostic test of specific-IgE with house dust mite allergen shows adequate result. Specific IgE test cannot be utilized for screening of cockroach allergy.

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