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Journal : Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)

Graves Disease (Thyroid Storm) with Polyautoimmune Disorders (Autoimmune Hemolytic Anemia and Probable Autoimmune Hepatitis) Mabruratussania Maherdika; Banundari Rachmawati; Andreas Arie Setiawan
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.v28i1.1745

Abstract

Graves' disease is caused by IgG antibodies that bind to the Thyroid Stimulating Hormone (TSH) receptor on the surfaceof the thyroid gland. These bonds drive the growth of stimulated thyroid follicular cells causing the glands to enlarge andincrease the production of thyroid hormones. Previous studies mention the association of HLA-B8 and HLA-DR3 withGraves' disease and the Cytotoxic T-lymphocyte-associated-4 (CTLA-4) gene on chromosome 2q33 as a result of reducingT-cell regulation, resulting in autoimmune disease. Autoimmune thyroid disease is often found together with otherautoimmune disorders (polyautoimmune). A 51-year-old male complained of dyspnea, yellowing of the body, and a lumpon the neck. One year ago, he was diagnosed with hyperthyroidism. Graves' disease was suspected due to a score of 22 forthe Wayne index, FT4 96.9 pmol/L, TSHs <0.01 μIU/mL, TRAb 10.8 IU/L, thyroid uptake test for toxic diffuse struma. Inaddition, the patient had atrial fibrillation and a thyroid storm with a Bruch Wartofsky index score of 65. Laboratoryexamination found normocytic normochromic anemia, thrombocytopenia, reticulocytosis, direct coomb test and autocontrol results positive one, SGOT 87 U/L, SGPT 59 U/L, alkali phosphatase 166 U/L, total bilirubin 38.13 mg/dL, directbilirubin 16.59 mg/dL, indirect bilirubin 21.54, LDH 318 U/L, establishing the diagnosis of Autoimmune Hemolytic Anemia(AIHA). Autoimmune hepatitis score: 15, so a diagnosis of probable autoimmune hepatitis was made.
The Differences of N–Acetyl–β–Glucosaminidase and β2 Microglobulin levels in Patients with and without Early Diabetic Nephropathy Cynthia Citra; Edward Kurnia Setiawan Limijadi; Banundari Rachmawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 2 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i2.1836

Abstract

Diabetic Nephropathy (DN) is becoming the most serious microvascular complication, which be marked by the presence of persistent albuminuria. N–asetil–β–glucosaminidase is dominant lyzosom enzyme in the renal tubule epitel. β2 microglobulin is low molecular weight protein which produced by major histocompatibility complex class 1 (MHC-1) expressed cell in all nucleated cell. N–asetil–β–glucosaminidase and β2 microglobulin could be new usefull marker for early DN. Analytic observational study with cross sectional approach was conducted in May – July 2019 involving 27 non diabetic patients (K1), 27 diabetic patients without DN (K2) and 27 diabetic patients with early DN (K3) at the Clinical Pathology department of Faculty of Medicine, Diponegoro University and Diabetic Clinic. Data include age, gender, fasting blood glucose, blood preasure and urine albumin creatinine ratio. N–asetil–β–glucosaminidase level between groups were analyzed using Anova, β2 microglobulin level between groups using Kruskal Wallis, p<0.05 were considered significant. There are significant differences in levels of N–asetil–β–glucosaminidase between K1 and K2 (p =0.01), K1 and K3 (p =< 0.01), K2 and K3 (p = 0.03) and β2 microglobulin  between K1 and K2 (p = 0.02), K1 and K3 (p =< 0.01), K2 and K3 (p< 0.01). N-acetyl-β-glucosaminidase and β2 microglobulin levels were higher in K2 compared to K1 and increased higher in K3 compared to K1 and K2. N-acetyl-β-glucosaminidase and β2 microglobulin can be used as an alternative marker for early DN. 
RDW, JUMLAH TROMBOSIT DAN RPR DENGAN INDEKS FIB-4 DI HEPATITIS C Yenny Yulianti; Banundari Rachmawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 22, No 2 (2016)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v22i2.1118

Abstract

Hepatitis C virus infection is one of the main causes of worldwide chronic liver disease. The determining of fibrosis level in the liverdisease is essential. The red blood cell distribution width (RDW) is a potential prognostic index for liver disease. The platelet (PLT)count has been used as the biomarker for liver fibrosis. RDW to platelet ratio (RPR) is devised to amplify the difference in the RDW andplatelets among patients with different liver fibrosis stages. Fibrosis 4 (FIB-4) indexes are accurate non-invasive methods to predict thelevel of liver fibrosis of HCV-monoinfected patients. The objective of this study is to know the correlation of RDW, PLT count, and RPR withFIB-4 index in hepatitis C patients by analyzing them. The study was carried out observationally with cross sectional approach betweenFebruary−March 2015 at the Dr. Kariadi Hospital, on samples collected consecutively from the medical records of hepatitis C patients.The data processing was performed with Pearson/Spearman correlation. There was a strong positive correlation between RDW and FIB-4index (r=0.624; p=0.000) and between RPR with FIB-4 index (r=0.674; p=0.000), while there was a strong negative correlationbetween PLT count and FIB-4 index (r=-0.600; p=0.000). From this study it can be concluded that there was an increased RDW and RPRresulting in a higher FIB-4 index. There was also found a decreased PLT resulting from higher FIB-4 index .The opinion of the researchersis that further studies for prospective multicentres are needed to be carried out, so that the results can be more generalized.
Thyroid Crisis and Septic Suspected Sepsis in the First Trimester of Pregnancy Mahmudah Hidayati; Banundari Rachmawati
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.v26i3.1535

Abstract

A normal pregnancy with physiological and hormonal changes can change thyroid function, accordingly, there are difficulties to establish the diagnosis of thyroid abnormality. The prevalence of hyperthyroidism in pregnancy is 0.6%. Approximately 1-2% of hyperthyroidism develops into a thyroid crisis. Knowledge of the diagnosis of the thyroid crisis in a pregnant female is very important to avoid complications. The 22-year-old female of thirteen weeks presented with vomiting, since two days before hospitalized, weakness, and decreased consciousness. During treatment, patients had diarrhea, melena, and was irritable. Physical examination showed blood pressure of 136/112 mmHg, pulse of 110 times/minute, respiration of 24 times/minute, and temperature of 38.3oC. Exophthalmos was found at the patient's eyes, but there was no enlargement of the thyroid and the patient often screamed hysterically. Routine urine examination showed proteinuria 1+, blood 3+, leukocytes 1+ in urinalysis, FT4 35.18 pmol/L and TSH <0.05 uIU/mL, leukocytes 15.2 x103/uL, SGOT 245 U/L, SGPT 366 U/L. The final diagnosis of this patient is a thyroid crisis and suspect sepsis in the first trimester of pregnancy. Thyroid Receptor Antibody (TRAb) examination should be performed to assure Graves disease or hyperthyroidism due to pregnancy (transient hyperthyroidism) as the cause.
KADAR ASAM URAT SERUM DAN KOMPONEN SINDROM METABOLIK MI Diah P; Banundari Rachmawati; Purwanto AP
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 20, No 3 (2014)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v20i3.469

Abstract

The incidence of metabolic syndrome (MetS) is significantly increasing. The elevated serum uric acid (SUA) level is correlated with the metabolic risk of cardiovascular. The relationship between SUA levels and components of MetS has been inconsistent. The aim of this study was to know the correlation between SUA level and component of MetS by analyzng. This study was a cross-sectional design conducted on healthy people at the Medical Check Up (MCU) Clinic, Dr. Moewardi Hospital, Surakarta from June 2012 until February 2013. MetS was defined according to the 2005 International Diabetes Federation (IDF) criteria. The statistical analysis was done by Student’s T test, Pearson or Spearman correlation coefficients. The researchers considered p<0.05 as statistically significant with a 95% confidence interval. A total of 80 healthy subjects, (range 19–57 years) were enrolled into this study. MetS was diagnosed in 40 persons where men (62.5%) were more than women and the non-MetS in women (62.5%) were more than men. In this study, a positive correlation was found between SUA and systolic blood pressure, diastolic blood pressure and waist circumference (Pearson r=0.354, 0.495, 0.399, respectively, p<0.05) in women, but not in men. The SUA was positively correlated with systolic blood pressure, diastolic blood pressure and waist circumference, particularly in women. A long term study is needed to investigate the consequence of increasing the SUA level in metabolic disorders and hormonal influences as well.
SERUM ZINC AND C-REACTIVE PROTEIN LEVELS AS RISK FACTORS FOR MORTALITY IN SYSTEMIC INFLAMMATORY RESPONSE SYNDROME Dwi Retnoningrum; Banundari Rachmawati; Dian Widyaningrum
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 1 (2017)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i1.1147

Abstract

Kondisi Systemic Inflammatory Response Syndrome (SIRS) berkebahyaan terjadinya sepsis dan kegagalan multi organ. Inflamasidapat menyebabkan terjadinya redistribusi zinc ke jaringan sehingga terjadi penurunan kadar zinc plasma. Kadar CRP pada SIRSmeningkat sebagai respons peningkatan protein tahap akut. Tujuan penelitian ini untuk mengetahui apakah kadar zinc dan CRP serummerupakan faktor kebahayaan kematian di pasien SIRS. Penelitian observasional analitik dengan pendekatan kohort prospektif di 30pasien SIRS berusia 27–64 tahun. Kadar zinc serum diperiksa dengan metode atomic absorbance spectrophotometer (AAS) dan CRPserum dengan metode latex agglutination immunoassay menggunakan alat autoanaliser. Kejadian kematian subjek dinilai setelah 28hari perawatan. Data dilakukan uji statistik Chi-Kwadrat, bila tidak memenuhi maka dilakukan uji alternatif Fisher. Besarnya nilaifaktor kebahyaan dilakukan perhitungan kebahayaan relatif. Rerata kadar zinc dan CRP berturut-turut 81,24 ± 8,72 μg/dL, dan 8,13± 8,12 mg/dL. Kematian dalam 28 hari adalah 33,3%. Penelitian ini menunjukkan bahwa kadar zinc plasma < 80 μg/dL bukanmerupakan faktor kebahayaan terjadinya kematian (p=0,114), sedangkan kadar CRP ≥ 10 mg/dL merupakan faktor kebahayaanterjadinya kematian di pasien SIRS (RR=3,28, 95% CI 1,33-8,13, p=0,015). Kadar zinc plasma bukan merupakan faktor kebahayaanterjadinya kematian pada SIRS, sedangkan kadar CRP merupakan faktor kebahayaan terjadinya kematian di pasien SIRS.
PACKED RED CELL DENGAN DELTA Hb DAN JUMLAH ERITROSIT ANEMIA PENYAKIT KRONIS (Packed Red Cells with Delta Hb and Erythrocytes in Anemia of Chronic Disease) Novita Indayanie; Banundari Rachmawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 21, No 3 (2015)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v21i3.1270

Abstract

Anemia chronic disease is the second common cause after iron deficiency anemia with hemoglobin levels below the referencevalue. The pathogenesis of anemia should be determined for treatment. Hematinics and or erythropoietin are other treatments besidestransfusion. The transfusion is started when Hb≤7g/dL. The PRC transfusion of 4ml/kg could increase Hb level by 1 g/dL, or 1 unit andcould increase 3–5% of hematocrit. The objective of this study was to know the correlation of PRC unit with delta Hb and erythrocytesin anemia of chronic disease. The 60 samples examined were from patients of the Kariadi Hospital Semarang suffering from anemia ofchronic disease and who were transfused with PRC from January up to March 2014. The study subjects comprised 28 men (46.7%) and32 women (53.3%), with a mean age of 47 years. The number of PRC given was between one (1) to four (4) units. The mean delta Hbwas 3.48 and the mean delta erythrocytes was about 1.03 (0.1 to 2.3). There was a significant correlation between PRC units and deltaHb (r:0.856, p:0.000), as well as delta erythrocytes (r:0.716, p:0.000). Based on this study, it can be concluded that PRC units have avery strong correlation with delta Hb and as well as with delta erythrocytes in patients suffering from anemia of chronic disease
COMPARISON OF GLYCEMIC STATE IN PATIENTS WITH AND WITHOUT HYPERURICEMIA Corrie Abednego; Banundari Rachmawati; Muji Rahayu
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 1 (2017)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i1.1153

Abstract

Hiperurisemia merupakan keadaan asam urat yang meningkat dalam serum. Beberapa penelitian melaporkan hiperurisemia menyebabkankerusakan sel beta pankreas dengan mekanisme apoptosis melalui jalur NF-kB serta berhubungan dengan komplikasi mikrovaskular danmakrovaskular pada pasien diabetes. Perbedaan status glikemia (glukosa darah puasa/GDP dan glukosa darah 2 jam post-prandial/GD2PPdan HbA1c) pada pasien dengan dan tanpa hiperurisemia belum banyak diketahui. Tujuan penelitian untuk membuktikan perbedaan statusglikemia pada pasien dengan dan tanpa hiperurisemia. Penelitian retrospektif, 110 pasien yang dibagi menjadi kelompok hiperurisemia dantanpa hiperurisemia. Glukosa darah puasa dan 2 jam PP diperiksa menggunakan metode heksokinase, asam urat dengan metode urikase,HbA1c dengan metode elektroforesis kapiler. Data diuji normalitas data dan perbedaan antara variabel, dianalisis dengan uji Mann-Whitney.Subjek 58 laki-laki dan 52 perempuan, nilai rerata umur pasien 56,36 ± 8,7 tahun. Pasien laki-laki, terdapat perbedaan bermakna statusglikemia (GDP, GD2PP, HbA1c) terhadap kelompok hiperurisemia dan tanpa hiperurisemia, p< 0,05. Pasien perempuan, terdapat perbedaanbermakna status glikemia (GDP dan GD2PP), p< 0,05 serta HbA1c tidak terdapat perbedaan bermakna pada pasien hiperurisemia dan tanpahiperurisemia dengan p=0,084. Terdapat perbedaan bermakna pada status glikemia pasien laki-laki dan perempuan terhadap kelompokhiperurisemia dan tanpa hiperurisemia, kecuali HbA1C pada perempuan. Dibutuhkan penilaian terhadap diet pasien yang dapat mempengaruhikadar asam urat.
Thyroid Crisis and Septic Suspected Sepsis in the First Trimester of Pregnancy Mahmudah Hidayati; Banundari Rachmawati
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.v26i3.1535

Abstract

A normal pregnancy with physiological and hormonal changes can change thyroid function, accordingly, there are difficulties to establish the diagnosis of thyroid abnormality. The prevalence of hyperthyroidism in pregnancy is 0.6%. Approximately 1-2% of hyperthyroidism develops into a thyroid crisis. Knowledge of the diagnosis of the thyroid crisis in a pregnant female is very important to avoid complications. The 22-year-old female of thirteen weeks presented with vomiting, since two days before hospitalized, weakness, and decreased consciousness. During treatment, patients had diarrhea, melena, and was irritable. Physical examination showed blood pressure of 136/112 mmHg, pulse of 110 times/minute, respiration of 24 times/minute, and temperature of 38.3oC. Exophthalmos was found at the patient's eyes, but there was no enlargement of the thyroid and the patient often screamed hysterically. Routine urine examination showed proteinuria 1+, blood 3+, leukocytes 1+ in urinalysis, FT4 35.18 pmol/L and TSH <0.05 uIU/mL, leukocytes 15.2 x103/uL, SGOT 245 U/L, SGPT 366 U/L. The final diagnosis of this patient is a thyroid crisis and suspect sepsis in the first trimester of pregnancy. Thyroid Receptor Antibody (TRAb) examination should be performed to assure Graves disease or hyperthyroidism due to pregnancy (transient hyperthyroidism) as the cause.
Graves Disease (Thyroid Storm) with Polyautoimmune Disorders (Autoimmune Hemolytic Anemia and Probable Autoimmune Hepatitis) Mabruratussania Maherdika; Banundari Rachmawati; Andreas Arie Setiawan
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.v28i1.1745

Abstract

Graves' disease is caused by IgG antibodies that bind to the Thyroid Stimulating Hormone (TSH) receptor on the surface of the thyroid gland. These bonds drive the growth of stimulated thyroid follicular cells causing the glands to enlarge and increase the production of thyroid hormones. Previous studies mention the association of HLA-B8 and HLA-DR3 with Graves' disease and the Cytotoxic T-lymphocyte-associated-4 (CTLA-4) gene on chromosome 2q33 as a result of reducing T-cell regulation, resulting in autoimmune disease. Autoimmune thyroid disease is often found together with other autoimmune disorders (polyautoimmune). A 51-year-old male complained of dyspnea, yellowing of the body, and a lump on the neck. One year ago, he was diagnosed with hyperthyroidism. Graves' disease was suspected due to a score of 22 for the Wayne index, FT4 96.9 pmol/L, TSHs <0.01 μIU/mL, TRAb 10.8 IU/L, thyroid uptake test for toxic diffuse struma. In addition, the patient had atrial fibrillation and a thyroid storm with a Bruch Wartofsky index score of 65. Laboratory examination found normocytic normochromic anemia, thrombocytopenia, reticulocytosis, direct coomb test and auto control results positive one, SGOT 87 U/L, SGPT 59 U/L, alkali phosphatase 166 U/L, total bilirubin 38.13 mg/dL, directbilirubin 16.59 mg/dL, indirect bilirubin 21.54, LDH 318 U/L, establishing the diagnosis of Autoimmune Hemolytic Anemia (AIHA). Autoimmune hepatitis score: 15, so a diagnosis of probable autoimmune hepatitis was made.
Co-Authors Agung Aji Prasetyo, Agung Aji Ahmad Reza Ajoekesoema, Tanti Andreas Arie Setiawan Andrew Johan Aryu Candra Asri Ragil Kemuning Asti, Herniah Basti Andriyoko Budi Mulyono Corrie Abednego Crisdayani, Carissa Putri Cynthia Citra Darmono SS Devi Ermawati Dian Widyaningrum Dian Widyaningrum Djuara P Lubis Driyah, Srilaning Dwi Retnoningrum Dwi Retnoningrum Edi Dharmana Edward Kurnia Setiawan Limijadi Edward Kurnia Setiawan Limijadi Edward Kurnia Setiawan Limijadi, Edward Kurnia Setiawan Edwin Basyar Elida Soviana Febe Christianto Fifin Luthfia Rahmi Hardhono Susanto Herniah Asti Wulanjani Hertanto Wahyu Subagio Ida Parwati Ignatius Riwanto, Ignatius Indranila Kustarini Samsuria Indriani Silvia Innawati Jusup Kartika, Nadini Kurniawati, Dewi M Lestari, Sarah Syifa Lisyani Budipardigdo Suromo Luciana Sutanto Lusiana Batubara Mabruratussania Maherdika Mahmudah Hidayati Meita Hendrianingtyas Meita Hendrianingtyas Melkior Krisna Arondaya MI Diah P Mila Niqi Itami Muchlis Ahsan Udji Sofro Muh Agus Barliyan Muji Rahayu Nadini Kartika Niken Puruhita Novita Indayanie Novitasari, Sherly Nyoman Suci Widyastiti Permatasari, Narulita Dyah Prihartiwi Purnamasari Probosuseno Probosuseno, Probosuseno Purnama, Yugi Hari Chandra Purwanto AP Putri Theresia LA Bancin Resty Ryadinency Retnaningsih - Ria Triwardhani Riansari, Anugrah Riwanto Samsuria, Indranila K Sanjaya Santoso Santoso Jaeri Santoso Jaeri Setiawan L, Edward Kurnia Soeharyo Hadisaputro Sofyan Harahap Subandhini Arika Pradati Suhartono, Suhartono Suharyo Hadisaputro Sukartini, Ninik Sulistiana Jhon Desel Surohadi, Natra D. Syaravina, Elita Theresia Ilyan Tjokorda Gde Dalem Pemayun Tri Indah Winarni Tri N. Kristina, Tri N. Triwardhani, Ria Tulaar, Angela B. M. Wardhani, Avriana Pety Wibisono, Agoes Wicaksono, Maulana Akbar Wicaksono, Muhammad Agung Wibowo Yenny Yulianti Yoanita Pratiwi Budiwiyono Yuswo Supatmo