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All Journal Medical Journal of Indonesia YARSI Medical Journal

Riadi Wirawan

Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta

Author-ID : 419032

Medicine & Pharmacology

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Peripheral blood and hemoglobin electrophoresis pattern in beta thalassemia major patients receiving repeated blood transfusion Wirawan, Riadi; Setiawan, Santy; Gatot, Djajadiman
Medical Journal of Indonesia Vol 13, No 1 (2004): January-March
Publisher : Faculty of Medicine Universitas Indonesia

One hundred and fifteen beta thalassemia major outpatients attending the Thalassemia Center Department of Child Health, Medical School University of Indonesia Dr. Cipto Mangunkusumo General Hospital for routine blood transfusion and hematology examination, participated in this study. There was a negative correlation between the size of the spleen and the peripheral blood parameters. All peripheral blood parameters tend to decrease with the enlargement of the spleen, and the condition is reversed after splenectomy. We observed that hypersplenism starts when the spleen is as big as S (V â VI). The hemoglobin electrophoresis pattern from beta thalassemia major patients receiving repeated blood transfusion did not show a dense HbF fraction, 90 patients showed a normal hemoglobin electrophoresis pattern. A hemoglobin analysis of both parents could be useful to confirm the diagnosis of beta thalassemia major for patients receiving repeated blood transfusion. In order to get a definite diagnosis, a genetic analysis by bio molecular technique is needed. (Med J Indones 2004; 13: 8-16)Â Keywords:Â Î² thalassemia major, hematology parameter, hemoglobin electrophoresis

Rhabdomyolysis in Indonesian marathon athlete Wirawan, Riadi; Ludong, Marina
Medical Journal of Indonesia Vol 12, No 4 (2003): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Serum and urine myoglobin assessments were conducted on 37 national marathon athletes who participated in the Asian Marathon III & Proklamaton XV. Three athletes showed a myoglobin value of < 50 ug/L and the other 34 athletes showed a myoglobin value of 211-3300 ug/L. Rhabdomyolysis were only found in 2 athletes, thus the prevalence of rhabdomyolysis is 6.1%. A correlation was found between myoglobinemia value and the athleteâs performance. (Med J Indones 2003; 12: 207-14) Keywords: Rhabdomyolysis, myoglobinemia & myoglobinuria

Diabetes mellitus in Î²-thalassemia major patients Wirawan, Riadi; Setiawan, Santy; Kusnandar, Simon; Munthe, Bulan G.
Medical Journal of Indonesia Vol 12, No 2 (2003): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Î²-thalassemia major is a disease caused by Î²Â polypeptide chain synthesis disorder which is inherited as an autosomal recessive from both parents which is marked by little or no Î²Â globin chain synthesis. Medication for Î²Â thalassemia major patients is by repeated blood transfusions, which causes hemochromatosis. Hemochromatosis can occur in various organs including the pancreas. The aim of the study was to assess the alteration of plasma glucose concentration and the hemochromatosis prevalence. Fasting plasma glucose concentration and serum ferritin examination were measured in 115 Î²Â thalassemia major patients with ages between 10-23 years who were out-patients in the Thalassemia Centre, Department of Child Health, Medical School, University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta. The plasma glucose concentration examination was conducted by the GDH enzymatic method, with American Diabetes Association (ADA) criteria in the evaluation, while the serum ferritin examination was conducted with the microparticle enzyme immuno assay (MEIA) method. All patients had hemochromatosis, 14.8% of the patients had impaired fasting glucose level and 2.6% of the patients showed indications of diabetes mellitus. Î²Â thalassemia major patients who receive frequent transfusions will develop hemochromatosis that will in turn impair the pancreatic function. (Med J Indones 2003; 12: 87-93) Keywords : Î²Â thalassemia major, hemochromatosis, diabetes mellitus

Renal impairment in Î² thalassemia major patients receiving repeated blood transfusion Wirawan, Riadi; Kusnandar, Simon; Suherli, Abas; Gatot, Djajadiman
Medical Journal of Indonesia Vol 12, No 4 (2003): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Î²-thalassemia major is a disease caused by Î² polypeptide chain synthesis disorder which is inherited in an autosomal recessive manner from both parents and which is marked by little or noÂ Î²-globin chain synthesis. Treatment for Î²-thalassemia major patients is by giving repeated blood transfusions, which causes iron accumulation, leading to hemochromatosis. Iron accumulation can occur in various body organ, including the kidneys. The aim of this study was to investigate the existence of renal impairment in Î²-thalassemia major patients. The subjects of this study were Î²-thalassemia major patients aged 15 - 28 years old who had received 6 units of packed red cells or more within 6 months. In this study, urine and serum samples of the subjects were taken and examined. Assay of serum iron was performed with Hitachi 737. Results were that 94.7% patients showed an increase in transferrin saturation and 40% of them had hemochromatosis; 73.4% had microalbuminuria; 1.3% had albuminuria and 21.3% had increased urinary Î²2- microglobulin (Î²2-m). A total of 78.6% of patients showed renal impairment. Conclusion of this study suggested that glomerular dysfunction happens in an earlier stage of the disease process. The high incidence of microalbuminuria is also attributed to defective ability of the proximal tubular cells to reabsorb protein besides dysfunction of the glomeruli. (Med J Indones 2003; 12: 215-223)Keywords: Î²-thalasemia major, repeated blood transfusion, renal impairment

A study on the intervention scheme to reduce anemia in female adolescences, in Curug, Tangerang Sayogo, Savitri; Sudardjat, Sri S.; Sudarsono, Sumedi; Wirawan, Riadi; Margono, Sri; Cobiac, Lynne
Medical Journal of Indonesia Vol 9, No 3 (2000): July-September
Publisher : Faculty of Medicine Universitas Indonesia

[no abstract available]

Erratum: A study on the intervention scheme to reduce anemia in female adolescences, in Curug, Tangerang Sayogo, Savitri; Sudardjat, Sri S.; Sudarsono, Sumedi; Wirawan, Riadi; Margono, Sri; Cobiac, Lynne
Medical Journal of Indonesia Vol 9, No 4 (2000): October-December
Publisher : Faculty of Medicine Universitas Indonesia

[This corrects the article DOI:Â 10.13181/mji.v9i3.632]

The first report of myeloma with IgD Îº and free Îº in Indonesia Wirawan, Riadi; Utami, Lidya; Muthalib, Abdul
Medical Journal of Indonesia Vol 20, No 3 (2011): August
Publisher : Faculty of Medicine Universitas Indonesia

IgD Îº myeloma is a rare plasma cell neoplasm case and has never been reported before in Indonesia. In normal condition,Â IgD level in blood is very low, therefore increase of IgD level in myeloma could be missed by serum protein electrophoresis.Â A case of a 59 years old female with severe bone pain is reported. In radiology evaluation, there were thoracal compressionÂ fracture and thoracal foramen narrowing. For this patient, the myeloma diagnosis was based on WHO criteria, the stageÂ IIIb was based on Durie and Salmon criteria, and bad prognosis with prognostic index stage III diagnosis was based onÂ International Prognostic Index from International Myeloma Working Group, respectively. In serum protein electrophoresisÂ we found a very small monoclonal spike and in immunofi xation there were monoclonal IgD Îº and free light chain Îº. (Med J Indones 2011; 20:217-21)Keywords: immunofixation, myeloma IgD Îº, protein electrophoresis

Steroid response as prognostic factor and its correlation with molecular assessment of childhood acute lymphoblastic leukemia Andriastuti, Murti; Gatot, Djajadiman; Wirawan, Riadi; Setiabudy, Rianto; Mansyur, Muchtaruddin; Ugrasena, I Dewa G.
Medical Journal of Indonesia Vol 24, No 4 (2015): December
Publisher : Faculty of Medicine Universitas Indonesia

Background: Survival rate of children with acute lymphoblastic leukemia (ALL) in Indonesia remains low. Risk stratification accuracy is important to improve survival. In developed countries, risk stratification is determined based on gene fusion that is known related to steroid resistency. Steroid response at day-8 correlates with prognosis. The assessment can be applied in centers that cannot perform molecular assessment. This study aims to evaluate whether steroid response correlated to molecular assessment. Methods: A cross-sectional study was performed at Child Health Department, Cipto Mangunkusumo Hospital (January 2013-March 2014), a total of 73 patients were enrolled. Steroid was given for 7 days. Peripheral blast count at day 8 was evaluated, good response if blast count <1000 /µL and poor if ≥1000 /µL. Fusion gene detection was also performed. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0.Results: Fusion gene was detected in 45 patients. In 1–10 years age group, 26/32 (81%) subjects had good response, while 75% in <1 year age group and 7/9 (78%) in ≥10 years age group had poor response. 5/7 (71%) subjetcs had leukocyte count >100,000 /µL and 7/8 (88%) with T-cell showed poor response. Age, leukocyte count, and T-cell were statistically correlated with steroid response (p<0.05). E2A-PBX1 fusion gene was the most common 19/45 (42%), followed by TEL-AML1 17/45 (38%), BCR-ABL 5/45 (17%), and MLL-AF4 1/45 (3%). Four of five subjects (80%) with BCR-ABL and one subject with MLL-AF4 had poor steroid response. On the other hand, 12/19 (63%) with E2A-PBX1 and 13/17 (77%) with TEL-AML1 had good response. There was no correlation between steroid response and molecular assessment.Conclusion: Steroid response correlates with age, leukocyte count, and T-cell but not with molecular assessment.

Co-Authors Abas Suherli Abdul Muthalib Aida Lydia, Aida Ailinda Theodora Tedja, Ailinda Theodora Ari Fahrial Syam Bulan G. Munthe Chudahman Manan Daldiyono Hardjodisastro Djajadiman Gatot Endah Purnamasari Fify Henrika, Fify Helsi Helsi I Dewa Gede Ugrasena Lidya Utami Lynne Cobiac Marcellus Simadibrata Marina Ludong Muchtaruddin Mansyur Murti Andriastuti, Murti Rianto Setiabudy Santy Setiawan Savitri Sayogo Simon Kusnandar Sri Margono Sri S. Sudardjat Sumedi Sudarsono

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