Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) is a journal published by “Association of Clinical Pathologist” professional association. This journal displays articles in the Clinical Pathology and Medical Laboratory scope. Clinical Pathology has a couple of subdivisions, namely: Clinical Chemistry, Hematology, Immunology and Serology, Microbiology and Infectious Disease, Hepatology, Cardiovascular, Endocrinology, Blood Transfusion, Nephrology, and Molecular Biology. Scientific articles of these topics, mainly emphasize on the laboratory examinations, pathophysiology, and pathogenesis in a disease.
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<![CDATA[Therapeutic Plasma Exchange in Crisis Myasthenia Gravis with Pregnancy ]]>
<![CDATA[Anak Agung Ayu Lydia Prawita]]>;
<![CDATA[Ida Ayu Putri Wirawati]]>;
<![CDATA[Sianny Herawati]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.1834
<![CDATA[Myasthenic Crisis (MC) is a clinical diagnosis defined by respiratory failure in patients with Myasthenia Gravis (MG). As MG symptoms worsen, the weakness of the respiratory muscles or upper airway can increase so much that it causes difficulty swallowing or breathing, resulting in respiratory distress. One of the triggers for a myasthenic crisis is pregnancy. In this case, the patient was undergoing a second pregnancy with a gestational age of 28-29 weeks and had been diagnosed with MG 4 years ago. The female patient, 27 years old, had complaints of shortness of breath, difficulty chewing, and weakness in the extremities. During her stay in the hospital, the patient's condition worsened and she experienced a myasthenic crisis. Therapeutic Plasma Exchange (TPE) was administered to the patient 3 times and the patient's had clinical improvement. The patient was discharged with pyridostigmine and methylprednisolone therapy. Therapeutic plasma exchange is a safe and effective procedure for the management of myasthenia gravis during pregnancy. Prompt diagnosis and proper management can reduce morbidity in myasthenia gravis, especially those in crisis.]]>
<![CDATA[Anti- N-MethyL-D-Aspartate Receptor Encephalitis in Children Infected with Herpes Simplex ]]>
<![CDATA[Ni Komang Krisnawati]]>;
<![CDATA[Ni Kadek Mulyantari]]>;
<![CDATA[Ni Nyoman Mahartini]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.1835
<![CDATA[Herpes Simplex Virus (HSV) is a common cause of infectious encephalitis in children, which can lead to severe neurological sequels. There is a new perspective suggesting that herpes simplex encephalitis plays an important role in triggering the synthesis of NMDA receptor antibodies. There have been no data on the incidence of anti-NMDA receptor encephalitis in Indonesia. Herpes simplex encephalitis was found in these patients as a risk factor for anti-NMDA receptor encephalitis. A 9-year-old male patient complained of seizures such as jerking of the right hand and smacking of the lips along with fever for 4 days before being admitted to the hospital. Complaints began with slurred speech and t inability of fingers to hold objects for the previous 8 days. From the physical examination, it was reported that the patient looked seriously ill, blood pressure was 110/80 mmHg, pulse was 117 beats per minute, the temperature was 38.5 C, and respiratory rate was 24 times per minute. Another physical examination was within normal limits. The results of a complete blood count at the time of initial treatment of patients showed mild leukocytosis due to a mild increase in monocytes, whereas blood gas and electrolyte analysis showed hypoventilation at the beginning of hospitalization in which mixed acid-base disturbance, respiratory acidosis, and metabolic alkalosis occurred. Analysis of cerebrospinal fluid in these patients showed mononuclear pleocytosis and the results of immunoserological test in serum indicated HSV1 and HSV2 infection and detected anti-NMDA receptor. Both clinical and laboratory findings in this study supported encephalitis. Herpes simplex virus infection can be a risk factor for patients suffering from anti-NMDA receptor encephalitis.]]>
<![CDATA[Leukocyte Count and Neutrophil/Lymphocyte Ratio as Predictor of Mortality in Sepsis Patients ]]>
<![CDATA[Sotianingsih Sotianingsih]]>;
<![CDATA[Samsirun Halim]]>;
<![CDATA[Ahmad Syauqi]]>;
<![CDATA[Lidia Teresia Sinaga]]>;
<![CDATA[Michelle Gracella]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.1977
<![CDATA[Mortality in septic patients remains high despite much progress in understanding the definition, pathophysiology, and management of sepsis through sepsis bundles. Both leukocyte count and Neutrophil/Lymphocyte Ratio (NLR) are relatively inexpensive routine tests for infectious patients. Several studies of leukocytes, total neutrophils, total lymphocytes, and neutrophil/lymphocyte ratio were carried out as alternative parameters for monitoring the severity and as prognostic factors. This study aimed to analyze the difference in leukocytes and NLR based on the outcome of sepsis patients and evaluate their role in predicting death. The study was an analytic cohort of sepsis patients in intensive care at Raden Mattaher Hospital Jambi as the subjects. The research variables were survivor and non-survivor outcomes, leukocyte count, and NLR evaluation at 0, 24, 72, and 144 hours. Data were analyzed using the SPSS 21 test of difference and survival test. There was a total of 34 subjects, which consisted of a group of survivors of 14 patients (41.18%) and non-survivors of 20 patients (58.82%). At the initial diagnosis of sepsis, there was a statistically significant difference in the leukocyte count (p=0.006) and NLR (p=0.042) between survivors and non-survivors. At initial diagnosis, the leukocyte count > 15.49 X 103/µL can predict the death of sepsis patients with a Hazard Ratio (HR) of 4.001. The survival rate of patients with a leukocyte count < 15.49X103/µL and > 15.49 X 103/µL was 89.4% and 64.3%, respectively, which was statistically significant (p=0.0002). At initial diagnosis, NLR with a value of> 13.2 can predict the death of sepsis patients with HR 3.370 (p=0.001). Leukocyte count > 15.49 X 103/µL and NLR > 13.2 at the initial diagnosis of sepsis showed a risk of death of 4.001 and 3.370 times higher risk in the 144-hour evaluation. Leukocyte count > 15.49 X 103/µL and NLR > 13.2 was able to be a predictor of mortality and an indicator of a need for aggressive management in sepsis patients.]]>
<![CDATA[Maximum Surgical Blood Ordering Schedule in Orthopedic Department at UNAIR Hospital January-June 2021 ]]>
<![CDATA[Diah Puspita Rini]]>;
<![CDATA[Alexa Surya Romansyah]]>;
<![CDATA[Andre Triadi Desnantyo]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2007
<![CDATA[Excessive ordering of blood components causes problems such as a lack of proper distribution of blood products between centers, increased costs, and workload of blood banks. Effective use of MSBOS will reduce the cross-match of patient blood samples and reduce unnecessary testing. This is also expected as a way to improve the quality of health services at UNAIR Hospital and reduce patient treatment costs. This study aimed to find out the MSBOS profile for orthopedic surgery at UNAIR Hospital in the period January-June 2021. This study is a cross-sectional study with a sample of orthopedic patients at UNAIR Hospital. The period was 6 months (January-June 2021). Cross-match to Transfusion Ratio (CTR), transfusion probability, and transfusion index calculations were carried out so that MSBOS could be formulated. A total of 33 units of blood were cross-matched from 21 patients in this study, whereas only 5 units of blood were transfused to 4 patients. It was found that 7 out of 8 types of surgeries had a CTR value of more than 2, a total of 6 types of surgeries had a low transfusion probability (below 30), and 6 types of surgeries had a TI below 0.5. In Total Hip Replacement (THR) and ORIF plating symphysis surgery, it is recommended that 2 units of blood be MSBOS, while for others, Group, Screen, Hold (GSH) is recommended. Further research with larger samples is needed to obtain more accurate results.]]>
<![CDATA[The Analysis of MPV, Plateletcrit, Platelet Distribution Width, and Total Platelets in AKI ]]>
<![CDATA[Ellen Kurniawati Tungka]]>;
<![CDATA[Yuyun Widaningsih]]>;
<![CDATA[Fitriani Mangarengi]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2012
<![CDATA[Patients with Acute Kidney Injury (AKI) who require hemodialysis had been reported to have a mortality rate of 50-70% in the last 30 years. Platelet and platelet index are two of the important hematological markers to be analyzed in AKI. This study aimed to analyze the levels of MPV, PCT, PDW, and total platelets in patients with AKI. A retrospective study using medical record data of 122 patients with AKI from January 2019 to December 2020 was conducted in Dr. Wahidin Sudirohusodo Hospital, Makassar. Patients were grouped based on disease outcomes and consisted of patients who died in the hospital and patients who recovered. Measurement of MPV, PCT, PDW, and platelet count was performed using a hematology analyzer. Mann-Whitney and independent T-tests were used for statistical analysis. The subjects of this study consisted of 80 AKI patients who died and 42 who recovered, the most affected age was > 56 years old. The mean MPV was significantly higher in subjects who died in the hospital (10.31±1.53 fL) than in patients who recovered (9.5±1.39 fL) (p<0.01). Mean PCT was higher in subjects who died in the hospital (0.85%) than in patients who recovered (0.18%), despite statistical insignificance (p>0.05). Mean PDW was higher in subjects who died in the hospital (14.2 fL) than in patients who recovered (13.2 fL), despite statistical insignificance (p>0.05). Mean platelet was lower in subjects who died in the hospital (174.3 x109L) than in patients who recovered (215.6 x109L), despite statistical insignificance (p>0.05). Mean platelet volume levels were elevated in AKI patients with poor outcomes, possibly associated with the pathogenesis of more severe inflammation caused by hyperaggregation and peripheral destruction of platelets, which provide positive feedback to the bone marrow to produce larger and more active platelets. The MPV levels were significantly higher in AKI patients with poor outcomes, whereas PCT, PDW, and total platelet levels were not significant.]]>
<![CDATA[Blood Culture Positivity Rate: Antibiotical Therapy Impact Before Sample Collection in Sepsis Patients ]]>
<![CDATA[Sri Kartika Sari]]>;
<![CDATA[Andaru Dahesihdewi]]>;
<![CDATA[Osman Sianipar]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2016
<![CDATA[Sepsis is one of the significant causes of global morbidity and mortality. One of the keystones of sepsis diagnosis and treatment is the Blood Culture (BC) test. BC performed after intravenous Antibiotic Administration (AA) appears to reduce the culture positivity rate. This study aimed to evaluate the influence of AA before obtaining blood culture samples on the positivity rate. This was a retrospective cohort study, conducted from January to February 2020 on patients with suspected sepsis at the Mataram General Hospital from January to December 2019. Patients with valid blood culture tests were included. Out of 178 suspected sepsis patients, 138 samples were culture-negative, and 40 samples were culture-positive. Out of 40 culture-positive patients, 23 (57.5%) samples were obtained before AA, whereas other 17 samples (42.5%) were obtained after AA. In addition, among 138 culture-negative patients, 101 (73.2%) subjects received antibiotics before sampling, and only 37 (26.8%) subjects received antibiotics after sampling. There was a significant difference in the blood culture positivity results between samples taken before and after AA (p=0.001). Samples were taken before AA had a 3.69 times greater possibility of positive culture results than samples taken after AA (OR 3.69; 95% CI 1.77-7.67; p= 0.0005). The percentage of positive culture results among subjects receiving antibiotics before sampling was highest (20%) in those whose samples were taken less than an hour before the next AA. Antibiotics administration of sepsis patients before blood culture sampling gives a lower positivity rate than AA after blood culture sampling.]]>
<![CDATA[The Relationship between Blood Gas Analysis Profile and the Outcome of Severe COVID-19 Patients ]]>
<![CDATA[Helena Sembai]]>;
<![CDATA[Sulina Yanti Wibawa]]>;
<![CDATA[Irda Handayani]]>;
<![CDATA[Darmawaty ER. Rauf]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2017
<![CDATA[Coronaviruses commonly infect the respiratory tract, leading to severe pneumonia. Respiratory problems cause numerous acid-base disorders in 2019 Coronavirus Disease (COVID-19) patients. Several studies have explored laboratory biomarkers used in the management and prognosis of COVID-19 patients during this pandemic; however, only a few focused on blood gas analysis. Determine the blood gas analysis pattern and its association with the outcome of severe COVID-19 patients treated in the Intensive Care Unit (ICU). This retrospective cohort study used secondary data from patients with severe COVID-19 treated in the ICU of Hasanuddin University Hospital between January and December 2021. There was a higher number of male (58.8%) compared to female patients (41.5%), with a mean age of 62 years. Respiratory alkalosis was the most prevalent blood gas disorder (24.4%). Metabolic alkalosis was a blood gas disorder with the highest number of recovery/improvement outcomes (8 patients). There was no significant relationship between blood gas analysis results and the outcome of severe COVID-19. In addition, no specific pattern was found in the results of blood gas analysis. Respiratory alkalosis was the most frequent blood gas disorder detected in these patients.]]>
<![CDATA[Characteristics of Anemia in the Elderly: Hospital-Based Study in West Java ]]>
<![CDATA[Agnes Rengga Indrati]]>;
<![CDATA[Yehezkiel Yonathan]]>;
<![CDATA[Hendro Hendro]]>;
<![CDATA[Lazuardi Dwipa]]>;
<![CDATA[Cissy Kartasasmita]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2018
<![CDATA[Geriatric anemia can cause many problems and is a major health condition worldwide and in Indonesia. It is important to know the characteristics and prevalence of anemia among geriatrics in Indonesia, especially in West Java. By using simple hematology parameters to detect anemia in geriatrics, and then giving adequate treatment, morbidity, and mortality due to anemia may decrease in geriatrics. This study aimed to identify the type of anemia, etiology, age, gender, and prevalence of elderly patients with anemia in West Java. This was a cross-sectional study. Patients above 59 years old attending the geriatric clinic in Hasan Sadikin General Hospital and the geriatric community was included in this study to be evaluated for anemia, the characteristics of anemia (normocytic, microcytic, and macrocytic) based on MCV and MCHC, age group (<=65 and > 65 year old), and gender. Among 247 elderly patients, anemia was found in 33 patients (13.64%) and mostly found in females. Mostly represented as normochromic normocytic anemia (78.8%) and microcytic hypochromic anemia (21.2%), respectively. Individuals older than 65 years old were mostly presented with microcytic hypochromic anemia (66.7%). Meanwhile, normocytic normochromic anemia was more commonly found in individuals below 65 years old (12.1%). Anemia was commonly found in people older than 65 years old. The most common type of anemia in geriatrics in West Java was normocytic normochromic. Females experience anemia more than males.]]>
<![CDATA[Correlation between Anthropometric Measurement and Kidney Function in the Elderly to Detection of Chronic Kidney Disease ]]>
<![CDATA[Debie Anggraini]]>;
<![CDATA[Prima Adelin]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2019
<![CDATA[Chronic Kidney Disease (CKD) is a very common clinical problem in elderly patients and is associated with increased morbidity and mortality. The proportion of the elderly is predicted to further rise to 20% by the year 2030 caused by the demographic change from a pattern of high birth rates and high mortality to low birth rates. Delayed mortality has contributed to the rise in the elderly population. The aging process involves physiological and nutritional changes that will affect the nutritional status of the elderly, leading to malnutrition and overweight. Aging is associated with considerable changes in body composition, higher BMI is associated with improved survival in patients with CKD and very low BMI levels have been consistently associated with high all-cause mortality in the elderly. The changes in Body Fat Percentage (BFP) in the elderly will affect the estimated Glomerular Filtration Rate (eGFR) in the elderly. This study aimed to determine the correlation between anthropometric measurement and kidney function in the elderly population. this research is an analytic observational study with a cross-sectional design, which involved 42 elderly people with age > 60 years in Guguak District, West Sumatera, Indonesia. Anthropometric measurement using the Waist-to-Height-Ratio (WHtR) method, Waist-to-Hip Ratio (WHR), Waist Circumference (WC), and Body Mass Index (BMI) and eGFR were calculated using the Cockcroft and Gault formula. The results of this study showed that the mean age of the elderly was 68±7.58 years, which consisted of 29.3% male and 70.7% female. The Pearson correlation test between WHR and eGFR obtained p<0.05 with r= 0.439 and the Pearson’s correlation test between BMI and eGFR obtained p<0.05 with r= 0.425. There was a moderate correlation between WHR with eGFR and BMI with eGFR in the elderly population.]]>
<![CDATA[Diagnostic Performance of Precore Protein 22 Kilodalton Levels of HBV DNA in Chronic Hepatitis B Patients ]]>
<![CDATA[Mas Aditya Senaputra]]>;
<![CDATA[B. Rina A. Sidharta]]>;
<![CDATA[Lusi Oka Wardhani]]>
<![CDATA[ INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023) ]]>
Publisher : <![CDATA[Indonesian Association of Clinical Pathologist and Medical laboratory ]]>
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DOI: 10.24293/ijcpml.v29i3.2020
<![CDATA[Hepatitis B Virus (HBV) infection causes inflammation of the liver, which has a high prevalence in both Indonesia and the world. Serum HBV deoxyribonucleic acid (DNA) is important in determining the initiation therapy for Chronic Hepatitis B (CHB) patients. However, it has several limitations. Precore protein 22 kilodalton (p22cr) is synthesized from the HBV gene in hepatocytes, representing covalently closed circle (ccc) DNA. This study aimed to analyze the diagnostic performance of p22cr levels on HBV DNA in CHB patients. An observational analytic study with a cross-sectional approach was conducted on 83 CHB patients who were examined at the Clinical Pathology Laboratory of Dr. Moewardi General Academic Hospital in December 2020. Blood plasma samples were taken for HBV DNA and p22cr examination by using Polymerase Chain Reaction (PCR) and Enzyme-Linked Immunosorbent Assay (ELISA), respectively. The cut-off level of p22cr was determined by the Receiver Operating Curve (ROC) with the widest area Under the Curve (AUC). Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), and accuracy were calculated for the diagnostic performance of p22cr. The cut-off point of p22cr on HBV DNA > 20,000 IU/mL was 7.440 ng/mL with AUC 0.693 (p=0.003). The diagnostic performance of p22cr levels on HBV DNA obtained 44.44% sensitivity, 82.98% specificity, 66.67% PPV, 66.10% NPV, 2.61 PLR, 0.67 NLR, and 66.27% accuracy. P22cr level has a good specificity so it can be an alternative examination of HBV DNA in making decisions on therapy in patients with chronic hepatitis B. Further research needs to be done using HBcrAg and excluding elderly patients.]]>
