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INDONESIA
Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Published by Perhimpunan Dokter Spesialis Patologi Klinik Indonesia
ISSN : 08544263     EISSN : 24774685     DOI : https://dx.doi.org/10.24293
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience
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.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 22 Documents
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Search results for , issue "Vol. 30 No. 1 (2023)" : 22 Documents clear
Convalescent Plasma Therapy for COVID-19 with Pregnancy in Sanglah Hospital, Denpasar Ni Luh Ayu Suwandari; Ni Kadek Mulyantari; Ida Ayu Putri Wirawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.1837

Abstract

The Coronavirus Disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO). Pregnant females are a vulnerable population to contract COVID-19. The most promising therapies for COVID-19 infection are Remdesivir and Convalescent Plasma Therapy (CPT). Convalescent plasma therapy in COVID-19 with pregnancy is rare. A 26-year-old female with 29-30 weeks pregnancy with complaints of shortness of breath and cough was referred. Physical examination showed an increase in respiratory rate. Laboratory tests showed increased WBC (leukocytosis), anemia, thrombocytosis, Neutrophil-Lymphocyte Ratio (NLR), SGOT, and C-reactive protein. The results of the RT-PCR molecular biology test showed confirmed COVID-19. In treatment, complaints worsened with a respiratory rate of 32 beats/minute and oxygen saturation of 93%. The patient was treated with CPT and showed clinical improvement. Convalescent plasma therapy in pregnancy with COVID-19 aims to prevent the binding of spike protein (S) in the virus with the ACE-2 receptor in the host. Convalescent plasma therapy should be carried out in the right conditions according to the agreed criteria. Because clinical and laboratory improvements were observed in this study after convalescent plasma therapy was administered, it can be considered as an alternative therapy in severe clinical conditions.
Salt-Wasting Congenital Adrenal Hyperplasia in A 2-Year-Old Patient Nanda Amelia; Tenri Esa; Liong Boy Kurniawan; Ratna Dewi Artati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.1925

Abstract

Congenital Adrenal Hyperplasia (CAH) is an autosomal recessive disorder due to deficiencies of enzymes involved in steroidogenesis in the adrenal cortex. It is known that 90% of CAH are due to 21-hydroxylase enzyme deficiency caused by mutation of the CYP21A2 gene. A female patient aged two years and one month old was reported with a diagnosis of salt-wasting CAH. The diagnosis was based on complaints of genital enlargement since birth. The patient had developed repeated vomiting and severe dehydration since newborn. The patient was diagnosed with CAH and under treatment with glucocorticoid replacement therapy by a pediatrician since the age of 5 months. Body height/age < -3 Standard Deviation (SD) of the Z-score chart (very short stature) and ambiguous genitalia were reported. Laboratory tests indicated thrombocytosis (795x103/uL), mild hyperkalemia (5.4 mmol/L), and increased testosterone (110.1 ng/dL). Bone age study affirmed an advanced bone age. History of increased 17-hydroxyprogesterone (109.19 ng/mL) and decreased morning serum cortisol levels (1.7 ug/dL). History of gynecological ultrasonography (USG) showed uterus, no bilateral testicular structure, hyperplasia of the left adrenal gland, and suggestive of genital ambiguity. The 21-hydroxylase deficiency causes a decrease in aldosterone and cortisol and an increase in androgens. Hypoaldosteronism causes hypovolemia, hyponatremia and hyperkalemia. Hypocortisolime causes hypoglycemia, decreased response to infection, and stress. Hyperandrogenism causes virilization of the genitalia and short stature in patients. A female patient aged two years and one month old was reported with a salt-wasting congenital adrenal hyperplasia diagnosis. Chromosome analysis was the recommended test in this case.
Polymorphonuclear-Mononuclear Ratio in Peripheral Blood as Hematologic Malignancy Predictor in Pancytopenia Indah Meyliza; JB. Suparyatmo; Dian Ariningrum
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2050

Abstract

Pancytopenia is a laboratory finding of decreased hematological cells characterized by hemoglobin of <13.5 g/dL for males or <11.5 g/dL for females, leukocytes of <4x109/L and platelets of <150x109/L. The data from Dr. Moewardi Hospital reported 56 cases of pancytopenia in 2020. Follow-up tests such as reticulocyte test, Bone Marrow Puncture (BMP), or bone marrow biopsy are needed to determine the cause of pancytopenia. This study aimed to assess the performance of the Pm/M ratio of peripheral blood as a screening instrument to predict the cause of pancytopenia. A cross-sectional study was carried out on pancytopenia patients undergoing laboratory tests at the Clinical Pathology Laboratories of Dr. Moewardi Hospital from January 2020 to June 2021. The cut-off point of the Pm/M ratio was determined by ROC and AUC curves. The results were presented in a 2x2 table. The Pm/M ratio <0.91 as a predictor of hematological malignancy had a sensitivity of 82.9%, specificity of 82.9%, PPV 82.9, NPV 82.9%, LR positive 4.833 and LR negative 0.207. The Pm/M ratio can be used as a screening biomarker to predict the cause of pancytopenia before performing BMP and to distinguish between hematological malignancy and non-hematological malignancy.
Analysis of Red Cell Distribution Width and Carcinoembryonic Antigen As Predictor of Severity Colorectal Cancer Eka Widia Pusfitasyari; Uleng Bahrun; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2052

Abstract

The incidence of CRC is 16.5 cases in 100,000 population with 6.7% mortality of all malignancies. RDW-CV values and CEA levelswere used as predictors of severity in various malignancies. This study aimed to analyze the RDW-CV and CEA levels as predictors of CRC severity. A Retrospective study using medical record data of 245 CRC patients at Dr. Wahidin Sudirohusodo Hospital. Samples were grouped based on stage (metastatic and non-metastatic), tumor location (right colon, left colon, and rectum), type of care (outpatient and inpatient), and outcome (improved and died). The distribution of RDW-CV and CEA data was tested using the Kolmogorov-Smirnov test, comparison of stage, outcome, and type of care using the Mann-Whitney test, correlation with Spearman's correlation test, comparison by location using the Kruskal-Wallis test and ROC curve to determine the cut-off. The median age of subjects was 53.7±12.4 years. RDW-CV values and CEA levels were higher in the metastatic stage than non-metastatic (p=0.005 vs. p=0.000). There was a significant relationship between the incidence of metastases with RDW-CV (p=0.005) and CEA (p=0.000) in CRC. ROC curve analysis shows the optimal cut-off value for RDW-CV as a metastatic prediction is 14.35% (sensitivity 60.4%; specificity=50%), and CEA was 3.24 ng/mL (sensitivity 70.3%; specificity=52.1%).  RDW-CV value was highest in the right colon compared to the left colon and rectum (p=0.009). RDW-CV values and CEA levels were higher in patients with mortality than those who recovered (p=0.016 vs. p=0.055). This study shows a significant relationship between RDW-CV and CEA with the metastatic stage of CRC, and based on the outcome, RDW-CV was higher in the mortality group.
Analysis of Platelet Lymphocyte Ratio on Severe COVID-19 and Dengue Hemorrhagic Fever Grade IV Verliyanti Verliyanti; Tenri Esa; Asvin Nurulita
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2053

Abstract

Thrombocytopenia can occur in severe COVID-19 or grade IV DHF. In COVID-19, lymphopenia occurs gradually due to Angiotensin Converting Enzyme-2 as the primary response to SARS-CoV-2 and cytokines that can damage lymphocytes.   Contrastingly, lymphocytosis occurs in dengue virus infection. Platelet-to-lymphocyte ratio (PLR) is a new inflammatory marker in predicting the severity of both diseases. This study aimed to analyze differences in PLR values in severe COVID-19 and grade IV DHF and determine the cut-off values. Retrospective research of a cross-sectional approach was carried out using medical record data of patients diagnosed with severe COVID-19 and grade IV DHF by clinicians at Dr. Wahidin Sudirohusodo Hospital from January 2017 to October 2021. The platelet-to-lymphocyte ratio was obtained from the complete blood count results using the flow cytometry method at the beginning of hospitalization. Mann-Whitney test and Receiver Operating Characteristics (ROC) curve were used for statistical analysis. A total of 74 severe COVID-19 and 33 grade IV DHF patients were involved; PRL of severe COVID-19 in dead patients was higher than in recovered patients (p>0.05). The platelet-to-lymphocyte ratio value was significantly lower in grade IV DHF patients who died compared to those who recovered (p<0.001). Platelet to-lymphocyte ratio cut-off of 48.30 for severe COVID-19 was obtained with an Area Under the Curve (AUC) of 0.631 (sensitivity of 54.3%, specificity of 78.6%) and cut-off of 0.715 for grade IV DHF with an AUC of 0.989 (sensitivity of 94.4%, specificity of 100%). There was a difference in PLR value in severe COVID-19 and grade IV DHF. Severe COVID-19 patients who died had higher PLR, whereas grade IV DHF patients had lower PLR values. Values above the PLR cut-off of 48.30 for severe COVID-19 and 0.715 for grade IV DHF can predict the severity of the disease.
Diagnostic Value of Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratio for COVID-19 Screening Johannes Dwight Risamasu; JB. Suparyatmo; Amiroh Kurniati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2054

Abstract

COVID-19 is caused by SARS-CoV-2, which can affect all ages. The prevalence of COVID-19 reported by the World Health Organization (WHO) in March 2020 was 3 million cases worldwide. The number of confirmed cases of COVID-19 reported by WHO in June 2020 in Indonesia was 28,233 cases. This research was an observational analytic study with a cross-sectional approach to determine the performance and cut-off of NLR, PLR, and MLR as a screening for COVID-19 infection conducted at the RSDM Clinical Pathology Installation in Surakarta from March 2020 to April 2021. The total subjects of this study were 348 people. The characteristics of the research subjects were presented in descriptive form. The Receiver Operating Characteristic (ROC) curve and the Area Under Curve (AUC) were used to determine the cut-off of NLR, PLR, and MLR. The results were presented in a 2x2 table. A computer program was used for statistical analysis. There was a significant relationship between NLR, PLR, and MLR and the incidence of COVID-19. A cut-off > 3.010, sensitivity 66.5%, specificity 61.9%, PPV 0.773, NPV 0.487, LR (+) 1.744, and LR (-) 0.541 were obtained for NLR as a COVID-19 screening. A cut-off > 157.035, sensitivity 63%, specificity 60.2%, PPV 0.755, NPV 0.455, LR (+) 1.583, and LR (-) 0.614 were obtained for PLR as a COVID-19 screening. A cut-off > 0.296, sensitivity 60%, specificity 58.5%, PPV 0.738, NPV 0.429, LR (+) 1.445, and LR (-) 0.684 were obtained for MLR as a screening for COVID-19. NLR and PLR cannot be used as the main screening biomarkers for COVID-19. Regardless of the clinical manifestations of patients, other biomarkers such as antigen swabs should be considered.
Comparison of Neutrophil-Lymphocyte Ratio in Patients with COVID-19 and Dengue Hemorrhagic Fever Adeline Nurul Hasanah; Tenri Esa; Uleng Bahrun
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2056

Abstract

Coronavirus Disease-19 (COVID-19) and Dengue Hemorrhagic Fever (DHF) can be found together in patients and are difficult to distinguish because they have the same antigenic viral structure, symptoms, and laboratory findings. Neutrophil-Lymphocyte Ratio (NLR) is one of the inflammatory markers that are both easy and have fast results, so it is considered adequate for managing both diseases. This study aimed to compare NLR values and cut-off based on degrees in COVID-19 and DHF patients. The study used data from medical records of 459 COVID-19 patients and 95 DHF patients treated at UNHAS RSPTN and Sayang Rakyat Hospital from July 2020 to August 2021. They had routine hematological examination results when they were first admitted. COVID-19 samples were grouped into severe and moderate degrees, and DHF samples were grouped into DHF without shock and DHF in shock. Mann-Whitney test, independent T-test, and ROC curve were used to compare the two groups (significant if the p-value was <0.05). There was a difference in NLR median between moderate COVID-19 (2.57) and severe COVID-19 (6.39) (p<0.001); between DHF without-shock (0.49) and DHF in-shock (0.43) (p<0.001). Neutrophil lymphocyte ratio cut-off between moderate and severe COVID-19 based on ROC curve was 5.66 (sensitivity 79.6%, specificity 73.5%), and between DHF without-shock and DHF in-shock was 0.39 (sensitivity 93.2%, specificity 83.3%). Neutrophil lymphocyte ratio values in COVID-19 are different from DHF. Neutrophil-lymphocyte ratio values are higher in severe COVID-19 than moderate, while NLR values are lower in DHF in shock rather than without shock.
Suitability Analysis of Gram Staining with Blood Culture in Bacteremia Eva Nada Maulida; Irda Handayani; Nursin Abdul Kadir
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2057

Abstract

Bacteremia is a serious bloodstream infection, requiring blood culture as the gold standard for definitive diagnosis and rational therapy, but it is time-consuming. The Gram stain should be considered as an alternative test, as it is easier and faster to determine empirical antibiotic therapy in order to minimize the use of broad-spectrum antibiotics. This study aimed to analyze the suitability of Gram staining results with blood cultures in bacteremia. Cross-sectional study design from August to September 2022 at Dr. Wahidin Sudirohusodo Hospital and Labuan Baji Hospital, Makassar. The study sample used specimens from automatic positive blood culture bottles of new bacteremia patients. Gram staining and sub-culture were performed to determine the type of Gram-positive or negative bacteria. Appropriate statistical analysis was used to compare the two methods. A total of 78 research samples were obtained. The results of subculture vs. Gram staining showed Gram-positive bacteria in 45 vs. 42 samples and Gram-negative bacteria in 33 vs. 36 samples, respectively. A comparative test using the Wilcoxon test showed no significant difference for the 2 tests, p-value = 0.257 (p > 0.05). The results of the Gram diagnostic test on culture showed high sensitivity and specificity, respectively: 88.9%, and 93.9% for Gram-positive bacteria, 93.9% and 88.9% for Gram-negative bacteria. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 95.32% and 95.32% for Gram-positive, 86.11%, and 95.23 % for Gram-negative bacteria, respectively. There is a suitability between Gram stain and automatic blood culture results with high diagnostic value. Gram staining is expected to be a guide for selecting empirical therapy based on Gram's classification until the AST test results come out.
Correlation of SARS-CoV-2 IgG/IgM Levels to COVID-19 Severity in Convalescent Plasma Donor Candidates Kery Bayu Santoso Katjong; Ratna Delima Hutapea; Rachmawati A. Muhiddin; Asvin Nurulita; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2058

Abstract

Coronavirus Disease-19 (COVID-19) is an infectious disease caused by Sars-CoV-2. The clinical manifestations of COVID-19 vary from asymptomatic, mild symptoms to severe symptoms. Plasma of people recovering from COVID-19 infection will likely contain specific polyclonal antibodies. These antibodies can provide passive immunity to the recipient. This study aimed to analyze the correlation of SARS-CoV-2 IgG/IgM levels to COVID-19 severity and length of negative conversion in COVID-19 patients as convalescent plasma donor candidates. The retrospective research used this study with data collected from May to December 2020. The study sample of 30 patients was taken from the medical record with a population that met the inclusion criteria. IgG/IgM levels were measured using AFIAS-6 Immunoanalyzer. The Shapiro-Wilk and Spearman rho non-parametric correlation tests were used for data analysis. The statistical test results with p-value <0.05 were reported as significant. There was no significant correlation between IgM levels and COVID-19 severity, with a p-value of 0.763 (p>0.05) and length of negative conversion with a p-value of 0.998 (p>0.05). There was a significant correlation between IgG levels and COVID-19 severity with a p-value of 0.014 (p<0.05) and length of negative conversion with a p-value of 0.004 (p<0.05). IgM/IgG levels affect the severity of the disease. IgM levels increase at the beginning of infection and decrease as the disease progresses, and IgG levels will increase slowly. IgM levels cannot be used to detect previous SARS CoV-2 infection, whereas IgG levels affect the length of negative conversion. There was a significant correlation between IgG and the severity of COVID-19 with a correlation strength of R=0.444 (weak correlation) and with a length of negative conversion with a relationship strength of R=0.509 (moderate correlation). SARS CoV-2 IgG levels of convalescent plasma donor candidates correlated to the severity and length of negative conversion.
Differences of Hepatitis B Serological Tests in Cirrhosis and Hepatocellular Carcinoma Patients Rika Adriati Datu Adam; Yuyun Widaningsih; Mutmainnah Mutmainnah
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 1 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i1.2059

Abstract

Cirrhosis and hepatocellular carcinoma (HCC) are the most common complications of chronic hepatitis B. Hepatitis B Virus (HBV) reactivation occurs in the inactive phase, characterized by reappearance of HBsAg or negative HBsAg. The prevalence of occult hepatitis B infection in cirrhosis and HCC ranges from 20% to 60%. This study aimed to analyze the differences in hepatitis B serological tests in patients with cirrhosis and HCC for diagnosis of acute or chronic hepatitis B. The current research was analytical and descriptive with a cross-sectional study design. This study involved 177 patients, including 50 cirrhosis patients and 127 HCC patients. Hepatitis B serological tests (HBsAg, HBeAg, anti-HBe, total anti-HBc) were analyzed using VIDAS instruments by the Enzyme-Linked Fluorescent Immunoassay (ELFA) method. Hepatitis B serological test results were grouped based on the interpretation of serological test results. The data were processed with the statistical test Kolmogorov-Smirnov test, independent T-test, and Chi-Square, and results with p<0.05 were reported as significant. This study found that most males suffer from cirrhosis and HCC due to chronic HBV infection, with a mean age of 57. Chronic hepatitis was most common in patients with cirrhosis and HCC  (71.2%). There was no significant difference in the interpretation of the hepatitis B serological test between patients with cirrhosis and HCC, with a p-value of 0.230 (p > 0.05). There was no significant difference in interpreting the hepatitis B serological test between cirrhosis and HCC. Both reactive HBsAg and non-reactive HBsAg can be obtained in cirrhosis and HCC.

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