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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 1,328 Documents
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CORRELATION OF TOTAL LYMPHOCYTE COUNT WITH CD4 COUNT IN HIV/TB COINFECTED PATIENTS Herniaty Rampo; Uleng Bahrun; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1393

Abstract

HIV-TB co-infection is a global challenge in the healthcare world. HIV infection causes CD4  to decrease which has a role in TB immunity. CD4 as a marker for HIV progression have expensive cost and not available in all healthcare facilities, so WHO recommended TLC as a substitute for CD4. This study aims to determine the correlation of TLC and CD4 in HIV-TB co-infection patients.This was a retrospective study using medical records of hospitalized patients with HIV-TB co-infection in Dr.Wahidin Sudirohusodo Hospital. The correlation was analyzed by Spearman test. CD4 data were divided into two groups: CD4 < 200 cells/mm3 and CD4 ≥ 200 cells/mm3 and Mann-Whitney test was performed. Data were also analyzed by ROC curve.In total 172 data with diagnosis of HIV-TB co-infection, Spearman test showed a positive correlation between TLC and CD4  with moderate correlation strength (p <0.001 and r = 0.56). Mann-Whitney test showed  a significant difference between CD4 < 200 cells/mm3 and CD4 ≥ 200 cells/mm3 (p < 0.001). ROC curve analysis showed that TLC has a good accuracy value for predicting CD4 in CD4 < 200 cells/mm3 (AUC = 0.911). Sensitivity  88.9% with specificity 84.7% was found in TLC 1154.9 cells/mm3 which predicted CD4  < 200 cells/mm3.There was a positive correlation between TLC and CD4 with moderate correlation strength. TLC can predict CD4 in CD4 <200 cells/mm3. We suggest further studies on patients who receive drug therapy.
CHRONIC MYELOGENEOUS LEUKEMIA TRANSFORMATION INTO ACUTE LYMPHOBLASTIC LEUKEMIA Endah Indriastuti; Arifoel Hajat
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1395

Abstract

Chronic Myelogenous Leukemia (CML) is a myeloproliferative neoplasm that can progress into various conditions. Transformation of CML into Acute Lymphoblastic Leukemia (ALL) is rare. A 22-year-old male with a history of CML since 2014 and positive BCR-ABL p210 in 2017 came with the complaint of weakness. Physical examination showed hepatosplenomegaly. Complete Blood Count (CBC) showed Hb 7.1 g/dL, WBC 290,620 /uL, platelet 434,000 /uL.Blood Smear Evaluation (BSE) suggested CML blastic crisis with DD of AML-M5. Patient’s condition got worse and the CBC result showed WBC 96,770/uL and platelet 7,000/uL in 2 weeks. Blood smear evaluation was dominated by mononuclear cells with scanty blue cytoplasm, no granules, no Auer rods, loose chromatin, and indistinct nucleoli, suggesting lymphoblasts with a proportion of 60%. The BMA result was dominated by lymphoblast, consistent with ALL. The immunophenotyping result was CD10+, CD34+(0.99%), CD79a+, HLA-DR+, and CD20+. Molecular examination showed positive RUNX1 and NRAS while FLT3, NPM1 and del(5q) was negative.  BCR-ABL gene can be found both in CML and ALL. CML transformation into ALL had been reported to be related with deletion of a transcription gene. Diagnosis of ALL can be established by BMA and immunophenotyping. CD34+ expression of lymphoblast in ALL can be varied and found to be minimal in this case. Patient with history of CML showed an ALL picture based on BSE, BMA, and immunophenotyping suggesting CML transformation into ALL although CD34+ expression was minimal.    
RAPID PROGRESSION OF CLAVICULAR SOLITARY PLASMACYTOMA TO MULTIPLE MYELOMA Hantoro Gunawan; Paulus Budiono Notopuro
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1398

Abstract

Solitary plasmacytoma is a monoclonal plasma cell malignancy restricted to one tumor. Fifty percent of cases can progress to Multiple Myeloma (MM). The median time to progression is 19 months. A case about plasmacytoma advancing rapidly to MM within two months from the initial diagnosis is described. A 45-year-old male attended the Surgery Outpatient Clinic with a chief complaint of progressive swelling on the left neck for two months. Physical examination revealed a fixed, solid, 8x8 cm mass on the left supraclavicular. Fine Needle Aspiration Biopsy (FNAB) showed plasmacytoma. Surgical biopsy and immunohistochemistry confirmed the diagnosis of plasmacytoma. Ki67 index was 80%. There was no abnormality in the laboratory examination. Two months later he was admitted to the Internal Ward with anemia and kidney disorder. Serum protein electrophoresis revealed an M-spike. Bone Marrow Aspiration (BMA) showed plasma cell proliferation of 78%, which confirmed the diagnosis of MM. Solitary plasmacytoma can occur on any bone, mostly on axial bones. Solitary plasmacytoma on the clavicle is very rare, with a prevalence of 0.45% of all primary bone tumors. Diagnosis of solitary plasmacytoma relies on tissue biopsy, laboratory, radiology and bone marrow aspiration. Progression of plasmacytoma to MM can be detected from CBC and clinical chemistry results. Serum protein electrophoresis and bone marrow aspiration results confirmed the diagnosis of MM. The high proliferation index (Ki67>8%) and tumor size (>5cm) were the risk factors for the rapid progression of plasmacytoma. Early detection of systemic symptoms is critical in the management of solitary plasmacytoma.  
DIAGNOSTIC VALUE OF NEUTROPHIL-LYMPHOCYTE RATIO TO DIFFERENTIATE ISCHEMIC AND HEMORRHAGIC STROKE Martina Rentauli; Liong Boy Kurniawan; Darwati Muhadi
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1446

Abstract

Stroke is a neurologic emergency disease and the main cause of high mortality. The inflammatory process in stroke due to cell and tissue damage causes an increase of leucocyte prominently neutrophil. Neutrophil Lymphocyte Ratio (NLR) is an easy-to-measure inflammatory marker. There is only a few data of NLR in Indonesia. This study aimed to know the difference in NLR values among ischemic and hemorrhagic stroke and to find out the diagnostic NLR to differentiate ischemic and hemorrhagic stroke patients. This study was a retrospective cross-sectional study using secondary data from Medical Record of Wahidin Sudirohusodo Hospital, Makassar. Leucocyte, neutrophil, and lymphocyte first data from adult stroke diagnosed patients were taken. Data statistically analyzed and diagnostic value of  NLR was determined by Receiver Operating Curve (ROC) analysis. Total of 402 patients was enrolled, 214 (54.72%) with ischemic stroke and 182 (46.8) with hemorrhagic stroke. There was a significant NLR difference between ischemic stroke (median 7.23) and hemorrhagic stroke (median 3.65) (p<0.001). Using cut-off 5.18, ROC curve showed of (AUC) 0.730 which had a weak performance to differentiate ischemic and hemorrhagic stroke with sensitivity 67.8% and specificity 68.6%. The neutrophil-lymphocyte ratio in hemorrhagic stroke is higher than ischemic stroke. Further studies with larger and more evenly distributed samples and consideration of sampling time are a suggestion.
THE CORRELATION OF ANEMIA AND HEPCIDIN SERUM LEVELS IN REGULAR HEMODIALYSIS PATIENTS WITH CHRONIC HEPATITIS C IN HAJI ADAM MALIK HOSPITAL MEDAN Wingsar Indrawanto; Adi Koesoema Aman; Alwi Thamrin
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1464

Abstract

End-Stage Renal Disease (ESRD) patients who undergo hemodialysis therapy are high-risk populations infected by the hepatitis C virus. Some studies have reported that hepcidin levels were decreased in patients with chronic hepatitis C. Hepcidin serum concentrations were also reported to increase in patients with renal failure in the line with increased severity of renal failure, which can cause the accumulation of hepcidin culminating in anemia due to iron deficiency. This study was to analyze the correlation of anemia and hepcidin serum levels in ESRD patients who underwent regular hemodialysis with chronic hepatitis C. This was an analytical observational study with cross-sectional design, conducted on 24 ESRD patients with chronic hepatitis C and 24 patients with ESRD without hepatitis who were undergoing regular hemodialysis therapy in the Adam Malik Hospital, Medan during July – September 2016. All study subjects were examined for full blood count and hepcidin serum levels. The result of the iron status was recorded from the patient’s medical record. In this study, the mean hemoglobin was 8.15±1.44 g/dL, mean hematocrit 25.42±4.53%, median hepcidin levels 29.75 (4.92-359.49) in the ESRD patients with chronic hepatitis C and mean hemoglobin 8.21±1.50 g/dL, mean hematocrit 25.25±4.37%, median hepcidin levels 30.33 (11.65-141.53) in the ESRD patients without hepatitis. The Spearman’s rho test showed a positive correlation that was significant between hepcidin and hemoglobin (r = 0.439, p=0.032), hepcidin and hematocrit (r = 0.021; p=0.024) in ESRD patients with chronic hepatitis C. This study showed a positive correlation between anemia and hepcidin serum levels in ESRD patients with chronic hepatitis C who underwent regular hemodialysis.
DIFFERENCE IN HbA1c LEVEL BETWEEN BORONATE AFFINITY AND ION EXCHANGE-HIGH PERFORMANCE LIQUID CHROMATOGRAPHY METHOD IN DIABETIC PATIENT Tuti Asryani; Ellyza Nasrul; Rikarni Rikarni; Tutty Prihandani
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 2 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i2.1466

Abstract

Glycated Hb (HbA1c) test is needed to control glycemic in high prevalence type 2 Diabetes Mellitus (DM) patients. Hemoglobin fraction separated and chemical reaction is two main concepts in the HbA1c test. Ion exchange-high performance liquid chromatography (HPLC) and boronate affinity use the first concept. Ion exchange-HPLC is a reference method in most of the clinical laboratory. Point of care testing (POCT) with boronate affinity method that has been standardized by the international institution is available. This study aimed to compare the boronate affinity POCT method and ion exchange-HPLC method. This cross-sectional study was conducted to 22 types 2 DM patients those fulfilled inclusion and exclusion criteria in January 2017 to February 2018. Level of HbA1c was assayed with boronate affinity POCT and ion exchange-HPLC method. A t-test was used to analyze data and no significant difference if p>0.005. Subjects of this study are females (59.1%) more than males (40.9%) with age mean 59.23 years old (8.1). Uncontrolled type 2 DM (77.3%) more than controlled type 2 DM (22.7%).Mean of HbA1 level was 8.0% (1.7) in boronate affinity POCT and 8.3% (1.8) in ion exchange-HPLC. T-test showed no significant difference between those two HbA1C assay methods (p>0.005). There was no difference HbA1c level between boronate affinity POCT method and ion exchange-HPLC method.
The Role of Effluent Analysis and Culture in Diagnosis and Monitoring of Peritoneal Dialysis-Related Peritonitis Nuri Dyah Indrasari; Najib Ali
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 2 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i2.1900

Abstract

Peritoneal Dialysis (PD) is one of the available renal replacement therapy options for End-Stage Renal Disease (ESRD). One of the most common complications of PD is peritonitis. A 13-year-old boy was admitted to the hospital due to cloudy effluent and abdominal pain four days before admission. He was diagnosed with ESRD in 2015 and has undergone Continuous Ambulatory Peritoneal Dialysis (CAPD) since 2017. The physical examination findings were as follows: the temperature was 36.6 C, the conjunctiva was anemic, the abdomen was tender, and both of the lower extremities were edematous. Peritoneal dialysis effluent analysis showed yellow and turbid effluent with a leukocyte count of 13.346 cells/µL and polymorphonuclear (PMN) cells predominance (69.3%), effluent and serum urea of 221 and 243 mg/dL, effluent and serum creatinine of 16.7 and 18.26 mg/dL, respectively. Effluent Gram stain showed increased leukocytes without bacteria, while effluent culture showed the growth of Methicillin-sensitive Staphylococcus aureus. According to the International Society of Peritoneal Dialysis 2022 guidelines, all criteria for infective peritonitis in this patient were met: clinical features (turbid effluent and abdominal pain), increased cell count (>100 cells/µL) with PMN >50%, and positive effluent culture. The patient was administered intravenous Ampicillin-Sulbactam based on the effluent culture and antimicrobial susceptibility testing. Serial effluent analyses suggested a return-to-normal trend in leukocyte and PMN counts. After 18 days of hospitalization, the patient was allowed to discharge based on clinical and laboratory improvements.
Detection of Partial Central Diabetes Insipidus in Limited Resource Setting Merci M. Pasaribu; Dina Nurul Istiqomah; Dewi Wulandari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 2 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i2.1939

Abstract

Antidiuretic hormone (ADH) is an endogenous prohormone peptide synthesized in the posterior hypothalamus that regulates water excretion by the kidney. Diabetes insipidus is a disorder characterized by the excretion of large amounts of urine (diabetes) that are hypotonic, watery, and tasteless (insipid). The rarity of this case is one of the causes of missed diagnosis. If not diagnosed properly, patients will receive therapy that exacerbates the disease. The Water Deprivation Test (WDT) is one of the dynamic tests that can be done to narrow the diagnosis. A 44-year-old female was admitted to the hospital with chief complaints of polydipsia and polyuria during the previous 9 months. The patient had a history of irregular menstruation, cesarean delivery due to abdominal mass, and breast lump surgery. Diabetes mellitus and thyroid disease were excluded. Her blood pressure during admission was 150/100 mmHg and her body mass index was 31.1. Fluid balance data obtained before the water deprivation test showed that the urine volume (output) was 7.150 mL per 24 hours, and the total water input was 6.290 mL. Water deprivation test results showed that the kidneys were partially respond to the administration of exogenous ADH, suggestive of partial central diabetes insipidus.
Ultra-Low Anti-Müllerian Hormone Levels in Recurrent Cystic Ovarian Neoplasm: A Case Report Merci Monica br Pasaribu; Naufal Arkan Abiyyu Ibrahim; Dayu Satriani
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 3 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i3.1940

Abstract

Fertility has been a major issue in the management of cystic ovarian neoplasm. This case report presents an extreme case of ultra-low AMH levels in a young female with recurrent cystic ovarian neoplasm and analyzes the potential causes. A twenty-two-year-old female presented with stomach discomfort. The patient had undergone two surgeries for ovarian neoplasm within the last six years. The patient had another abdominal lump suspected to be a residual tumor mass. After further examination, the patient was diagnosed with cystic ovarian neoplasm. The laboratory findings showed low T4 levels, increased TSH levels, and ultra-low AMH levels (0.023 ng/mL). Management of cystic ovarian neoplasm should concern the effect on fertility. The AMH level can be used for pre-treatment counseling in these patients.
Transient Abnormal Myelopoiesis in Down Syndrome Patients Widya Pratiwi; Amaliyah T. Lopa; Darwati Muhadi; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 3 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i3.2024

Abstract

Neonates with Down Syndrome (DS) have a propensity to develop the unique myeloproliferative disorder, Transient Abnormal Myelopoiesis (TAM). Transient abnormal myelopoiesis usually resolves spontaneously in < 3 months, but approximately 10% of patients with TAM die from hepatic or multi-organ failure. After remission, 20% of patients with TAM progress into acute myeloid leukemia associated with down syndrome (ML-DS). The patient was a full-term 2-day-old baby girl with a birth weight of 3300 gr. Physical examination revealed dysmorphic facial features, hypertelorism, macroglossia, and low set ears, which is a characteristic sign of DS face, skin rash, and there was no anus. On examination of peripheral blood smears and bone marrow aspiration, hematological abnormalities, and circulating blast cells were found. Early diagnosis of low-lying anorectal malformation (MAR) without fistula and down syndrome. In treating patients with TAM, it is first necessary to know whether they have trisomy 21 syndrome, then trace the existing hematological disorders to find the GATA 1 genetic mutation. The most crucial hematological problem in patients with DS is leukemia. Mutations in the GATA 1 gene and the presence of DS can result in abnormal proliferation of megakaryocytes and erythroid progenitors in the fetus and hematological abnormalities in TAM. Transient abnormal myelopoiesis can be fatal in up to 10% of patients and resolves spontaneously. Therefore, laboratory examinations are very significant, including blood tests, peripheral blood smears, supporting examinations such as bone marrow aspiration, monitoring of clinical symptoms, and close monitoring of comorbidities. Examination repeat or follow-up bone marrow aspiration is required within six months of patient follow-up to reduce the risk of further complications. In this case, a follow-up examination is highly recommended because if there are no changes, the further examination must be carried out.

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