Gangguan Eritrosit

CATATAN LOGO

1. CBC – confirm Anemia & find hypochromic
microcytic picture from BSE and Red
Cells Indices ( Hb, PCV ,MCV , MCH ,
MCHC)

2. SI – Fe2+ released from Transferrin + ferrozine
(chromagen) → measured colored
complex

TIBC – serum + excess FeCl2 → to fill all Transferrin-
binding sites → the excess Fe is fixed by Mg-
carbonate → Fe-saturated Transferrin is
measured with Ferrozine (= TIBC)

* CBC: complete Blood Count

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% Saturasi Transferrin = SI/TIBC X 100%
Erythropoeisis berkurang /gagal jika % Tf.Sat < 15%

3. Ferritin Serum :
Serum Ferritin level ~ Fe-storage
Ferritin <15 ug/L → defisiensi Fe definitif
N/↑ Ferritin pada anemia def. Fe , jika :
- ada penurunan/kegagalan fs.liver ( damaged
hepatocyte),
hemolysis, inflammation / infection /
malignancy (krn Ferritin = acute-phase
protein )

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4. Transferrin Serum :
diukur dengan metode immunodiffusi
nilai normal : 2-4 g/L

5. Evaluasi Sumsum tulang (BMA) :

(pengecatan Besi di Sutul dengan: Perls
atau Prussian Blue stain )

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SOAL LATIHAN : LOGO

1. Nyonya B, usia 35 tahun, MRS (Masuk Rumah Sakit)
dengan keluhan pusing, dan badan terasa lemah. Pemeriksaan
fisik: KU lemah, Tensi: 100/60 mmHg, Nadi:92 x/menit, RR: 20
x/menit, suhu:37˚C. Kepala/Leher: anemis, tidak dijumpai ikterus,
dyspnea dan sianosis, Thorak/Cor dan Abdomen :dalam batas
normal (dbn). Extremitas: dbn. Hasil laboratorium: Hb 8 g/dl,
RBC 3,20 x 1012/L, Hematokrit 24 %, MCV 75 fl, MCH 25 pg,
MCHC 33 g/dl. Jika anda adalah dokter jaga di RS tersebut, dari
data yang ada, kemungkinan diagnosis pasien tersebut adalah:

A. Anemia normokromik-normositik Company Logo
B. Anemia hipokromik-mikrositik
C. Anemia makrositik
D. Anemia makrositik-megaloblastik
E. Anemia makrositik-non megaloblastik

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Lanjutan …...soal latihan LOGO

2. Dari kasus ny. B, 35 tahun tersebut, diagnosis diferensial untuk
penyebab anemianya adalah:

A. Anemia defisiensi folat, anemia defisiensi Vitamin B12,
B. Anemia karena perdarahan akut, anemia aplastik
C. Anemia defisiensi besi, thalasemia, anemia sideroblastik
D. Anemia hemolitik, anemia pada penyakit mielofibrosis
E. Anemia pada penyakit liver, anemia pada penyakit hipotiroid

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Lanjutan …...soal latihan LOGO

3. Dari soal kasus Ny.B, 35 tahun tersebut, langkah
pemeriksaan laboratorium selanjutnya yang perlu
dilakukan untuk konfirmasi diagnosis adalah:

A. pemeriksaan bilirubin, haptoglobin, hitung retikulosit
B. Serum Iron, TIBC dan Feritin
C. Pemeriksaan B12 dan asam folat dalam darah
D. Pemeriksaan T3, T4 dan TSH
E. Pemeriksaan Biopsi sumsum tulang

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CLINICAL CASE LOGO

A 35-year-old man complains of chronic physical
fatigue, which began 3-4 weeks ago. He said he felt
tired all of the time even through his occupation as a
software developer was mentally but not physically
demanding. He breathed comfortably at rest but, when
he exerted himself, he experienced difficulty in
breathing and had hard time catching his breath. He
also complained of „more than usual” mental fatigue,
confessing an increasing inability to concentrate and
focus his attention on tasks at hands.

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Colleagues noticed his pallor and his
inattentiveness at brainstorming sessions and
suggested he reschedule his annual physical
examination for an earlier date. He complained
of vague abdominal pain and sense of
abdominal fullness. His appetite was depressed,
and he thought perhaps his physical and mental
symptoms were caused by poor diet. However,
attempts to increase eating resulted in nausea.
His stools, he said, were sometimes loose and
tarry. Eventually, increased heart palpitations
and chest pain made him seek medical advice

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Laboratory findings revealed the LOGO

followLinabgo:ratory test Patient Normal

RBC (red blood cell count) 3.5 T/L 4.5-6.0
HCT (hematocrit ratio) 28% T/L

40-52%

Hb (hemoglobin) 8.0g/dL 13-17g/dL

MCV (mean corpuscular 70fL 78-95fL
volume) 22.8pg 29pg
28% 34%
MCH (mean corpuscular
hemoglobin)

MCHC (mean corpuscular
hemoglobin concentration)

QUESTIONS LOGO

Case history questions:
1. What general medical condition is suggested by

the person’s symptoms?

2. What fundamental change in function of blood
related to the red blood cells could
simultaneously affect the function of several
systems (cardiovascular, respiratory,
gastrointestinal, and others)?

3. What specific diagnosis is supported by the
laboratory findings?

4. How could the stool be related to the laboratory
findings?

ANSWER LOGO

1. AAnnsewmerias:

2. A reduction in oxygen-carrying capacity of
the blood and thus a reduction in the delivery
of oxygen to various body tissues

3. An iron defficiency anemia

4. Most cases of iron-defficiency anemia result
from internal blood loss.
Dark, tarry loose stools suggest bleeding
from the gastrointestinal tract and warrant
further tests to determine the exact cause

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POLISITEMIA(ERITROSITOSIS) LOGO

❖ Peningkatan patologis massa eritrosit
❖ massa eritrosit normal : (sea level)

- Pria : 26 - 32 ml / kg BB
- Wanita : 23 - 29 ml / kg BB
❖ eritrositosis : massa eritrosit > normal
( PCV : pria >51% ; wanita >48% )

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Klasifikasi :
I. Primer (Otonomik)
A. Polisitemia Vera
B. Eritrositosis Murni (Eritremia)
II. Sekunder
A. Fisiologis (Oksigenasi Jaringan  )
B. Non-fisiologis (Oksigenasi Jaringan N)
III. Eritrositosis Relatif

ERYTHROCYTOSIS - DIAGNOSTIC TESTS LOGO

• Complete Blood Count

• Bone Marrow examination
• Arterial Blood Gas analysis
• Leukocyte Alkaline Phosphatase
• P5O
• IVP or renal ultrasound
• Liver ultrasound or CT scan
• Erythropoietin level
• Erythroid progenitor assay
• Sleep apnea evaluation

POLISITEMIA VERA LOGO

• Proliferasi klonal neoplastik sel
progenitor hematopoitik pluripoten

• Kriteria diagnosis Polisitemia vera :

Kategori A
1.Massa eritrosit:
pria > 36 ml / kgBB (PCV > 54%)
wanita> 32 ml/ kgBB(PCV > 51%)
2. Saturasi oksigen > 92%
3. Splenomegali

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Kategori B
1. Trombositosis (> 400.000 / ml)
2. Lekositosis (> 12.000 / ml)
3. Skor LAP
4. B12 serum > 900 pg/ml

• Diagnosis PV + bila :
A1 ++A2 ++ A3 + atau

A1 ++A2 ++ dan 2 dari kategori B +

PRIMARY “PURE” ERYTHROCYTOSISLOGO
( ERYTHREMIA )

• peningkatan massa eritrosit murni
• tidak ada penyebab eritrositosis sekunder
• kadar eritropoitin normal atau rendah
• mungkin akibat mutasi gene reseptor

eritropoitin → progenitor eritroid jadi lebih
sensitif terhadap eritropoitin.

II. ERITROSITOSIS SEKUNDER LOGO

• Merupakan respons terhadap keadaan lain
yang bersifat :
- fisiologis : akibat oksigenasi jaringan yang 
- non fisiologis : tanpa penurunan oksigenasi
jaringan

III. ERITROSITOSIS RELATIF LOGO

• Sindroma Gaisbock
• Stress erythrocytosis
• Pseudo erythrocytosis

- Massa eritrosit tinggi normal
- Volume plasma rendah

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