UNIVERSITAS AIRLANGGA



Detail Article

Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 19 / No. 3 / Published : 2013-01

Order : 4, and page :156 - 160

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Original Article :

[iron deficiency in pregnant women by haemoglobin reticulocyte (ret-he)]

Author :

  1. Petriana Primiastanti*1
  2. Ninik Sukartini*2
  1. Divisi Hematologi, Departemen Patologi Klinik Fakultas Kedokteran Universitas Indonesia-Rumah Sakit Cipto Mangunkusumo. Jl. Diponegoro no. 71 Jakarta Pusat, 10420
  2. Divisi Hematologi, Departemen Patologi Klinik Fakultas Kedokteran Universitas Indonesia-Rumah Sakit Cipto Mangunkusumo. Jl. Diponegoro no. 71 Jakarta Pusat, 10420

Abstract :

Iron deficiency is the most common nutrional deficiency in the world, mostly in developing and industrial countries. Population with highest risk of iron deficiency generally are reproductive-age women. In Indonesia, the prevalence of iron deficiency anemia in pregnant women is about 50.5%. Anemia due to iron deficiency in pregnancy can affect both mother as well as the foetus. In order to prevent permanent systemic complication, it is important to do early detection before iron deficiency anaemia developes. In the early phase of iron deficiency prior to anaemia, additional tests of ferritin, serum iron and saturation index are needed besides the complete blood count. A new parameter named reticulocyte hemoglobin equivalent (RET-He) has been developed to detect the level of hemoglobin in an immature erythrocyte or reticulocyte. Reticulocytes will be present in the peripheral circulation for only 24--48 hours, so the RET-He will give more appropriate information about the condition of bone marrow iron. When the bone marrow iron is depleted, the RET-He will show a decrease. In several hematology analyzers, for example Advia 2120 and Sysmex XE 2100, this parameter can be tested together with CBC, so no additional blood sample is needed. The aim of this study is to know iron deficiency in healthy first and second trimester pregnant women by screening using RET-He and compare the result to other parameters that are now available, such as: hemoglobin, ferritin, transferrin saturation. Those parameters can develop RET-He cut-off with optimal sensitivity and specificity. The study comprised 100 healthy pregnant women from I and II trimester who did not develop anemia yet during their last pregnancy. The subjects were divided into three (3) groups based on ferritin and transferrin saturation: 67 women (67%) without iron deficiency, 17 women (17%) with iron deficiency stage I, and 16 women (16%) with iron deficiency stage II. Hemoglobin, RET-He, and transferrin saturation showed a mean ± SD of 12.35 ± 1.02 g/dL, 33.60 ± 1.88 pg and 28.63 ± 1.07%, respectively. Median ferritin (min-max) was 40.10 (6.24-191.30)ng/mL. By using receiver operating curve (ROC) in this study RET-He point was found at 33.65 pg as an optimal cut-off point to differentiate iron deficiency with sensitivity and specificity of 67 % and 64.18 % respectively. From cross tabs table of RET-He with ferritin as the gold standard and 33.65 pg as the cut-off point results were 47.8% positive predictive value (PPV), 79.6% negative predictive value (NPV), positive likelihood ratio (LR) 1.86 and negative likelihood ratio (LR) 0.52. ) In this study, significant differences between non iron deficiency and the iron deficiency stage II groups and between iron deficiency stage I and iron deficiency stage II groups were found. There was no difference between the non iron deficiency and iron deficiency stage I groups.     Kekurangan zat besi merupakan defisiensi nutrisi terbanyak di seluruh dunia, terjadi di negara berkembang maupun yang maju. Kekurangan zat  besi dapat terjadi di semua golongan umur, tetapi jumlah penyakit tertentu tertinggi di kelompok perempuan masa reproduksi. Di Indonesia anemia akibat kekurangan zat besi di ibu hamil diperkirakan sebesar 50,5%. Anemia akibat kekurangan zat besi dalam kehamilan dapat memberikan komplikasi bagi ibu dan janinnya. Penapisan dini penting dilakukan sebelum terjadi anemia akibat kekurangan zat besi, untuk mencegah komplikasi sistemik yang menetap. Pada tahap awal kekurangan zat besi sebelum terjadi anemia, diperlukan pemeriksaan feritin, serum zat besi, dan saturasi transferin, selain pemeriksaan darah lengkap. Saat ini telah dikembangkan tolok ukur hemoglobin setara retikulosit (RET-He) yang dapat menemukan kadar hemoglobin dalam eritrosit muda. Usia retikulosit di peredaran hanya berlangsung antara 24-48 jam, oleh karena itu RET-He lebih menggambarkan keadaan sebenarnya dari status zat  besi di sumsum tulang.8 Saat zat besi di sumsum tulang menurun, RET-He juga akan mengalami penurunan. Pada saat ini pemeriksaan RET-He sudah dapat dilakukan menggunakan alat hitung sel darah otomatis. Pemeriksaan RET-He tidak memerlukan tabung darah tambahan karena pemeriksaan tersebut sudah merupakan bagian dari penghitung retikulosit yaitu menggunakan alat analisis hematologik, sehingga biaya tambahan tidak diperlukan.8 Penelitian ini bertujuan untuk mengetahui kejadian kekurangan zat besi di perempuan hamil trimester I dan II yang sehat dengan menapis menggunakan tolok ukur RET-He dan membandingkannya dengan pembatas ukur yang sudah dipakai selama ini, yaitu: hemoglobin, feritin, dan saturasi transferin. Di samping itu juga untuk mendapatkan titik potong RET-He dengan kepekaan dan kekhasan yang terbaik di perempuan hamil trimester I dan II sehat tersebut. Pada penelitian ini didapatkan 100 perempuan hamil trimester I dan II yang tidak menunjukkan anemia, yang  terdiri dari tiga (3) kelompok berdasarkan feritin dan saturasi transferin yaitu: 67 (67%) subjek tanpa kekurangan zat besi, 17 (17%) yang dengan kekurangan zat  besi tahap I, dan 16 (16%) yang dengan kekurangan zat  besi tahap II. Rerata ± SD kadar hemoglobin, RET-He, dan saturasi transferin adalah 12,35 ± 1,02 g/dL,  33,60 ± 1,88 pg, dan 28,63 ± 1,07%. Median (min-maks) feritin adalah 40,10 (6,24 -191,30) ng/mL. Didasari kurva ROC yang dibuat untuk menentukan titik potong nilai RET-He yang memberikan kepekaan dan kekhasan terbaik dibandingkan dengan feritin sebagai baku emas, didapatkan RET-He dengan titik potong 33,65 pg di kepekaan 67% dan kekhasan 64,18% dan area under curve (AUC) 66,4%, serta didapatkan PPV 47,8%, NPV 79,6%, LR positif 1,86 dan LR negatif 0,52. Perbedaan bermakna kadar RET-He ditemukan antara kelompok tanpa kekurangan zat besi dan dengan yang kekurangan zat tahap II, dan antara kelompok yang berkekurangan zat tahap I dan tahap II. Perbedaan bermakna antara kelompok tanpa kekurangan zat besi dan yang berkekurangan zat tahap I tidak terdapat.

Keyword :

Iron deficiency, pregnant woman, RET-He,


References :

Isniati,(2007) Efek suplementasi tablet Fe obat cacing terhadap kadar hemoglobin remaja yang anemia di pondok pesantren tarbiyah islamiyah pasir kec.IV angkat candung tahun 2008 Jakarta : J Sains Tek Far

Scholl T,(2005) Iron status during pregnancy: setting the stage for mother and infant Amerika : American Journal of Clinical Nutrition

Thomas C, Thomas L,(2002) Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency USA : Clinical Chemistry

Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap III L, Wenstrom K,(2005) Hematological disorders Philadelphia : McGraw-Hill

Wirawan R,(2011) Pemeriksaan hematologi dasar Jakarta : Badan Penerbit Fakultas Kedokteran Universitas Indonesia





Archive Article

Cover Media Content

Volume : 19 / No. : 3 / Pub. : 2013-01
  1. {(active Caspase-3 In Acute Myeloid Leukaemia (aml) And Acute Lymphoblastic Leukaemia (all)}
  2. (principle Modification Of β-glucan Detection From Candida Albicans In Serum)
  3. Apoptosis Index Between Females And Males In Regular Hemodialysis
  4. [iron Deficiency In Pregnant Women By Haemoglobin Reticulocyte (ret-he)]
  5. (higher Level Of Ctx In Osteoporotic Women Compared To Normal And Osteopenic Women)
  6. (cystatin C, Hba1c And Albumin Creatinine Ratio)
  7. (lactate Dehydrogenase (ldh) During Storage)
  8. (cd4+ T Lymphocyte As A Prognosis Predictor In Sepsis Patients)
  9. (angiotensin Ii On Adipocytes Culture Exposed With High Glucose)
  10. (the Panleucogating Method For Lymphocyte Cd4 Counting In Hiv Patients)
  11. (c3c Serum Complement And Blood T-cd4+ Lymphocyte)
  12. (cell Based Hemostatis – In Vivo)
  13. Neonatal Acute Myeloid Leukaemia

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