UNIVERSITAS AIRLANGGA



Detail Article

Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 17 / No. 1 / Published : 2010-01

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Original Article :

Plasma secretory phospholipase-a2 activity inthrombocytopenic dengue haemorrhagic fever

Author :

  1. Endang Retnowati K*1
  2. Wiyanda Hidayati S*2
  3. Liana *3
  1. Bag PK FK-UNAIR/RSU Dr. Soetomo Surabaya
  2. Bag PK FK-UNAIR/RSU Dr. Soetomo Surabaya
  3. Bag PK FK-UNAIR/RSU Dr. Soetomo Surabaya

Abstract :

  Infected macrophages by dengue virus will produce phospholipase-A2 (PLA2) enzyme, that can promote arachidonic acid metabolism that produce inflammatory mediators, causing endhothelial damage and severe plasma leakage. Capillary endothelial damage can cause platelet adhesion and aggregation, so that many platelets will be consumed. The role of sPLA2 (secretory phospholipase-A2), which is a part of PLA2 in dengue and thrombocytopenia up to now has not been widely studied. The objective of the study is to analyze the association between the activity of plasma secretory phospholipase-A2 and the degree of thrombocytopenia in DHF adult patients. the study is carried out by a cross sectional, observational analytical study on 45 hospitalized adult patients suffering dengue hemorrhagic fever in the Tropical Infection Ward, Department of Internal Medicine, Dr. Soetomo Hospital Surabaya, which has been conducted from February – December 2009. The diagnosis of Dengue Haemorrhagic Fever (DHF) was based on the 1997 World Health Organization (WHO) criteria, that minimally had one positive serology marker of dengue. Venous blood was taken from the patient for examining the activity of secretory phospholipase-A2 by correlated enzyme assay method, and platelet count using automated hematology analyzer. The results of the secretory phospholipase-A2 activity and degree of thrombocytopenia were analyzed by Pearson correlation test to determine the correlation between the two variables. In this study so far was found that the secretory phospholipase-A2 activity in DHF patients was 36.9-195.6 unit/mL (mean 97.49 unit/mL, SD 30.06 unit/mL). The mean of secretory phospholipase-A2 activity was increased according to the degree of thrombocytopenia severity. The mean of secretory phospholipase-A2 activities were 91.65 unit/mL, 98.94 unit/mL, and 110.47 unit/mL. The degree of thrombocytopenia was divided into mild, moderate, and severe. Most of the patients showed mild thrombocytopenia. The sPLA2 activity in this study was increased in DHF patients with second day of fever, and then decreased at the third and forth day of fever, and increased in DBD patients suffering fifth day of fever. The statistical analyzes show a non significant correlation between secretory phospholipase-A2 activity and degree of thrombocytopenia (p=0.579). This result may be caused by several factors which influencing the thrombocytopenia in DHF, such as bone marrow suppression, dengue viral serotype, influence of cytosolic phospholipase-A2 (cPLA2) activity, and other proinflammatory cytokines which in this study could not be controlled. Statistical analyzes show a significant correlation between sPLA2 activity and the day of fever (p=0.04). Further studies should have to be carried out in order to know the pattern of sPLA2 activity in DHF grade I, II, III, and IV, and to know the influence of other proinflammatory cytokines and viral serotypes in sPLA2 activities.       Makrofag yang terinfeksi virus dengue akan memproduksi enzim fosfolipase-A2 (PLA2), yang dapat memicu metabolisme asam arakidonat, menghasilkan mediator inflamasi yang memperberat kerusakan endotel kapiler dan perembesan plasma. Kerusakan endotel kapiler merangsang agregasi serta adesi trombosit, sehingga trombosit banyak terkonsumsi. Masih belum banyak diketahui peran fosfolipase-A2 sekretoris (sPLA2 ), yang merupakan bagian dari enzim PLA2 di perjalanan penyakit DBD, khususnya pada trombositopenia. Tujuan penelian ini untuk mengetahui hubungan antara aktivitas sPLA2 plasma dengan derajat trombositopenia pada demam berdarah dengue dewasa. Penelitian ini adalah penelitian analitik observasional dengan rancang bangun potong lintang (cross sectional), yang dilakukan mulai Februari sampai Desember 2009. Sampel terdiri dari 45 penderita DBD yang dirawat di Ruang Penyakit Tropik Infeksi  RSUD Dr. Soetomo Surabaya. Diagnosis DBD berdasarkan kriteria WHO tahun 1997, dengan minimal salah satu hasil uji serologis dengue positif. Pengambilan sampel darah vena dilakukan untuk pemeriksaan aktivitas sPLA2 dengan prinsip correlated enzyme assay, dan hitung trombosit dengan hematology analyzer. Hasil pemeriksaan aktivitas sPLA2 dan derajat trombositopenia dianalisis dengan uji korelasi Pearson untuk menentukan korelasi antara kedua variabel tersebut. Aktivitas sPLA2 plasma di penderita DBD berkisar antara 36,9 unit/mL hingga 195,6 unit/mL, dengan rerata 97,49 unit/mL, dan SD 30,06 unit/mL. Terdapat peningkatan rerata aktivitas sPLA2 plasma dengan semakin berat derajat trombositopenia. Rerata aktivitas sPLA2  plasma di trombositopenia ringan, sedang, dan berat, berturut-turut adalah 91,65 unit/mL, 98,94 unit/mL, dan 110,47 unit/mL. Aktivitas sPLA2 penderita DHF pada trombositopenia sedang meningkat pada demam hari kedua dan kemudian menurun pada demam hari kelima Hasil analisis statistik menunjukkan tidak terdapat korelasi bermakna antara aktivitas sPLA2  plasma dan derajat trombositopenia di penderita DBD dewasa, dengan p=0,579. Hal ini mungkin disebabkan banyak faktor lain yang mempengaruhi terjadinya trombositopenia pada DBD, yang belum dapat dikendalikan di penelitian ini, yang juga merupakan keterbatasan penelitian, antara lain pengaruh supresi sumsum tulang, serotipe virus dengue, dan adanya pengaruh aktivitas fosfolipase-A2 sitosolis (cPLA2 ) yang juga ikut membentuk senyawa arakidonat, serta pengaruh sitokin proinflamasi yang lain. Perlu dilakukan penelitian lebih lanjut untuk mengetahui pola aktivitas sPLA2 di penderita DBD derajat I,II,III, dan IV, serta penelitian mengenai pengaruh sitokin proinflamasi yang lain dan serotipe virus dengue terhadap aktivitas sPLA2 pada DBD.

Keyword :

secretory phospholipase-A2 activity, thrombocytopenia, DHF,


References :

WHO,(1997) Dengue Haemorrhagic Fever: Diagnosis, Treatment, and Control Geneva : WHO

Soewandojo E,(2004) Tatalaksana Demam Berdarah Dengue pada Orang Dewasa Surabaya : Airlangga University Press

Noisakran S, Perng GC,(2008) Alternate Hypothesis on the Pathogenesis of Dengue Hemorrhagic Fever (DHF)/ Dengue Shock Syndrome (DSS) in Dengue Virus Infection Society for Experimental Biology and Medicine USA : Biology and Medicine

Nasronudin,(2007) Imunopatofisiologi Infeksi Virus Dengue Surabaya : Airlangga University Press

5Krishnamurti C, Peat RA, Cutting MA, and Rothwell SW,(2002) Platelet Adhesion to Dengue-2 Virus-Infected Endothelial Cells USA : American Journal of Tropical Medicine and Hygiene,





Archive Article

Cover Media Content

Volume : 17 / No. : 1 / Pub. : 2010-01
  1. (urine Eosinophyl In Acute Interstitial Nephritis (ain)
  2. Methicillin Resistant On Staphylococcus Aureus At Hospital Ward
  3. The Validity Examination D-dimer Assay Between Immunofiltration Method And Immunoturbidimetric Method
  4. Plasma Secretory Phospholipase-a2 Activity Inthrombocytopenic Dengue Haemorrhagic Fever
  5. Dengue Virus Profile In Surabaya From 2008-2009
  6. Correlation Between Serum Neuron-specific Enolase And Glasgow Coma Scale In Traumatic Head Injury
  7. Cut Off Value Dengue Quantitative Ns1 Antigen As Predictor Severity Of Dengue Viral Infection In Children
  8. The Role Of γ-interferron Gene (ifng) Polymorphism In Phenotype Histology Lupus Nephritis
  9. Quantification Of Gram Staining On Various Specimens
  10. Flaming Cells In Multiple Myeloma

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