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Abstrak :
ABSTRAK Ruang Lingkup dan Cara penelitian : Benturan berulang akibat getaran yang ditimbulkan alat bor 'rack drill' , dapat merupakan jejas pada eritrosit dalam pembuluh darah telapak tangan para pengebor yang menggunakannya, sehingga dapat menimbulkan hemolisis intravaskuler dan hemoglobinuria. Untuk membuktikan hal tersebut dilakukan penelitian terhadap 31 orang pengebor yang menggunakan 'rock drill' di suatu Pertambangan Emas. Kepada para pengebor tersebut dilakukan anamnesis dan pemeriksaan jasmani. Sebelum dan sesudah menggunakan 'rock drill', para pengebar diperiksa kadar Hb, nilai Ht, kadar Hb plasma, hemoglobinurin dan hemosiderinurinnya. Hasil dan Kesimpulan : Sesudah menggunakan 'rock drill', kadar Hb plasma para pengebor meningkat (p < 0,002); ini menunjukkan adanya hemolisis intravaskuler. Jumlah hemolisis yang terjadi dipengaruhi oleh lamanya pemajanan getaran (is = 0,422 ; p < 0,002), dan cara memegang handel 'rack drill' (p = 0,04), tetapi tidak dipengaruhi oleh umur pengebor (p > 0,10), masa kerja sebagai pengebor (p > 0,105, dan kekuatan getaran 'rock drill' yang digunakan (p > 0,05). Hemolisis yang terjadi akibat pemajanan getaran 'rock drill' selama 1 jam 15 menit sampai dengan 3 jam 20 menit, tidak menimbulkan penurunan kadar Hb (p > 0,10), maupun nilai Ht (p > 0,05). Hemoglobinuria dijumpai pada 6 (19,35 pengebor (p > 0,10), sedangkan hemosiderinuria ditemukan pada semua pengebor yang menunjukkan bahwa proses hemolisis intravaskuler tersebut telah berlangsung kronis dan berulang.

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ABSTRACT Scope and Method of Study: Repeated trauma due to rock drill vibration can cause intravascular Hemolysis and traumatic hemoglobinuria to the rock drillers. This study was carried out on 31 rock drillers in a gold mine to prove the occurrence of intravascular hemolysis and hemoglobinuria on the rock drillers. The study consists of interview, physical examination, and determination of hemoglobin level, hematocrite value, plasma hemoglobin level, hemoglobinurine, and hemosiderinurine before and after rock drill vibration exposure. Findings and Conclusions: After rock drill vibration exposure, the plasma hemoglobin level of the rock drillers increased ( p < 0,002). This finding indicates that there was an intravascular hemolysis. The degree of the hemolysis depended on the duration of the exposure (rs = 0,422; p < 0,002), and the manner of holding the rock drill handle- (p = 0,04), but it wasn't influenced by age (p > 0,10), work duration (p > 0,10), and the vibration intensity (p > 0,05). After one exposure ranging between 1 hour 15 minutes and 3 change the hemoglobin level (p > 0,10) nor the hematocrite value (p > 0,05). Hemoglobinuria was detected in 6 (19,35 7.) of the rock drillers (p > 0,10), and hemosiderinuria were found in all study subjects. The latter showed that the intravascular hemolysis was a chronic recurrent process.

Abstrak :
[ABSTRAK
Latar belakang. Komponen darah washed erythrocyte (WE) mempunyai fungsi yang sama dengan leukodepleted PRC (LD-PRC) yaitu untuk mencegah atau mengurangi reaksi transfusi. Namun banyak kekhawatiran para klinisi tentang cara pembuatan komponen darah WE dan bahan yang terkandung pada filter leukosit untuk menangkap leukosit. Tujuan utama dari penelitian ini adalah memberikan bukti secara ilmiah akan keamanan dalam pemakaian komponen darah PRC yang telah dimodifikasi ini dan juga memberikan pemahaman tentang pemakaian yang benar untuk komponen darah ini. Metoda. Penelitian ini menggunakan desain potong lintang pada 52 sampel darah. Pemeriksaan darah dilakukan pada 26 sampel WE sebelum dan sesudah menjadi komponen darah WE dan 26 sampel LD-PRC sebelum dan sesudah menjadi komponen darah LD-PRC. Pemeriksaan hematologi diperiksa secara otomatis menggunakan Sysmex Xn-2000, total protein diperkirakan menggunakan ADVIA 1650/1800, sedangkan hemolisis darah diamati menggunakan uji Osmotic Fragility Test (OFT). Hasil. Menunjukan kadar hemoglobin pada kelompok WE berkurang 15,4%, volume hematokrit menurun 8,55%, kadar protein menurun 98,4 %, dan jumlah leukosit menurun 87,31% dibandingkan dengan kelompok PRC sebelum dicuci. Selain itu, kadar hemoglobin dari komponen darah leukodepleted menurun 29,1%, volume hematokrit meningkat 21%, kadar protein menurun 79,1% dan jumlah leukosit menurun 99,9% dibandingkan dengan kelompok WB sebelum dijadikan komponen leukodepleted PRC. Persentase hemolisis pada komponen darah WE dan LD-PRC adalah < 0,8% Perbedaan bermakna komponen darah WE dan LD-PRC dapat diamati pada parameter penilaian protein sisa dan leukosit sisa (p<0,05). Simpulan. Dalam pembuatan komponen darah WE protein plasma berkurang sebanyak 98,4%, sedangkan dalam pembuatan leukodepleted PRC, jumlah leukosit berkurang sebanyak 99,97%. Terjadinya hemolisis dapat diabaikan karena pada kedua komponen darah, hemolisis terjadi < 0,8%. Jika diperlukan komponen darah dengan kandungan protein plasma yang sedikit dapat digunakan komponen darah WE, sementara itu jika diperlukan komponen darah dengan jumlah leukositnya sedikit dapat digunakan/dipilih komponen darah leukodepleted.

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ABSTRACT
Background. Washed erythrocyte (WE) and leukodepleted erythrocyte (LD-PRC) are normally used in clinical transfusion to prevent transfusion reaction. However, clinicians are wondering on the safety of those two blood components. The open system with saline for erythrocyte washing and the use of filter for blood leukodepletion still leave quiries on the possibility of hemolysis and their effectiveness for clinical transfusion. This study aims to provide scientific reasoning and the appropriate use of WE and leukodepleted blood respectively. Methods. A cross sectional approach was employed in this study on two groups of blood component consisting of 52 blood samples each , i.e. WE and LD-PRC respectively. Blood examinations were carried out on 26 WE samples prior to and after washing and on 26 LD-PRC samples prior to and after leukodepletion. Blood indices were examined automatically using Sysmex Xn-2000, total protein was estimated using ADVIA 1650/1800, while blood hemolysis was observed employing Osmotic Fragility Test (OFT). Results. It was shown that hemoglobin concentration of WE group decreased by 15.4%, hematocrit volume decreased by 8.55%, protein concentration decreased by 98.4%, and leukocyte count decreased by 87.3% compared to those the original Packed Red Cells. In addition, it was shown that the hemoglobin concentration of the leucodepleted blood component decreased by 29.1%, hematocrit volume increased by 21%, protein concentrations decreased 79.1% and the leukocyte count decreased by 99.9%. All the sampel of the WE blood products and all the LD-PRC blood sampel has hemolysis level <0,8% However, a significant difference in protein concentration and leukocyte count was observed betwen WE and LD-PRC (p<0.05). Conclusion. The process of erythrocytes? washing decreased the plasma protein concentration by 98.4%, whilst the process of leucodepletion decreased the leucocyte count by 99.97%. Hemolysis during the preparation of both blood components could be negligible. It is concluded that WE blood component is preferable for transfusion when low plasma protein is required. On the other hand, leukodepleted PRC is preferable when blood component with low in leucocyte count is required.;Background. Washed erythrocyte (WE) and leukodepleted erythrocyte (LD-PRC) are normally used in clinical transfusion to prevent transfusion reaction. However, clinicians are wondering on the safety of those two blood components. The open system with saline for erythrocyte washing and the use of filter for blood leukodepletion still leave quiries on the possibility of hemolysis and their effectiveness for clinical transfusion. This study aims to provide scientific reasoning and the appropriate use of WE and leukodepleted blood respectively. Methods. A cross sectional approach was employed in this study on two groups of blood component consisting of 52 blood samples each , i.e. WE and LD-PRC respectively. Blood examinations were carried out on 26 WE samples prior to and after washing and on 26 LD-PRC samples prior to and after leukodepletion. Blood indices were examined automatically using Sysmex Xn-2000, total protein was estimated using ADVIA 1650/1800, while blood hemolysis was observed employing Osmotic Fragility Test (OFT). Results. It was shown that hemoglobin concentration of WE group decreased by 15.4%, hematocrit volume decreased by 8.55%, protein concentration decreased by 98.4%, and leukocyte count decreased by 87.3% compared to those the original Packed Red Cells. In addition, it was shown that the hemoglobin concentration of the leucodepleted blood component decreased by 29.1%, hematocrit volume increased by 21%, protein concentrations decreased 79.1% and the leukocyte count decreased by 99.9%. All the sampel of the WE blood products and all the LD-PRC blood sampel has hemolysis level <0,8% However, a significant difference in protein concentration and leukocyte count was observed betwen WE and LD-PRC (p<0.05). Conclusion. The process of erythrocytes’ washing decreased the plasma protein concentration by 98.4%, whilst the process of leucodepletion decreased the leucocyte count by 99.97%. Hemolysis during the preparation of both blood components could be negligible. It is concluded that WE blood component is preferable for transfusion when low plasma protein is required. On the other hand, leukodepleted PRC is preferable when blood component with low in leucocyte count is required., Background. Washed erythrocyte (WE) and leukodepleted erythrocyte (LD-PRC) are normally used in clinical transfusion to prevent transfusion reaction. However, clinicians are wondering on the safety of those two blood components. The open system with saline for erythrocyte washing and the use of filter for blood leukodepletion still leave quiries on the possibility of hemolysis and their effectiveness for clinical transfusion. This study aims to provide scientific reasoning and the appropriate use of WE and leukodepleted blood respectively. Methods. A cross sectional approach was employed in this study on two groups of blood component consisting of 52 blood samples each , i.e. WE and LD-PRC respectively. Blood examinations were carried out on 26 WE samples prior to and after washing and on 26 LD-PRC samples prior to and after leukodepletion. Blood indices were examined automatically using Sysmex Xn-2000, total protein was estimated using ADVIA 1650/1800, while blood hemolysis was observed employing Osmotic Fragility Test (OFT). Results. It was shown that hemoglobin concentration of WE group decreased by 15.4%, hematocrit volume decreased by 8.55%, protein concentration decreased by 98.4%, and leukocyte count decreased by 87.3% compared to those the original Packed Red Cells. In addition, it was shown that the hemoglobin concentration of the leucodepleted blood component decreased by 29.1%, hematocrit volume increased by 21%, protein concentrations decreased 79.1% and the leukocyte count decreased by 99.9%. All the sampel of the WE blood products and all the LD-PRC blood sampel has hemolysis level <0,8% However, a significant difference in protein concentration and leukocyte count was observed betwen WE and LD-PRC (p<0.05). Conclusion. The process of erythrocytes’ washing decreased the plasma protein concentration by 98.4%, whilst the process of leucodepletion decreased the leucocyte count by 99.97%. Hemolysis during the preparation of both blood components could be negligible. It is concluded that WE blood component is preferable for transfusion when low plasma protein is required. On the other hand, leukodepleted PRC is preferable when blood component with low in leucocyte count is required.]

Abstrak :
ABSTRAK
Hemolisis merupakan masalah yang umum dijumpai dalam praktik laboratorium dengan prevalensi 3,3 dari total spesimen yang diterima di laboratorium. Hemolisis memiliki pengaruh yang berbeda pada pemeriksaan PT dan APTT pada subyek sehat dan pasien Sysmex CS2100i merupakan alat koagulometer yang menggunakan prinsip deteksi koagulasi dengan transmisi cahaya foto-optikal yang dilengkapi dengan detektor hemolisis ikterik dan lipemik HIL dan multiple wavelength detector. Aspek terpenting dalam praktik laboratorium terkait hemolisis adalah mengetahui batasan indeks hemolisis yang dapat menimbulkan bias bermakna di dalam suatu pemeriksaan dalam hal ini PT dan APTT. Jumlah subyek penelitian sebesar 70 orang yang dibagi dua yaitu, kelompok sehat sebesar 35 orang dan kelompok sakit dengan warfarin sebesar 35 orang. Pembuatan hemolisat dilakukan dengan metode trauma mekanik menggunakan syringe insulin dengan jarum 30G. Pada hasil PT dan APTT subyek sehat didapatkan uji repeated measures ANOVA bermakna, p=0,001 dan subyek sakit dengan warfarin didapatkan uji Friedman bermakna, p=0,001. Uji post-hoc Dunnett subyek sehat untuk hasil PT didapatkan nilai bermakna pada konsentrasi hemolisis 150, 200, 250, 330 dan 500 mg/dL, sedangkan hasil APTT didapatkan hasil bermakna pada konsentrasi hemolisis 250, 330, dan 500 mg/dL. Uji post-hoc Wilcoxon subyek sakit untuk hasil PT didapatkan nilai bermakna pada konsentrasi hemolisis 100, 150, 200, 250, 330 dan 500 mg/dL, sedangkan hasil APTT didapatkan nilai bermakna pada konsentrasi hemolisis 250, 330 dan 500 mg/dL.Bias hemolisis maksimal yang masih dapat diterima dengan kriteria Ricos dkk untuk PT dan APTT subyek sehat masing-masing adalah 100 mg/dL, sedangkan subyek sakit dengan warfarin adalah 50 mg/dL dan 200 mg/dL. Batasan dengan kriteria CLIA untuk PT dan APTT subyek sehat adalah 330 mg/dL dan 250 mg/dL, sedangkan subyek sakit dengan warfarin adalah 330 mg/dL baik untuk PT maupun APTT. Dari grafik scatter didapatkan tren pemanjangan hasil PT dan APTT subyek sehat, sedangkan pada subyek sakit dengan warfarin didapatkan tren pemanjangan hasil PT dan pemendekan hasil APTT. Penerapan batasan bias hemolisis maksimal memungkinkan praktisi laboratorium untuk tetap menerima spesimen dengan interferensi hemolisis pada pemeriksaan PT dan APTT, memastikan hasil yang dikeluarkan tetap akurat, tanpa menunda penatalaksanaan terhadap pasien dan mengurangi biaya dan ketidaknyamanan yang timbul akibat pengambilan kembali spesimen.

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ABSTRACT
Hemolysis is a common problem in laboratory practice with a prevalence of 3.3 of the total specimens received in the laboratory. Haemolysis have a different influence on the examination of the PT and APTT in healthy and patients subjects. Sysmex CS2100i is a coagulometer with the photo optical method, equipped with hemolysis, icteric and lipemic detector HIL and multiple wavelength. The most important aspect in laboratory practice is to know the limits associated with haemolysis that can cause significant bias in PT and APTT assay. The total number of research subjects are 70 people, divided into 35 healthy subjects and 35 patient subject undergoing warfarin therapy. Hemolysate was conducted using a mechanical trauma using insulin syringe with 30G needle.. Repeated measures ANOVA test of PT and APTT on healthy subjects obtained a significant statistical result, p 0.001. The warfarin users also had a significant statistical result with Friedman test, p 0.001. Post hoc Dunnett test on PT values of healthy subjects, obtained a statisticaly significant results in hemolysis concentration of 150, 200, 250, 330 and 500 mg dL, while the APTT results obtained significant statistical results in haemolysis concentration of 250, 330, and 500 mg dL. Wilcoxon post hoc test of PT on patient subjects obtained significant result in the haemolysis concentration of 100, 150, 200, 250, 330 and 500 mg dL, while the APTT values obtained significant results in hemolysis concentration 250, 330 and 500 mg dL. The maximum bias that still could acceptable by Ricos et al criteria for PT and APTT on healthy subjects for both were 100 mg dL, whereas patient subjects undergoing warfarin therapy was 50 mg dL and 330 mg dL. Using CLIA criteria for PT and APTT on healthy subjects resulted maximum bias was 330 mg dL and 250 mg dL, whereas warfarin users was 330 mg dL for PT and APTT. There was a trend of increase in the readings of PT and APTT on healthy subjects, while on patient subjects undergoing warfarin there was a trend of increase in PT and decrease of APTT results. The application of acceptable hemolysis bias limit, enable laboratory practitioners to process hemolysis specimens in PT and APTT assays, ensuring the results is still accurate without delaying clinical decision and to reduce the cost and inconvenience arising from the specimen recollection.

Abstrak :
Latar belakang: Kemampuan survival sel darah merah ini dapat dilihat dari hemolisis sel darah merah selama penyimpanan. Penurunan survival sel darah merah ini kemungkinan salah satunya karena masih adanya leukosit dalam komponen darah. Adanya leukosit dalam produk PRC dapat meningkatkan storage lesion sehingga menurunkan kemampuan survival sel darah merah ini. Selain mengurangi jumlah leukosit, upaya untuk menjaga kestabilan membran sel darah merah dilakukan dengan cara menggunakan manitol dalam additive solution. Metode : 40 sampel PRC yang terdiri dari kantong PRC, PRC+Filter, PRC+SAGM, PRC+SAGM+Filter yang disimpan dengan suhu 2°-6°C diperiksa kadar glukosa, pH dan hemolisis pada hari ke-0, 7, 14, 21, 28, 35, dan 42. Data hasil penelitian ini dianalisis menggunakan uji statistik ANOVA dengan batas kemaknaan <0,05. Hasil : Penggunaan filter untuk mengurangi jumlah leukosit didapatkan hasil yang bermakna (<0,05). Terjadi penurunan kadar glukosa, pH dan peningkatan hemolisis selama penyimpanan pada semua jenis kantong. Tingkat hemolisis produk darah PRC pada hari ke-35 telah lebih dari standar, sedangkan pada tiga produk PRC yang lain pada masa simpan 42 hari masih dalam batas normal. Kesimpulan : Baik pengurangan leukosit mau pun penambahan additive solution pada PRC dapat mempertahankan viabilitas sel darah merah sehingga pada penyimpanan hari ke-42.

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ABSTRACT Background: The ability of red blood cell survival can be seen from hemolysis of red blood cells during storage. The decrease in survival of red blood cells is probably one of them because of the presence of leukocytes in the blood component. The presence of leukocytes in PRC products can increase storage lesion thereby reducing the survival of red blood cells. In addition to reducing the number of leukocytes, efforts to maintain the stability of the red blood cell membrane are carried out by using mannitol in additive solutions. Methods: 40 PRC samples consisting of PRC bags, PRC+Filters, PRC+SAGM, PRC+SAGM+Filters stored at 2°-6°C were examined for glucose, pH and hemolysis levels on days 0, 7, 14 , 21, 28, 35, and 42. Data from the results of this study were analyzed using ANOVA statistical tests with significance limits <0.05. Results: The use of filters to reduce the number of leukocytes showed significant results (<0.05). A decrease in glucose levels, pH and increased hemolysis during storage in all types of bags. The level of hemolysis of PRC blood products on the 35th day was more than standard, whereas in the other three PRC products the 42-day shelf life was still within normal limits. Conclusion: Both leukocyte reduction and additive solution addition in PRC can maintain the viability of red blood cells so that at the 42nd day storage.