tag:blogger.com,1999:blog-4963689966586623252024-03-13T13:56:42.651-07:00Blog Juruteknologi Makmal Perubatan @ MAD LAB BLOGInformasi dari Makmal perubatan anda. Blog ini memberikan informasi berguna untuk Juruteknologi Makmal Perubatan berkaitan ujian-ujian yang biasa dijalankan dan teknologi yang digunakan di dalam makmal. Semoga ianya dapat memberi manafaat kepada semua, terutamanya Junior MLT.
Unknownnoreply@blogger.comBlogger64125tag:blogger.com,1999:blog-496368996658662325.post-73446902295801206652022-03-29T07:26:00.000-07:002022-03-29T07:26:05.315-07:00VDLR vs RPR<p> </p><span style="font-family: arial; font-size: 12pt;"><div style="text-align: justify;"><span style="font-size: 12pt;">Syphilis is
one of the well-known sexually transmitted infections. This disease is caused
by the bacteria Treponema pallidum. Syphilis can be detected by different
tests. These tests are divided into two parts: the </span><b style="font-size: 12pt;"><i>nontreponemal tests</i></b><span style="font-size: 12pt;">
and the </span><b style="font-size: 12pt;"><i>treponemal tests</i></b><span style="font-size: 12pt;">. </span></div></span><p class="MsoNormal" style="text-align: justify;"><span style="font-size: 12.0pt; line-height: 107%;"><span style="font-family: arial;">The nontreponemal tests can detect
non-specific treponemal antibodies. There are two common tests under the
nontreponemal test. They include <b><i>VDRL</i></b> (Venereal Disease Research
Laboratory) and <b><i>RPR</i></b> (Rapid Plasma Reagin). These two tests are
performed in the same way. However, they have a few differences.</span></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdUCqUt34b5DQvi4etRlUGhdWjs3HPsiEd8ggsK_oSRRUei8rEufM3_aeQWIQ8nFeg15bO27ckYniPzNAxKqWzCVLyve8QjT6jio81ajzmXfQWj4cXkLqJPYHBSMLTZ3XRRVB9IdvpdISK6bIGvpy4y1KzPuewyCYOzFyqWcVbcucC5UgxmL_b9xCC/s310/treponema.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="163" data-original-width="310" height="163" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdUCqUt34b5DQvi4etRlUGhdWjs3HPsiEd8ggsK_oSRRUei8rEufM3_aeQWIQ8nFeg15bO27ckYniPzNAxKqWzCVLyve8QjT6jio81ajzmXfQWj4cXkLqJPYHBSMLTZ3XRRVB9IdvpdISK6bIGvpy4y1KzPuewyCYOzFyqWcVbcucC5UgxmL_b9xCC/s1600/treponema.jpg" width="310" /></a></div><br /><p></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;"><span style="font-family: arial;">VDRL test
was developed by the<i> Venereal Disease Research Laboratory</i> during World
War I. This test is still done today to detect syphilis. <o:p></o:p></span></span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;"><span style="font-family: arial;">
</span></span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;"><span style="font-family: arial;">RPR was
developed as a more advanced VDRL. RPR is just the VDRL antigen, but it
contains carbon or delicately divided charcoal particles. With these charcoal
particles, it allows the visualization of the reaction or flocculation between
the specimen and the antigen without the use of a microscope. <o:p></o:p></span></span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;"><span style="font-family: arial;"><br /></span></span></p><p class="MsoNormal"><b><span style="font-size: 16.0pt; line-height: 107%;"><span style="font-family: arial;">RPR-VDRL (Serologic
Tests for Syphilis)<o:p></o:p></span></span></b></p><p class="MsoNormal"><span style="font-family: arial;">A variety of serologic tests for syphilis are available,
including:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">1)<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->VDRL (Venereal Disease Research Laboratory)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">2)<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->RPR (Rapid Plasma Reagin)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">3)<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->FTA-ABS (Fluorescent Treponemal Antibody
Absorption)<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">4)<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->TP-MHA (Treponema Pallidum Microhemagglutination
Assay)<o:p></o:p></span></p><p class="MsoNormal"><span style="font-family: arial;">Each differs the others in the precise substance being
measured, complexity, and specificity. All are satisfactory for use in managing
syphilis. Abnormals may be:<o:p></o:p></span></p><p class="MsoNormal" style="text-indent: 36.0pt;"><span style="font-family: arial;">Reactive, </span><span style="font-family: arial; text-indent: 36pt;">Weakly reactive, or </span><span style="font-family: arial; text-indent: 36pt;">Bordeline</span></p><p class="MsoNormal"><span style="font-family: arial;">Whenever a screening test (RPR, VDRL) is positive, a more
specific test (FTA-ABS, TP-MHA) should be used to confirm the test and rule out
a "biologic false positive."<o:p></o:p></span></p><p class="MsoNormal"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal"><b><span style="font-size: 20.0pt; line-height: 107%;"><span style="font-family: arial;">A “negative”
or "nonreactive" test may indicate:<o:p></o:p></span></span></b></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient doesn't have syphilis<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient has syphilis, but is so early in the
course of the disease that the test has not yet turned positive. In these
cases, the test may never turn positive if the patient is effectively treated.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient had primary syphilis, had a positive
test, was effectively treated, 6 months have passed and the test has now
reverted to negative.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient had secondary syphilis, had a
positive test, was effectively treated, 12-18 months have passed and the test
has now reverted to negative.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient has syphilis, but his/her immune system
is impaired.<o:p></o:p></span></p><p class="MsoNormal"><o:p><span style="font-family: arial;"> </span></o:p></p><p class="MsoNormal"><b><span style="font-size: 20.0pt; line-height: 107%;"><span style="font-family: arial;">A “positive”
or "reactive" test may indicate:<o:p></o:p></span></span></b></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient has syphilis.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient had syphilis, was effectively
treated, but the test has not yet returned to negative:<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">o<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->With primarily syphilis, it typically takes
about 6 months for the test to turn negative.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">o<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->With secondary syphilis, it typically takes
12-18 months for the test to turn negative.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">o<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The longer syphilis remains untreated, the
longer it will take for the test to return to normal, and the less likely it is
to ever return to normal.<o:p></o:p></span></p><p class="MsoNormal">
</p><p class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: arial;">·<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]-->The patient has a biologic false positive (BFP)<br /></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo3; text-indent: -18.0pt;"><span style="font-family: arial;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEha2yPc0khC-xOa1-FlWwk5ScP2OdGJtj9UzcaZsJkZyiwBZQKPiNjpOSpYeS9POeIKMd4QKMeWDFksZq0-NZYSR1_iwxm2t_uff0zL_A3cIx-JpyHPT9iwAPOdcex9RXxz-qfSC8bWZkjxXLOa1HLur-C9wWpeqIoY26ugzRNU4x6DrgGWXMPAFRGB/s1880/syphilis%20develop.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1289" data-original-width="1880" height="337" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEha2yPc0khC-xOa1-FlWwk5ScP2OdGJtj9UzcaZsJkZyiwBZQKPiNjpOSpYeS9POeIKMd4QKMeWDFksZq0-NZYSR1_iwxm2t_uff0zL_A3cIx-JpyHPT9iwAPOdcex9RXxz-qfSC8bWZkjxXLOa1HLur-C9wWpeqIoY26ugzRNU4x6DrgGWXMPAFRGB/w509-h337/syphilis%20develop.jpg" width="509" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgKBAPYn8STs0JmRwOZ5arWIuZGqanZIMR8ZxP4l-6_Gk5H8rnm_KxU3QfR815RqrcMaJ8eNxls49AkDhTsGX37DZ5ycpWh4rP97j2cgCIhIOmsMGFoXzq6YHSpwbxx65OIetVgz2ShMA-_dk1VVDQZ_EM7moy0hwK98IpHdH8NXEtHeUf_alA3YRbw" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="938" data-original-width="917" height="462" src="https://blogger.googleusercontent.com/img/a/AVvXsEgKBAPYn8STs0JmRwOZ5arWIuZGqanZIMR8ZxP4l-6_Gk5H8rnm_KxU3QfR815RqrcMaJ8eNxls49AkDhTsGX37DZ5ycpWh4rP97j2cgCIhIOmsMGFoXzq6YHSpwbxx65OIetVgz2ShMA-_dk1VVDQZ_EM7moy0hwK98IpHdH8NXEtHeUf_alA3YRbw=w452-h462" width="452" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><p></p><p class="MsoNormal"><span style="font-family: arial;">The traditional screening algorithm pathway (see <b>FIGURE
1</b>) relies on the initial analysis of a NTT such as the RPR (rapid plasma
reagin) or Venereal Disease Research Laboratory (VDRL) test. If the initial
result is <i>reactive</i>, then additional testing is done to confirm the
primary result. This additional testing can be done a number of ways including
via TP-PA, fluorescent treponemal antibody absorption (FTA-ABS), enzyme
immunoassay (EIA), or chemiluminescence immunoassay (CLIA)<span style="background: white; color: #666666; font-size: 10.5pt; line-height: 107%;"> </span>A <i>reactive</i> result on
this confirmatory test is to be considered diagnostic of active <i>T.
pallidum</i> infection. Additional specificity for <i>T. pallidum</i> diagnosis
is achieved with IgG- and/or IgM-class antibodies detected with the NTT methods
described above..</span></p><p class="MsoNormal"><span style="font-family: arial;"> </span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"></div><p class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo3; text-indent: -18.0pt;"></p><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiOcgWYNtBEdBvli-mPwuCzXGn0l4RWVS3Ju2p9B8dBYawtD4tSDVbkEs0c939wKJD_6q37ECCTBhg5HjWGTDqQxp3LrKFaiXt9t_Y_pMdoAxkwuCJD81u0sy-Al8SXxkOQEO9QpT8rQAxli86CXe7iKJk9bdn1FgYdwxDL_YLYynZNsOCkXt24WEHS" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="938" data-original-width="923" height="468" src="https://blogger.googleusercontent.com/img/a/AVvXsEiOcgWYNtBEdBvli-mPwuCzXGn0l4RWVS3Ju2p9B8dBYawtD4tSDVbkEs0c939wKJD_6q37ECCTBhg5HjWGTDqQxp3LrKFaiXt9t_Y_pMdoAxkwuCJD81u0sy-Al8SXxkOQEO9QpT8rQAxli86CXe7iKJk9bdn1FgYdwxDL_YLYynZNsOCkXt24WEHS=w460-h468" width="460" /></a></div><br /></span></div><p></p><p class="MsoNormal"><span style="font-family: arial;">The reverse algorithm (see <b>FIGURE 2</b>) is another
alternative used by health care providers. Recent studies have indicated that
reverse sequence screening may detect more cases of early or latent syphilis
than the traditional forward screening algorithm.<sup>6</sup> As
recommended by the Centers for Disease Control and Prevention (CDC), discordant
syphilis IgG and RPR results are to be resolved by a second treponemal test
(TP-PA).<sup>7</sup> In the presence of a positive syphilis IgG and
non-reactive RPR, a non-reactive treponemal test indicates a false positive
syphilis IgG screen because TP-PA has a higher sensitivity than syphilis IgG
screening.<sup>8</sup> A treponemal confirmation test deemed positive
typically results in patient treatment, as the regimen is inexpensive and the
consequences of a missed public health opportunity can be large.</span><o:p></o:p></p><p class="MsoNormal"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhOy_rhVExszdwwI_aAOeDWX39E3KCT4ngH0hM1REqkinyQmVmPNJ4KhlEcSHiPW7BhdYA-crphKPPebOKFte0We7vLOs9T8PnBktt_5EyJo9i4VJKVLJprSPtvOr2Q9Vn54AXjaIAZAK4B6UKVwnyWyfsssg7VmDYIuR7kNUAucvFwSpGTLdc8Xlth" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="414" data-original-width="938" height="277" src="https://blogger.googleusercontent.com/img/a/AVvXsEhOy_rhVExszdwwI_aAOeDWX39E3KCT4ngH0hM1REqkinyQmVmPNJ4KhlEcSHiPW7BhdYA-crphKPPebOKFte0We7vLOs9T8PnBktt_5EyJo9i4VJKVLJprSPtvOr2Q9Vn54AXjaIAZAK4B6UKVwnyWyfsssg7VmDYIuR7kNUAucvFwSpGTLdc8Xlth=w629-h277" width="629" /></a></div><p></p><p class="MsoNormal"><span style="font-family: arial;">This reverse algorithm pathway is gaining traction among
obstetric health care providers due to the cross-reactivity of the RPR test
with medical conditions such as other infections (eg, HIV), pregnancy,
autoimmune disorders, injection-drug use, older age, or immunizations.
Screening out this approximately 1% of the population that exists as <i>false
positive</i> has become a necessity (see <b>FIGURE 3</b>). Aside from
the obvious benefits of lab automation, this method also represents less
intensive patient follow-up and stress from treatment. Although not as widely
preferred as the forward algorithm, CPL provides guidance to clinicians for
interpreting reverse algorithm results (see <b>FIGURE 4</b>). Both of
these approaches are summarized in <b>FIGURE 5</b>.</span><o:p></o:p></p><p class="MsoNormal"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhFG00Wk2G0AtqCDB2FLWR6RM5TrCU4L5P8YmTts-GOKS2A8V12FC17TZwF72eLWRvg7QEvgoG8Kra7RP4a35fqzCCGrJk44-5-wmqUx9FnBJxooUc1_tTH2cifWbBOAaQ6l1a4matUmHkS3XZQlVoNYzYndTK1O444ThPhfhNOd5lJeRj0OdJAKkNj" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="619" data-original-width="938" height="429" src="https://blogger.googleusercontent.com/img/a/AVvXsEhFG00Wk2G0AtqCDB2FLWR6RM5TrCU4L5P8YmTts-GOKS2A8V12FC17TZwF72eLWRvg7QEvgoG8Kra7RP4a35fqzCCGrJk44-5-wmqUx9FnBJxooUc1_tTH2cifWbBOAaQ6l1a4matUmHkS3XZQlVoNYzYndTK1O444ThPhfhNOd5lJeRj0OdJAKkNj=w651-h429" width="651" /></a></div><br /><br /><p></p><p class="MsoNormal"><br /></p><p class="MsoNormal"><o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo3; text-indent: -18.0pt;"><span style="font-family: arial;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhU3_aCwhab7BzEgf3in_GvsBpTpnIiFZDsYNEbS0n3uW53pFI0Q1z23eMnlT7JmIaCeGoYKmekbwxYIr98wPhIMkUIrmY-tono_TCQOr4xTTs0AQly_Ho63swuR8q-PvGsh0pGGgNSLPXXWaxAvEdUkffn30QXRSP1luFESDNkLv7A6lGHB0W6plQg" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="648" data-original-width="938" height="448" src="https://blogger.googleusercontent.com/img/a/AVvXsEhU3_aCwhab7BzEgf3in_GvsBpTpnIiFZDsYNEbS0n3uW53pFI0Q1z23eMnlT7JmIaCeGoYKmekbwxYIr98wPhIMkUIrmY-tono_TCQOr4xTTs0AQly_Ho63swuR8q-PvGsh0pGGgNSLPXXWaxAvEdUkffn30QXRSP1luFESDNkLv7A6lGHB0W6plQg=w648-h448" width="648" /></a></span></div><span style="font-family: arial;"><br /></span><span style="font-family: arial;">One significant potential limitation of using the reverse
algorithm exclusively is the prevalence of the impact of false-positive results
that can contribute to a burden of anxiety and treatment.</span><sup style="font-family: arial;">9</sup><span style="font-family: arial;"> However,
other more obvious benefits of the reverse screening pathway include the
ability to perform the treponemal IgG test on a high throughput analyzer (such
as the Bio-Rad BioPlex 2200). Furthermore, the quantitative result obtained
from this test aids in the monitoring of disease progression, especially during
the tertiary phase. The reverse screening process studied by the University of
Iowa Hospitals and Clinics has proven that 99% of results screened negative (1%
screened positive).</span><sup style="font-family: arial;">10</sup><span style="font-family: arial;"> While the initial IgG treponemal test may
be more expensive per test, overall client satisfaction is improved by
providing results more rapidly. </span><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><span style="font-size: 12.0pt; line-height: 107%;"><br /></span><p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-8995872522721546892019-11-15T19:47:00.003-08:002021-10-16T01:36:16.754-07:00Autoimmune Hepatitis<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-vOJskhhN7Q8/Xc9t2Qc_pVI/AAAAAAAADrI/Gayr8e8KZdgQRTCTOYnUz_87mG10jNZEQCLcBGAsYHQ/s1600/autoimmune-hepatitis-AIH-based-on-autoantibody-profiles-of-patients.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="558" data-original-width="740" height="241" src="https://1.bp.blogspot.com/-vOJskhhN7Q8/Xc9t2Qc_pVI/AAAAAAAADrI/Gayr8e8KZdgQRTCTOYnUz_87mG10jNZEQCLcBGAsYHQ/s320/autoimmune-hepatitis-AIH-based-on-autoantibody-profiles-of-patients.png" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Diagnosis of autoimmune hepatitis in any patient who has
acute hepatitis or acute liver failure (defined by the new onset of
coagulopathy include the following assays:<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Serum antinuclear antibody (ANA)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Anti–smooth muscle antibody (ASMA)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Liver-kidney microsomal type 1 (LKM-1) antibody<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Serum protein electrophoresis (SPEP)<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Quantitative immunoglobulins<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Urgent liver biopsy, transjugular if appropriate, may help
to confirm the clinical suspicion of autoimmune hepatitis.<o:p></o:p></div>
<div class="MsoNormal">
Laboratory findings in autoimmune hepatitis include the
following:<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Elevated serum aminotransferase levels (1.5-50
times reference values)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Elevated serum immunoglobulin levels, primarily
immunoglobulin G (IgG)<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Seropositive results for ANAs, SMAs, or LKM-1 or
anti–liver cytosol 1 (anti-LC1) antibodies<o:p></o:p></div>
<div class="MsoNormal">
In 50% of patients, abnormal results on liver function tests
include decreased albumin levels and prolonged prothrombin time.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">Autoantibody Assays<o:p></o:p></span></b></div>
<div class="MsoNormal">
Autoimmune hepatitis is characterized by positive findings
on autoantibody tests, as follows:<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->AIH-1 - ASMA and ANA<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->AIH-2 - Anti–LKM-1 antibody<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->AIH-3 - Antibodies to soluble liver antigen
(anti-SLA)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-iKSiWAbsj0w/Xc9vFp-CbII/AAAAAAAADrU/XoGvHxpg93QYupByAmBg8K8X_SfHK9xzQCLcBGAsYHQ/s1600/autoimmune-hepatitis-better-understanding-2-15-638.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="479" data-original-width="638" height="240" src="https://1.bp.blogspot.com/-iKSiWAbsj0w/Xc9vFp-CbII/AAAAAAAADrU/XoGvHxpg93QYupByAmBg8K8X_SfHK9xzQCLcBGAsYHQ/s320/autoimmune-hepatitis-better-understanding-2-15-638.jpg" width="320" /></a></div>
<div class="MsoNormal">
<o:p>+</o:p></div>
<div class="MsoNormal">
SMAs are present in 90%-100% of patients with autoimmune
hepatitis type 1 (AIH-1). ANAs are present in 10% of patients with AIH-1 and in
association with SMAs in 40%-60% of patients with AIH-1. Titers range from
1:100-500,000. SMAs occur in low titers in healthy children and patients with
viral hepatitis and other diseases that do not affect the liver.<o:p></o:p></div>
<div class="MsoNormal">
LKM-1 antibodies are present in 40%-45% of patients with
AIH-2 and are associated with anti-LC1 antibodies in 50% of patients. Anti-LC1
antibodies occur alone in 30% of patients with AIH-2; these antibodies
recognize formiminotransferase cyclodeaminase, a liver-specific 58kD metabolic
enzyme. Anti-asialoglycoprotein receptor antibodies occur more often in
patients with AIH-1 and may serve as a marker of inflammatory activity.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Other autoantibodies may be evident. Atypical perinuclear
antineutrophil cytoplasmic antibodies (pANCA) are frequently present. Czaja et
al have shown that patients with autoimmune hepatitis who have positive test
results for actin antibody are younger, more commonly test positive for human
leukocyte antigen (HLA)–DR3, and required transplantation more frequently than
patients with ANAs who test negative for actin antibody<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Serum Proteins and
Immunoglobulins<o:p></o:p></b></div>
<div class="MsoNormal">
An IgG-predominant polyclonal hypergammaglobulinemia is a
common finding in patients with untreated autoimmune hepatitis. Gamma globulin
values typically range from 3-4 g/dL and frequently are as high as 5-6 g/dL.
Cases of hyperviscosity syndrome secondary to high IgG levels are reported.
Autoimmune hepatitis is an unlikely diagnosis in patients who have acute
hepatitis without hypergammaglobulinemia.<o:p></o:p></div>
<div class="MsoNormal">
The gamma globulin or the IgG level may be followed on a
regular basis as a marker of disease responsiveness to therapy.<o:p></o:p></div>
<div class="MsoNormal">
Patients with AIH-2 commonly have partial immunoglobulin A
(IgA) deficiency.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Aminotransferases<o:p></o:p></b></div>
<div class="MsoNormal">
Serum aminotransferases (aspartate aminotransferase [AST]
and alanine aminotransferase [ALT]) are elevated in 100% of patients at initial
presentation, with average values of 200-300 U/L. Aminotransferase values
correlate poorly with the degree of hepatic necrosis; however, values in the
thousands may indicate acute hepatitis or a severe flare of preexisting
disease.<o:p></o:p></div>
<div class="MsoNormal">
Continued elevation of the aminotransferases in the face of
continuing therapy is a reliable marker for ongoing inflammatory activity in
the liver. Normalization of the aminotransferase levels during therapy is an
encouraging sign, but active liver inflammation is present in more than 50% of
patients with normalized liver chemistries. Indeed, biochemical remission may
precede true histologic remission by 3-6 months.<o:p></o:p></div>
<div class="MsoNormal">
Typically, patients are treated for at least 1 year after
documentation of normal liver chemistries. Liver biopsy is recommended by some
experts to confirm that the patient is in histologic remission. Drug withdrawal
may be attempted at this time (see Treatment).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Worsening of aminotransferase levels in a patient undergoing
treatment or in a patient who is in remission may signal a resurgence of
disease activity.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Other liver
chemistries<o:p></o:p></b></div>
<div class="MsoNormal">
Serum bilirubin and alkaline phosphatase values are mildly
to moderately increased in 80%-90% of patients. A sharp increase in the
alkaline phosphatase values during the course of autoimmune disease might
reflect the development of PSC or the onset of hepatocellular carcinoma as a
complication of cirrhosis.<o:p></o:p></div>
<div class="MsoNormal">
Hypoalbuminemia and prolongation of the prothrombin time are
markers of severe hepatic synthetic dysfunction, which may be observed in
active disease or decompensated cirrhosis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Complete Blood Count
and Other Blood Studies<o:p></o:p></b></div>
<div class="MsoNormal">
Other hematologic abnormalities may include the following:<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Mild leukopenia<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Normochromic anemia<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Coombs-positive hemolytic anemia<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Thrombocytopenia<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Elevated erythrocyte sedimentation rate<o:p></o:p></div>
<div class="MsoNormal">
Eosinophilia is uncommon, but counts ranging from 9% to 48%
are described. Autoimmune hepatitis has even been described as the sole
presenting feature of idiopathic hypereosinophilic syndrome.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Hepatic Imaging
Studies<o:p></o:p></b></div>
<div class="MsoNormal">
Imaging studies, in general, are not helpful in reaching a
definitive diagnosis of autoimmune hepatitis; however, the presence of
heterogeneous hepatic echotexture on abdominal ultrasound or abnormal contrast
enhancement on abdominal CT imaging may suggest the presence of active
inflammation or necrosis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The appearance of an irregular nodular liver may confirm the
presence of cirrhosis. Furthermore, these imaging studies may be used to rule
out the presence of hepatocellular carcinoma, a potential complication of
autoimmune hepatitis–induced cirrhosis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When alkaline phosphatase levels are 7-8 times reference
values or gamma glutamyl transferase levels are 2-3 times reference values, a
patient with autoimmune hepatitis and ulcerative colitis may require endoscopic
retrograde cholangiopancreatography (ERCP) to rule out coexisting primary
sclerosing cholangitis (PSC).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Liver Biopsy<o:p></o:p></b></div>
<div class="MsoNormal">
Liver biopsy is the most important diagnostic procedure in
patients with autoimmune hepatitis. This procedure can be performed
percutaneously, with or without ultrasound guidance, or by the transjugular
route. The latter is preferred if the patient has coagulopathy or severe
thrombocytopenia. A transjugular liver biopsy also may be preferable if ascites
is present or if the liver is small, shrunken, and difficult to reach
percutaneously.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Liver biopsy routinely is performed in the outpatient
setting to investigate abnormal liver chemistries. Liver biopsy should be
performed as early as possible in patients with acute hepatitis who are thought
to have autoimmune hepatitis. Confirmation of the diagnosis enables initiation
of treatment at an early stage in the disease process.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The role of biopsy in patients presenting with well-established
cirrhosis secondary to autoimmune hepatitis is less clear. As an example, the
initiation of treatment in a patient with cirrhosis, normal aminotransferase
levels, and a minimally elevated gamma globulin level is not expected to
influence the disease outcome.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-h25nB5d7RCA/Xc9w6NJgwxI/AAAAAAAADrg/qXR5zesypjUYWw2HOB0G-wszB3cU55YVwCLcBGAsYHQ/s1600/autoimmune.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="420" data-original-width="720" height="186" src="https://1.bp.blogspot.com/-h25nB5d7RCA/Xc9w6NJgwxI/AAAAAAAADrg/qXR5zesypjUYWw2HOB0G-wszB3cU55YVwCLcBGAsYHQ/s320/autoimmune.jpg" width="320" /></a></div>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Histologic Findings<o:p></o:p></b></div>
<div class="MsoNormal">
Histopathologic findings on liver biopsy specimens are
crucial to determining the diagnosis of autoimmune hepatitis and the disease's
severity. Liver biopsy findings can help to differentiate autoimmune hepatitis
from chronic hepatitis C virus (HCV) infection, alcohol-induced hepatitis,
drug-induced liver disease, primary biliary cirrhosis, and PSC. [43]<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Autoimmune hepatitis is characterized by a portal
mononuclear cell infiltrate that invades the limiting plate surrounding the
portal triad and permeates the surrounding lobule (ie, periportal infiltrate)
and beyond. A plasma cell infiltrate sometimes occurs, which, in the past, led
to the use of the term plasma cell hepatitis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Biopsies may show evidence for interface hepatitis (ie,
piecemeal necrosis), bridging necrosis, and fibrosis. Interface hepatitis
essentially spares the biliary tree but may involve most of the lobule. Lobular
collapse, best identified by reticulin staining, is a common finding.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Interface hepatitis does not predict a progressive disease
course. By contrast, a strong likelihood exists that cirrhosis will develop
when bridging necrosis is present. The presence or absence of cirrhosis on
liver biopsy is an important determinant of the patient's prognosis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Fibrosis is present in most patients with autoimmune
hepatitis. Without effective therapy, fibrosis starts to connect the portal and
central areas, which ultimately leads to cirrhosis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In 1999, the International Autoimmune Hepatitis Group
established a scoring system that is particularly helpful in establishing the
diagnosis of autoimmune hepatitis in problematic cases. [44, 45]<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Histopathologic findings in patients with autoimmune
hepatitis are characteristic but nonspecific; autoimmune hepatitis has findings
in common with chronic viral hepatitis, drug-associated chronic hepatitis, and
several other chronic liver disorders. Multinucleated giant hepatocytes are
found in 10%-20% of biopsy specimens; their occurrence after the neonatal
period may suggest a diagnosis of autoimmune hepatitis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Tucker et al indicate that the presence of characteristic
hyaline droplets in the cytoplasm of Kupffer cells on routine hematoxylin and
eosin (H&E) from biopsy specimens in pediatric patients with autoimmune
hepatitis may provide a useful diagnostic clue to distinguish this disease from
other forms of chronic hepatitis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-hphU2tSyKHA/Xc9tEt5udTI/AAAAAAAADrA/svtzmHRuQP8MvebqSN3yoeoXPBefZX4bwCLcBGAsYHQ/s1600/autoimmune-hepatitis-rajesh-14-638.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="479" data-original-width="638" height="240" src="https://1.bp.blogspot.com/-hphU2tSyKHA/Xc9tEt5udTI/AAAAAAAADrA/svtzmHRuQP8MvebqSN3yoeoXPBefZX4bwCLcBGAsYHQ/s320/autoimmune-hepatitis-rajesh-14-638.jpg" width="320" /></a></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-72058113544356129942016-12-17T00:54:00.002-08:002021-10-16T01:36:56.223-07:00SMEAR SEL DARAH NORMAL<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span style="background: white; color: #2c3e50; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Sel darah merah atau
eritrosit, Eritrosit berasal dari bahasa Yunani yakni Erythros (merah) dan
kytos (selubungi sel darah). Sel darah merah ( eritrosit ) berbentuk bulat
pipih dan cekung pada bagian tengahnya ( biconcave ). </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://2.bp.blogspot.com/-J7Y1w64JLko/WFTu5v6maZI/AAAAAAAADEg/qAoAxyCL_tE-KgMA9nA92NQcn2RvAZRgwCLcB/s1600/Pic1%2Bred-cell.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://2.bp.blogspot.com/-J7Y1w64JLko/WFTu5v6maZI/AAAAAAAADEg/qAoAxyCL_tE-KgMA9nA92NQcn2RvAZRgwCLcB/s1600/Pic1%2Bred-cell.jpg" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
Pic1 - RBC bentuk 3D</div>
<div class="MsoNormal">
<span style="background: white; color: #2c3e50; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="background: white; color: #2c3e50; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Eritrosit berwarna merah
karena mengandung hemoglobin. Sel darah merah ini dibentuk dalam sumsum tulang,
kemudianya beredar ke seluruh bagian tubuh yang melalui pembuluh darah. </span></div>
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<span style="background: white; color: #2c3e50; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="background: white; color: #2c3e50; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Jangkahayat sel darah merah lebihkurang 120 hari. Sel darah merah yang telah
tua akan dimusnahkan pada organ hati dan limpa. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Sebelum anda
benar-benar boleh mempelajari perubahan patologi dalam sel-sel merah, anda
perlu tahu bentuk morfologi normal sel darah merah. Berikut adalah imej smear sel
darah yang normal. Terdapat beberapa perkara yang perlu perhatikan di sini.<o:p></o:p></span></div>
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<a href="https://3.bp.blogspot.com/-xpRc7-94AVM/WFTvJjRT9II/AAAAAAAADEk/2yh03io2k_gahRMJRMm4T7zgFjCqQUc1wCLcB/s1600/normal_rbcs1344993011339.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="261" src="https://3.bp.blogspot.com/-xpRc7-94AVM/WFTvJjRT9II/AAAAAAAADEk/2yh03io2k_gahRMJRMm4T7zgFjCqQUc1wCLcB/s320/normal_rbcs1344993011339.jpg" width="320" /></a></div>
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Pic1.1 Smear Normal RBC</div>
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<br /></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Pertama, sel-sel tersebar samarata di lapangan. Ada
yang bersentuhan dan ada yang kelihatan sedikit bertindih, sel-sel tidak semua bertindihan
di atas satu sama lain. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Terdapat sedikit ruangan diantara sel-sel tersebut, tiada
ruangan/kawasan yang luas diantara sel-sel merah. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Ini menunjukkan fokus berada
dalam kawasan smear darah yang sesuai untuk dibuat penilaian. Fokus kawasan kajian
yang betul - "zon morfologi" - adalah terletak pada bahagian tengah
smear (diantara bahagian ekor dan kepala). </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Dalam zon ini, sel-sel hampir tidak
menyentuh diantara satu sama lain, seperti yang dilihat dalam foto ini.<o:p></o:p></span></div>
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<a href="https://1.bp.blogspot.com/-PSTfp87DNXc/WFTv5yMo5UI/AAAAAAAADEw/xePPdbRp4hcVHZJHqGSzIkoDDwSbJKgnACLcB/s1600/Pic2%2Bnormal-blood1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="216" src="https://1.bp.blogspot.com/-PSTfp87DNXc/WFTv5yMo5UI/AAAAAAAADEw/xePPdbRp4hcVHZJHqGSzIkoDDwSbJKgnACLcB/s320/Pic2%2Bnormal-blood1.jpg" width="320" /></a></div>
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<i>Pic2 : Smear Normal RB</i></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Kedua, (rujuk Pic2) sel-sel kelihatan mempunyai
jumlah hemoglobin yang normal . </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Lihat kawasan putih di tengah-tengah setiap sel
merah. Itulah "zon pucat pusat." Ia meliputi kira-kira 1/3 diameter keseluruhan
sel merah (sel-sel seperti ini dipanggil
normochromic). </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Jika ia lebih besar, ini bermakna bahawa sel tidak mempunyai
hemoglobin yang mencukupi (sel seperti ini dipanggil hypochromic) dan dikenali
sebagai anemia.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Seterusnya, lihat bentuk sel-sel ini: semuanya
berbentuk bulat. </span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">Itulah apa morfologi sel yang normal. Secara keseluruhan,
tidak ada sejumlah besar sel-sel merah yang berbentuk (seperti bentuk runcing,
bentuk titisan air mata, atau yang berbentuk sabit).</span></div>
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<span style="font-family: "Times New Roman", serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman", serif; font-size: 12pt;">Kepelbagaian bentuk seperti
ini dipanggil poikilocytosis (</span><span style="color: red; font-family: "Times New Roman", serif; font-size: 12pt;">rujuk Pic3</span><span style="font-family: "Times New Roman", serif; font-size: 12pt;">). </span></div>
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<span style="font-family: "Times New Roman", serif; font-size: 12pt;">Darah
yang normal mempunyai poikilocytosis yang minimum (kebanyakan sel-sel darah
berbentuk sempurna dan bulat). Sesetengah kes anemia, seperti kes thalassemia
yang teruk, mempunyai poikilocytosis yang ketara (kebanyakan sel mempunyai
kepelbagaian bentuk).</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
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<a href="https://1.bp.blogspot.com/-p6qbozWzWlY/WFTwvrwObBI/AAAAAAAADE0/sJAePiTvc7sJ6BmAg2qGqDCyQ6MImoDCwCLcB/s1600/Pic3%2Bpoikilocytosis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://1.bp.blogspot.com/-p6qbozWzWlY/WFTwvrwObBI/AAAAAAAADE0/sJAePiTvc7sJ6BmAg2qGqDCyQ6MImoDCwCLcB/s320/Pic3%2Bpoikilocytosis.jpg" width="320" /></a></div>
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<i>Pic3 : Poikilocytosis</i></div>
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<br /></div>
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<a href="https://4.bp.blogspot.com/-8CStci2n0rE/WFTxRRD6ddI/AAAAAAAADE8/MgQ2XkJszJ4ONswEj204QK5u84ECWfH5wCLcB/s1600/Pic3%2Bpoikilocytosis.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://4.bp.blogspot.com/-8CStci2n0rE/WFTxRRD6ddI/AAAAAAAADE8/MgQ2XkJszJ4ONswEj204QK5u84ECWfH5wCLcB/s320/Pic3%2Bpoikilocytosis.png" width="320" /></a></div>
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<i>Pic3.1 </i><i> : Lebih banyak variasi dan saiz sel darah (anisopoikilocytosis), Nilai RDW lebih tinggi.</i></div>
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<br /></div>
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<a href="https://4.bp.blogspot.com/-w37oHTWbB9E/WFTyVBaiRwI/AAAAAAAADFM/oySeuykhwA49msAAm3PoJ6rzz77xs3k4wCLcB/s1600/Pic3.1thakassaemia%2Bintermediate.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://4.bp.blogspot.com/-w37oHTWbB9E/WFTyVBaiRwI/AAAAAAAADFM/oySeuykhwA49msAAm3PoJ6rzz77xs3k4wCLcB/s320/Pic3.1thakassaemia%2Bintermediate.jpg" width="320" /></a></div>
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<i>Pic3.2 : Antara variasi sel darah</i></div>
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<br /></div>
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<a href="https://3.bp.blogspot.com/-RNJ8afWeQ1w/WFTytgrvzwI/AAAAAAAADFQ/cusbkPqwxpkykoSJCB0nAzcQgQq9JJ7zwCLcB/s1600/Pic3.2.1basophilic_stippling.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://3.bp.blogspot.com/-RNJ8afWeQ1w/WFTytgrvzwI/AAAAAAAADFQ/cusbkPqwxpkykoSJCB0nAzcQgQq9JJ7zwCLcB/s1600/Pic3.2.1basophilic_stippling.jpg" /></a></div>
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<i>Pic3.2.1 : Basophilic stippling</i></div>
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<i><br /></i></div>
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</div>
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<a href="https://2.bp.blogspot.com/-X8YIeo18Trw/WFT2kl3n9qI/AAAAAAAADF8/YIXC-jxkv4Q1e7TvVWZEeS3jp7YKDKUFQCLcB/s1600/Pic3.2thalassaemia%2Bwith%2Bbasophilic%2Bstippling.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://2.bp.blogspot.com/-X8YIeo18Trw/WFT2kl3n9qI/AAAAAAAADF8/YIXC-jxkv4Q1e7TvVWZEeS3jp7YKDKUFQCLcB/s320/Pic3.2thalassaemia%2Bwith%2Bbasophilic%2Bstippling.jpg" width="320" /></a></div>
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<br /></div>
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</div>
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<i>Pic3.2.2 : Kes Thalassaemia dengan Basophillic stippling</i></div>
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<br /></div>
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<a href="https://1.bp.blogspot.com/-VpGsFpG_dAk/WFT31ZmXyRI/AAAAAAAADGI/7XE3YKeZ8gg0gOxlNHItPdFfIYOk_V7GgCLcB/s1600/Pic3.2.1Basophilic%2BStippling.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://1.bp.blogspot.com/-VpGsFpG_dAk/WFT31ZmXyRI/AAAAAAAADGI/7XE3YKeZ8gg0gOxlNHItPdFfIYOk_V7GgCLcB/s320/Pic3.2.1Basophilic%2BStippling.jpg" width="320" /></a></div>
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</div>
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<i>Pic3.2.3</i> <span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;"><i>RBC dengan basophilic stippling/basophilia
(sel darah merah yang mengandungi satu titik kecil pada bahagian tepi dinding
sel). Ia adalah granul RNA atau gumpalan ribosom. Kadang-kadang terlihat pada
smear yang normal. Mudah dilihat pada pesakit yang mengalami “lead poisoning”</i></span><span style="color: red; font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;">.</span></div>
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<span style="color: red; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<br /></div>
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<a href="https://2.bp.blogspot.com/-AslqLUJQGIc/WFT4Yi35n5I/AAAAAAAADGM/uAR7xJ5QWfEzzm7kTrlcjAIQTRxQwgkRACLcB/s1600/Pic3.2.2%2BNucleated%2BRBC.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://2.bp.blogspot.com/-AslqLUJQGIc/WFT4Yi35n5I/AAAAAAAADGM/uAR7xJ5QWfEzzm7kTrlcjAIQTRxQwgkRACLcB/s1600/Pic3.2.2%2BNucleated%2BRBC.jpg" /></a></div>
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Pic3.2.4</div>
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<br /></div>
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<a href="https://3.bp.blogspot.com/-5_DZ2zJLcE0/WFT4eGN5N0I/AAAAAAAADGQ/2P2wz7sf37w-WlCfy3KngSBuy140TeS-QCLcB/s1600/Pic3.2.3%2BNucleated%2BRBC.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://3.bp.blogspot.com/-5_DZ2zJLcE0/WFT4eGN5N0I/AAAAAAAADGQ/2P2wz7sf37w-WlCfy3KngSBuy140TeS-QCLcB/s320/Pic3.2.3%2BNucleated%2BRBC.jpg" width="319" /></a></div>
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<i><br /></i></div>
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<i>Pic3.2.5 Nucleated RBC - <span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;">Nucleated red cells - Sel darah dengan
nukleus padat dan berwarna gelap di tengah-tengah sel. Dapat dilihat pada bayi
(3-4 hari) . Kronik haemolytic anemia. Megaloblastic anemia. Jangkitan
kongenital (syphilis, CMV, rubella). Postspleenectomy. Tindakbalas
Leukoerythroblastic. Jangkitan Fungal dan mycobacterial. Dyselectropoeitic
anemia</span></i></div>
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<i><span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;"><br /></span></i></div>
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<i><span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;"><br /></span></i></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Sukar untuk mengukur secara visual saiz sel darah
merah. Di bawah mikroskop, agak sukar untuk menentukan sama ada saiz sel-sel darah
merah adalah bersaiz normal (normocytic), bersaiz kecil (microcytic) (Pic4),
atau bersaiz besar (macrocytic) (Pic4.1). </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Anda perlu melihat nilai MCV (<i><span style="background: white; color: #444444;">Mean
corpuscular volume</span></i>), nilai ini menentukan sama ada sel-sel darah
mempunyai saiz yang normal atau tidak. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">MCV normal adalah diantara 80 dan 100
femtoliters; sel darah merah dengan MCV kurang daripada 80 dianggap microcytic
(sel darah bersaiz kecil), dan sel-sel merah dengan MCV lebih 100 dianggap macrocytic
(sel darah bersaiz lebih besar). Ini adalah kriteria penting untuk menilai kes
anemia <o:p></o:p></span></div>
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<span style="color: red; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<a href="https://4.bp.blogspot.com/--3qrGQ0P180/WFT48bLyfHI/AAAAAAAADGY/UhgVtUuyZf4x1ghh3_KeDGK7c2X-sZCCgCLcB/s1600/Pic4%2Bnormal%2526microcytic.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://4.bp.blogspot.com/--3qrGQ0P180/WFT48bLyfHI/AAAAAAAADGY/UhgVtUuyZf4x1ghh3_KeDGK7c2X-sZCCgCLcB/s320/Pic4%2Bnormal%2526microcytic.jpg" width="320" /></a></div>
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<i>Pic4 : Normal dan Microcytic sel</i></div>
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<i><br /></i></div>
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<a href="https://3.bp.blogspot.com/-TpY2yi9XmDw/WFT49qge-uI/AAAAAAAADGc/OgjDunTNevwfUMxlpNXNCqcqtor-aqqHwCLcB/s1600/Pic4.1%2Bnormal%2526macrocytic.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://3.bp.blogspot.com/-TpY2yi9XmDw/WFT49qge-uI/AAAAAAAADGc/OgjDunTNevwfUMxlpNXNCqcqtor-aqqHwCLcB/s1600/Pic4.1%2Bnormal%2526macrocytic.jpg" /></a></div>
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<i>Pic5 : Normal dan Macrocytic sel.</i></div>
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<i><br /></i></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Oleh itu, dengan pengamatan menggunakan mikroskop
adalah mungkin untuk mengetahui, berapa banyak sel-sel darah yang berbeza dari
segi saiz dan bentuk. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Anda boleh lihat, dengan mata kasar anda, sama ada
sel-sel darah mempunyai banyak saiz yang sama, atau sama ada terdapat pelbagai
saiz dari yang kecil kepada saiz yang besar. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Sel darah yang normal biasanya
bersifat anisocytosis yang minimum (purata sel-sel darah bersaiz sama),
beberapa kes anemia, seperti anemia kekurangan zat besi yang teruk, keadaan anisocytosis
adalah lebih ketara (terdapat banyak sel darah yang kecil dan yang besar).</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Parameter CBC yang menunjukkan variasi dalam saiz sel adalah nilai RDW. Jika nilai RDW adalah rendah, ini bermakna keadaan anisocytosis adalah minimum, dan kebanyakan sel mempunyai saiz yang hampir sama. Jika
RDW adalah sangat tinggi, bermakna terdapat anisocytosis yang ketara, dimana sel-sel berbeza dari segi saiz. Ini adalah satu lagi nilai
yang boleh membantu anda apabila anda cuba untuk mendiagnosis kes anemia.<o:p></o:p></span></div>
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<a href="https://4.bp.blogspot.com/-8RC6ZO7wUOY/WFT6w-t0XSI/AAAAAAAADGs/OPTtA06gQOkiRsLvpNHGN3woKEzKTl_BQCLcB/s1600/Pic5%2BIron-deficiency-anemia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://4.bp.blogspot.com/-8RC6ZO7wUOY/WFT6w-t0XSI/AAAAAAAADGs/OPTtA06gQOkiRsLvpNHGN3woKEzKTl_BQCLcB/s320/Pic5%2BIron-deficiency-anemia.jpg" width="320" /></a></div>
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<i>Pic5 Kes <span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;">IDA yang teruk. Pelbagai saiz dan
morfologi sel dapat dilihat.</span></i></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Akhir sekali, bagi satu smear darah yang normal,
sepatutnya anda tidak akan menjumpai “nucleated red
blood cells”, organisma berjangkit (seperti organisma malaria) dalam
sel-sel merah, “Pappenheimer bodies”, “Howell-Jolly” atau apa saja morfologi yang pelik.<o:p></o:p></span></div>
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<a href="https://3.bp.blogspot.com/-4wWdFMO00eo/WFT7RrRgVLI/AAAAAAAADGw/uQvzTQD8gyIuNO53maUIXBCQs0u4sE0vACLcB/s1600/Pic6%2BHowell-Jolly.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="210" src="https://3.bp.blogspot.com/-4wWdFMO00eo/WFT7RrRgVLI/AAAAAAAADGw/uQvzTQD8gyIuNO53maUIXBCQs0u4sE0vACLcB/s320/Pic6%2BHowell-Jolly.jpg" width="320" /></a></div>
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<i>Pic6<span style="background-color: white;"> : <span style="text-align: justify;">Howell-Jolly bodies – </span><span style="text-align: justify;">Adalah partikel intracellular berbentuk bulat (kromatin
DNA yang padat). Biasanya terdapat hanya</span></span><span style="background-color: white; text-align: justify;"> satu pada sel, tetapi kadang-kadang
boleh lebih dari satu. Tardapat pada kes </span><span style="border: 1pt none windowtext; padding: 0cm; text-align: justify;">Megaloblastic anaemia dan
Mylodysplastic</span></i></div>
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<a href="https://2.bp.blogspot.com/-KCbcs3PcLLY/WFT7vg7WEaI/AAAAAAAADG8/K_ZbwXsMrz088Bcm0Rb8BuH2bMs3Vg8ggCLcB/s1600/Pic6.1%2BHowell-Jolly-Bodies.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="222" src="https://2.bp.blogspot.com/-KCbcs3PcLLY/WFT7vg7WEaI/AAAAAAAADG8/K_ZbwXsMrz088Bcm0Rb8BuH2bMs3Vg8ggCLcB/s320/Pic6.1%2BHowell-Jolly-Bodies.jpg" width="320" /></a></div>
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Pic6.1 : <i><span style="background-color: white;"><span style="text-align: justify;">Howell-Jolly bodies</span></span></i></div>
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<a href="https://4.bp.blogspot.com/-7ffGvTlB1W4/WFT7yDjYOMI/AAAAAAAADHA/07sqI4cLHT8yxFSXDRBWwOVLhG5KD-hTgCEw/s1600/Pic6.1%2BPappenheimer%2Bbodies.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="255" src="https://4.bp.blogspot.com/-7ffGvTlB1W4/WFT7yDjYOMI/AAAAAAAADHA/07sqI4cLHT8yxFSXDRBWwOVLhG5KD-hTgCEw/s320/Pic6.1%2BPappenheimer%2Bbodies.jpg" width="320" /></a></div>
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<i>Pic6.2 : Pappenheimer body - <span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;">Granul abnormal iron yang
terdapat dalam sel darah. Granul blue-purple yang padat. </span><span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;"> </span><span style="font-family: "Times New Roman", serif; font-size: 12pt; text-align: left;">Terdapat pada individu yang mengalami sideroblastic
anemia, hemolytic anemia, dan penyakit sickle cell.</span></i></div>
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<a href="https://3.bp.blogspot.com/-dII8t7TPv9M/WFT73dC2BRI/AAAAAAAADHI/QOPF7GhRFY0nNby7ogSVUhgqbpsDTBEqQCEw/s1600/Pic6.3%2BPappenheimer%2Bbodies.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" src="https://3.bp.blogspot.com/-dII8t7TPv9M/WFT73dC2BRI/AAAAAAAADHI/QOPF7GhRFY0nNby7ogSVUhgqbpsDTBEqQCEw/s320/Pic6.3%2BPappenheimer%2Bbodies.jpg" width="320" /></a></div>
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<i>Pic6.3 : Pappenheimer body</i></div>
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<a href="https://1.bp.blogspot.com/-k_fUBxlcHZg/WFT74zQXhMI/AAAAAAAADHM/vTOsU-T5UKEhEnIGPQnlCCBoMt2NqXBfQCEw/s1600/Pic6.4%2BPappenheimer%2Bbodies.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" src="https://1.bp.blogspot.com/-k_fUBxlcHZg/WFT74zQXhMI/AAAAAAAADHM/vTOsU-T5UKEhEnIGPQnlCCBoMt2NqXBfQCEw/s320/Pic6.4%2BPappenheimer%2Bbodies.jpg" width="320" /></a></div>
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<i>Pic6.4 : Pappenheimer body</i></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-3240401418318076922015-11-06T17:29:00.002-08:002021-10-16T01:37:13.538-07:00Ujian Saringan Dadah Dalam Air Kencing<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-size: x-large;">Ujian Saringan Dadah Dalam Air Kencing</span><br />
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<span style="background-color: white;"><span style="font-size: large;">PELAKSANAAN KOD AMALAN PENCEGAHAN DAN PEMBASMIAN PENYALAHGUNAAN DADAH, ALKOHOL DAN BAHAN DI TEMPAT KERJA dan </span></span><span style="font-family: "times new roman"; font-size: large; line-height: normal;">Ujian Saringan Dadah Dalam Air Kencing.</span><br />
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<span style="background-color: white; font-family: "arial" , "helvetica" , sans-serif;">Kod Amalan ini bertujuan membantu majikan dan pekerja bagi memenuhi tanggungjawab di bawah Akta Keselamatan dan Kesihatan Pekerjaan (AKKP) 1994 untuk menangani masalah dadah, alkohol dan bahan di tempat kerja. Di bawah Seksyen 15 AKKP, majikan bertanggungjawab untuk memastikan keselamatan, kesihatan dan kebajikan semua pekerjanya. Seksyen 24(1) AKKP pula menjelaskan bahawa pekerja bertanggungjawab untuk memberi perhatian yang munasabah bagi keselamatan dan kesihatan dirinya dan orang lain yang mungkin terjejas oleh tindakannya di tempat kerja. Untuk itu, Bahagian Kesihatan Pekerjaan telah dipertanggungjawab bagi melaksanakan pemantauan pematuhan Koda Amalan Pencegahan dan Pembasmian Penyalahgunaan Dadah, Alkohol dan Bahan Di Tempat Kerja di peringkat negeri dengan cara melakukan </span><span style="color: black; line-height: normal; text-align: left;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Ujian Saringan Dadah Dalam Air Kencing</span></span><span style="background-color: white;"><span style="font-family: "arial" , "helvetica" , sans-serif;">. Majikan atau tempat kerja dipantau dipandu pada beberapa aspek, seperti mengadakan dasar, pembentukan Jawatankuasa Pencegahan dan pembasmian penyalahgunaan dadah, alkohol dan bahan di tempat kerja dan latihan pekerja dan pegawai-pegawai yang bertanggung jawab.</span></span><br />
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<span style="color: black; line-height: normal; text-align: left;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Antara jenis-jenis dadah dalam Ujian Saringan Dadah Dalam Air Kencing adalah :</span></span></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-88566906175896646542015-09-16T08:53:00.001-07:002021-10-16T01:37:32.574-07:00Diagnosis Jangkitan Akut HCV<div dir="ltr" style="text-align: left;" trbidi="on">
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HCV Akut</h1>
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<b style="font-family: 'Times New Roman', serif;">Definisi HCV akut</b><br />
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<span style="line-height: 115%;"><span style="font-family: Times, Times New Roman, serif;">Definisi Jangkitan HCV akut : Jangkitan akut hepatitis C berlaku dalam tempoh 6 bulan pertama selepas jangkitan. Apabila Hepatitis C yang akut berterusan melebihi enam bulan, ia akan membawa kepada Hepatitis C kronik . Takrif </span></span><span style="font-family: Times, 'Times New Roman', serif; line-height: 115%;">HCV Akut </span><span style="font-family: Times, 'Times New Roman', serif; line-height: 115%;">tidak mengambil kira sama ada pesakit mempunyai tanda-tanda klinikal atau simptom hepatitis akut. Rasional bagi memilih 6 bulan sebagai tempoh masa untuk menentukan jangkitan akut adalah berdasarkan bukti bahawa kebanyakan individu yang sembuh dari HCV adalah dalam tempoh 6 bulan.</span></div>
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<span style="line-height: 115%;"><span style="font-family: Times, Times New Roman, serif;">Terminologi berkaitan dengan jangkitan HCV akut : Kajian klinikal dan penyelidikan telah menggunakan banyak istilah untuk merujuk kepada jangkitan </span></span><span style="font-family: Times, 'Times New Roman', serif; line-height: 115%;">HCV Akut</span><br />
<span style="line-height: 115%;"><span style="font-family: Times, Times New Roman, serif;">, termasuk jangkitan akut, jangkitan fasa akut, jangkitan awal, jangkitan baru, dan jangkitan yang baru diperolehi. Jangkitan awal biasanya merujuk kepada pesakit yang mempunyai HCV RNA positif dan anti-HCV positive. <o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Times, Times New Roman, serif;">Jangkitan Akut = anggaran tempoh akut jangkitan kurang daripada 6 bulan<o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Times, Times New Roman, serif;">Jangkitan baru = anggaran tempoh jangkitan lebih lama daripada 6 bulan, tetapi kurang dari 2 tahun.</span><span style="font-family: Times New Roman, serif;"><o:p></o:p></span></span></div>
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<b style="font-family: 'Times New Roman', serif;">HCV akut</b><b><span style="color: #00556d; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: MS;"> : Diagnosis makmal <o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Ujian makmal untuk Jangkitan Awal HCV : Ujian makmal untuk Hepatitis C Akut adalah ujian HCV RNA, anti-HCV dan aminotransferase alanine (ALT). Pesakit yang dijangkiti dengan hepatitis C virus biasanya menunjukkan keputusan abnormal pada setiap ujian berikut : RNA HCV dikesan, paras ALT meningkat, dan anti-HCV positif.<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">HCV RNA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">: Dalam kebanyakan kes, HCV RNA dikesan dalam darah pada tempoh masa 1 hingga 2 minggu selepas jangkitan. Tempoh bermula dari jangkitan sehingga HCV RNA dikesan dalam plasma melalui ujian makmal disebut sebagai "eclipse phase" (Rajah 4), atau "fasa previremic". Semasa fasa <i>eclipse</i>, HCV mungkin telah menjangkiti sel hepatosit, dan pada sesetengah pesakit, ujian kualitatif HCV RNA dengan tahap sensitiviti yang tinggi akan menunjukkan jumlah replikasi HCV RNA (pada tahap kurang daripada 10 salinan / ml) dalam darah. Fasa <i>edlipse</i> diikuti oleh 8 hingga 10 hari "<i>ramp-up</i>" fasa di mana kadar replikasi HCV RNA meningkat dengan pesat dan mudah dikesan dalam plasma; tahap HCV RNA biasanya memuncak 6 hingga 10 minggu selepas jangkitan ("fasa dataran") dan masih kekal di antara tahap-tahap puncak bagi kira-kira 40 hingga 60 hari (Rajah 5). Pengesanan HCV RNA semasa jangkitan akut tidak tetap kerana tahap HCV RNA boleh turun naik dengan ketara dalam tempoh tersebut. Dalam beberapa tempoh, bilangan HCV RNA mungkin boleh jatuh di bawah tahap dikesan. Walaubagaimanapun pada permulaan gejala, bilangan HCV RNA yang dikesan adalah seragam.<o:p></o:p></span></div>
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<b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: MS;">Alanine Aminotransferase (ALT)</span></b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: MS;">: Dalam tempoh 4-12 minggu selepas jangkitan HCV, kebanyakan pesakit akan mengalami masalah fungsi hati, seperti yang ditunjukkan oleh ujian makmal, peningkatan pada paras ALT serum. Biasanya paras ALT meningkat setelah kehadiran HCV RNA dikesan kira-kira 1 hingga 2 minggu, secara umumnya kesan ini berlaku sebelum kehadiran anti-HCV. Purata paras ALT selepas jangkitan akut boleh mencapai 800 IU julat / L. Pusat Kawalan dan Pencegahan Penyakit biasanya menggunakan peningkatan paras ALT ke tahap yang lebih besar daripada 400 IU / L sebagai sebahagian daripada kriteria diagnostik.<o:p></o:p></span></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-86165488311134983162015-09-06T09:19:00.001-07:002021-10-15T22:06:50.157-07:00KITARAN SEL DARAH MERAH (RBC)<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal"><span style="color: #1e42f6; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: MS;"><span style="font-size: x-large;">KITARAN SEL DARAH MERAH (RBC)</span><o:p></o:p></span><br />
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</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Darah adalah cairan yang terdapat pada semua haiwan tingkat tinggi yang berfungsi mengangkut zat-zat dan oksigen yang diperlukankan oleh jaringan tubuh, mengangkut bahan kimia hasil metabolisme, dan juga sebagai pertahanan terhadap virus atau bakteria. Istilah perubatan yang berkaitan dengan darah diawali dengan perkataan haemo atau hemato yang berasal dari bahasa yunani haima yang berarti darah (Perutz, 1978).<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">2.5 juta sel darah merah dimusnahkan pada setiap saat. Ianya mewakili 0.00001% daripada jumlah 25 trilion sel-sel darah merah, dan sel-sel ini perlu diganti semula untuk mengekalkan homeostasis (<i>kawalan keseimbangan biologi badan</i>). Penghasilan sel-sel darah merah yang baru - Erythropoiesis (mengambil masa 4 hari)<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Arial, sans-serif;">Semua sel darah dihasilkan dari haemocytoblasts (stem sel pluripotential). Proses ini dipanggil Haematopoiesis / Haemopoiesis.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Arial, sans-serif;">Haemocytoblasts juga dikenali sebagai sel stem pluripotential. Sel-sel ini bereplikasi , sekali gus menyediakan bekalan sel yang berterusan.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Arial, sans-serif;"><br />
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<span style="font-size: large;">KITARAN SEL DARAH MERAH (RBC)</span><br />
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</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Arial, sans-serif;"><b><i>Proses replikasi sel berlaku sangat cepat:</i></b><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 35.4pt;"></div><ul style="text-align: left;"><li><span style="font-family: Arial, sans-serif; text-indent: 35.4pt;">Sel darah merah mempunyai kitaran hayat kira-kira 120 hari</span></li>
<li><span style="font-family: Arial, sans-serif; text-indent: 35.4pt;">Platelet mempunyai kitaran hayat kira-kira 7 hari</span></li>
<li><span style="font-family: Arial, sans-serif; text-indent: 35.4pt;">Granulocytes mempunyai kitaran hayat hanya kira-kira 7 jam</span></li>
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<div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><b><i>Penghasilan sel-sel adalah seperti berikut:</i></b><o:p></o:p></span></div><div class="MsoNormal"><br />
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<div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><i>Hari 1 – proerythroblast</i><o:p></o:p></span></div><div class="MsoNormal"><span style="background: rgb(224, 241, 249); font-family: Arial, sans-serif;">-Saiz sel: Besar (>2x saiz RBC)</span><span style="font-family: Arial, sans-serif;"><br />
<span style="background: #E0F1F9;">- Nukleus: (~80% isipadu sel), bentuk bulat, di tengah, nukleolus yang jelas</span><br />
<span style="background: #E0F1F9;">- Sitoplasma: basophilic (gelap/royal blue) kehadiran polyribosom (Hb mRNA)</span></span><span style="font-family: Arial, sans-serif;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><span style="background: #E0F1F9;"><br />
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<div class="MsoNormal"><span style="font-family: Arial, sans-serif;">- nukleus mengecut. Pembentukan Hb sedang berlaku.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><br />
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</i></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><i>Hari 3 - erythroblast polychromatophilic</i> </span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">- sel-sel semakin kecil, kehilangan organel, nukleus mengecut, menghasilkan Hb.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">- Saiz sel: sederhana (saiz 1.5x RBC)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">- Nukleus: kecil, bulat, kromatin yang padat<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">- Sitoplasma: kebiruan<o:p></o:p></span></div><div class="MsoNormal"><br />
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</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><i>Hari 4 - normoblast</i></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"> - mengandungi 35% daripada Hb daripada RBC penuh. </span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">-Masih mengandungi nukleus. Jarang dijumpai kecuali pada beberapa jenis penyakit .<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><br />
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</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><i>Hari 5-7 - reticulocyte</i> </span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">- mengambil masa 2 hari untuk matang.</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">-Tidak mempunyai nukleus, dan akan mensintesiskan banyak Hb. </span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">-Saiz berkurang secara beransur-ansur dan membentuk RBC sel. Pada orang dewasa yang sihat, kira-kira 0.8% RBC adalah reticulocytes. </span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">-Reticulocytes adalah lebih besar daripada RBC biasa dan masih mengandungi beberapa RNA (walaupun tidak mempunyai nukleus), dan ini digunakan untuk mensintesiskan yang Hb yang lain.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><br />
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</span></div><div class="MsoNormal"></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><i>Hari 8</i> - RBC tidak lagi mengandungi RNA, dan tidak boleh mensintesis Hb lagi.<span style="color: #1e42f6; font-size: 13.5pt; font-weight: bold;"><o:p></o:p></span></span><br />
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</span> <span style="font-family: Arial, sans-serif;">Baca lagi <a href="http://mylab2u.blogspot.my/2015/09/kitaran-sel-darah-merah-rbc.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+blogspot/UTYws+(MEDICAL+LABORATORY+TECHNOLOGIST)" rel="nofollow" target="_blank">di sini</a></span></div></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-22876326240795910392015-07-30T01:54:00.005-07:002021-10-16T01:30:08.850-07:00Hyponatremia<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-PXBw0syLFbc/VbniQH4X-oI/AAAAAAAABqk/6ywewr5RmAU/s1600/images.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="http://2.bp.blogspot.com/-PXBw0syLFbc/VbniQH4X-oI/AAAAAAAABqk/6ywewr5RmAU/s200/images.jpg" width="200" /></a></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-large;">HYPONATREMIA</span></div><div class="separator" style="clear: both; text-align: center;"></div><br />
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</div><div class="MsoNormal"><b><i>Hyponatremia adalah suatu keadaan yang berlaku apabila paras natrium dalam darah adalah terlalu rendah. Natrium merupakan elektrolit, dan ia membantu mengawal kandungan air yang dalam badan dan di sekeliling sel-sel.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Salah satu factor penyebab hyponatremia - minum air terlalu banyak semasa melakukan sukan lasak - menyebabkan sodium di dalam badan menjadi cair. Apabila ini berlaku, paras air dalam tubuh akan meningkat, dan sel-sel anda mula membengkak. Bengkak ini boleh menyebabkan masalah kesihatan sehingga boleh mengancam nyawa.<o:p></o:p></i></b></div><br />
<div class="MsoNormal"><b><i>Rawatan hyponatremia adalah bertujuan untuk mengembalikan kesimbangan cecair badan. Bergantung kepada punca hyponatremia, anda hanya perlu mengurangkan berapa banyak anda minum. Dalam kes-kes lain hyponatremia, anda mungkin perlukan cecair intravena dan ubat-ubatan.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i><br />
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</i></b></div><div class="MsoNormal"><b><u>Punca-punca <o:p></o:p></u></b><span style="font-size: large;">Hyponatremia</span></div><div class="MsoNormal"><b><u><br />
</u></b></div><div class="MsoNormal"><b><i>Natrium memainkan peranan penting dalam badan anda. Ia membantu mengekalkan tekanan darah yang normal, membantu fungsi saraf dan otot anda, dan mengawal keseimbangan cecair badan anda.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Paras natrium normal adalah antara 135 dan 145 milliequivalents per liter (mEq / L) natrium. Hyponatremia berlaku apabila natrium dalam darah anda jatuh di bawah 135 meq / L.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Banyak faktor yang menjadi penyebab hyponatremia, termasuk:<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Ubat-ubatan tertentu - Beberapa ubat-ubatan seperti pil air (diuretik), antidepresan dan ubat tahan sakit, boleh menyebabkan andakerap membuang air kecil atau berpeluh lebih daripada biasa.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Masalah jantung, buah pinggang dan hati - Kegagalan jantung kongestif dan penyakit tertentu yang melibatkan buah pinggang atau hati boleh menyebabkan cecair terkumpul di dalam badan anda, ini akan mencairkan natrium dalam badan, menurunkan paras keseluruhannya.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i><br />
</i></b></div><div class="MsoNormal"><b><i>Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH). Dalam keadaan ini, hormon anti-diuretik (ADH) hasilkan, menyebabkan badan anda cenderung untuk mengekalkan air dan bukannya kumuhkan menerusi air kencing.<o:p></o:p></i></b></div><div class="separator" style="clear: both; text-align: center;"></div><br />
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</i></b></div><div class="MsoNormal"><b><i>Sakit yang kronik, muntah-muntah atau cirit-birit yang teruk. Ini menyebabkan badan anda kehilangan cecair dan elektrolit seperti natrium.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Minum terlalu banyak air. Kerana anda kehilangan natrium melalui peluh, minum terlalu banyak air semasa aktiviti lasak, seperti maraton dan triathlon akan mencairkan kandungan natrium dalam darah anda. Minum air terlalu banyak pada masa yang lain juga boleh menyebabkan natrium rendah.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Dehidrasi. Mengambil air terlalu sedikit juga boleh menjadi masalah. Jika anda mendapat dehidrasi, badan anda kehilangan cecair dan elektrolit.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Perubahan hormon. Adrenal gland insufficiency (Penyakit Addison) memberi kesan kepada keupayaan kelenjar adrenal anda untuk menghasilkan hormon yang membantu mengekalkan keseimbangan natrium, kalium dan air di dalam badan. Paras hormon tiroid yang rendah juga boleh menyebabkan paras sodium yang rendah.<o:p></o:p></i></b></div><div class="MsoNormal"></div><div class="MsoNormal"><b><i>Dadah Ecstasy. Amphetamine ini meningkatkan risiko kes-kes yang teruk dan juga mengakibatkan maut pada pesakit hyponatremia.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i><br />
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</i></b></div><div class="MsoNormal"><b><i>Faktor-faktor berikut boleh meningkatkan risiko untuk </i></b>Hyponatremia <b><i>:<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Umur. Orang dewasa mungkin mempunyai faktor-faktor yang menyumbang lebih untuk hyponatremia, termasuk perubahan yang berkaitan dengan usia, pengambilan ubat-ubatan tertentu dan kemungkinan lebih besar untuk mendapat penyakit kronik yang mengubah keseimbangan sodium badan.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Ubat-ubatan/dadah tertentu. Ubat-ubatan yang meningkatkan risiko andamengalami hyponatremia termasuk diuretik thiazide serta beberapa antidepresan dan ubat penahan sakit. Di samping itu, dadah jenis Ecstasy telah dikaitkan dengan kes-kes maut hyponatremia.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i>Keadaan yang mengurangkan perkumuhan air dari badan anda. Situasi yang boleh meningkatkan risiko hyponatremia antara lain termasuk penyakit buah pinggang, Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) dan kegagalan jantung.<o:p></o:p></i></b></div><div class="MsoNormal"></div><div class="MsoNormal"><b><i>Aktiviti fizikal yang lasak. Mereka yang minum terlalu banyak air semasa aktiviti maraton, ultramarathons, triatlon dan aktiviti lasak jarak jauh, aktiviti berintensiti tinggi adalah antara penyumbang kepada peningkatan risiko hyponatremia.<o:p></o:p></i></b></div><div class="MsoNormal"><b><i><br />
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</i></b></div></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-26334526363964275482015-04-02T09:38:00.001-07:002021-10-16T01:38:08.235-07:00How do drugs cause thrombocytopenia?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="text-align: left;">When a patient is thrombocytopenic, one of the things on your differential should be a drug reaction. The three drugs that are most commonly responsible for thrombocytopenia are quinine, quinidine and vancomycin (and heparin, which gets its own category - see below). There are other drugs that can do it too, which you can look up if you need to, but they're much less common culprits. </span></div>
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<span style="color: #cf0053; font-family: helvetica, verdana, arial, sans-serif; font-size: small; text-align: -webkit-auto;">How do drugs cause <span style="font-size: large; text-align: left;">Thrombocytopenia</span>?</span></center>
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<span style="color: #333333; font-family: helvetica, verdana, arial, sans-serif; font-size: 16px; line-height: 1.3em; text-align: -webkit-auto;">Drugs cause thrombocytopenia either by directly damaging platelets, or by causing the immune system to take the platelets out. Most of the time, when the immune system is involved, the problem is that the drug has bound to the platelet membrane and formed a new antigen that the immune system sees as foreign. The membrane protein that drugs seem to like to bind to the most is glycoprotein IIV/IIIa.</span></center>
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<span style="color: #cf0053; font-family: helvetica, verdana, arial, sans-serif; font-size: small; text-align: -webkit-auto;">Heparin-induced thrombocytopenia</span></center>
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<span style="color: #333333; font-family: helvetica, verdana, arial, sans-serif; font-size: 16px; line-height: 1.3em; text-align: -webkit-auto;">Heparin can also cause <span style="text-align: left;">Thrombocytopenia</span> but it's separated out into its own category because it has a specific pathogenesis and potentially severe clinical consequences. Only about 5% of patients who are on heparin get thrombocytopenia. More often than not, it happens right away and doesn't mean much clinically (these cases are called type I thrombocytopenia and are due to platelet aggregation).<br />
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Less commonly, thrombocytopenia occurs a week or two after the start of heparin treatment; these cases are called type II thrombocytopenia and are much more dangerous. It turns out that heparin binds to platelet factor 4, which is a normal component of platelet granules. The immune system sees the heparin-platelet complex as foreign, and makes antibodies against it. Weirdly, as these antibodies bind to platelets, the platelets are activated, and patients can get life-threatening thromboses. You have to stop the heparin right away, and give another anticoagulant, otherwise the patient may lose a limb or worse, get a pulmonary embolus and die. </span></center>
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<a href="http://1.bp.blogspot.com/-vBeKjYdQoyE/VR1u5wKlzUI/AAAAAAAABoM/p7OpCP7WL20/s1600/thrombocytopenia-in-pregnancy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="http://1.bp.blogspot.com/-vBeKjYdQoyE/VR1u5wKlzUI/AAAAAAAABoM/p7OpCP7WL20/s1600/thrombocytopenia-in-pregnancy.jpg" width="320" /></a></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-6378817280708850762015-03-01T08:03:00.001-08:002021-10-16T01:40:56.062-07:00PLATELET<div dir="ltr" style="text-align: left;" trbidi="on">
Ujian hemostasis<br />
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<a href="http://3.bp.blogspot.com/--iUXDzBalGc/VPM3_CQGEDI/AAAAAAAABik/N2mhU6LOvPQ/s1600/pltclum.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/--iUXDzBalGc/VPM3_CQGEDI/AAAAAAAABik/N2mhU6LOvPQ/s1600/pltclum.jpg" /></a></div>
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<a href="http://1.bp.blogspot.com/-3JPUHGPXDLM/VPM39mbmldI/AAAAAAAABic/ESlu8tuegj0/s1600/plat.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://1.bp.blogspot.com/-3JPUHGPXDLM/VPM39mbmldI/AAAAAAAABic/ESlu8tuegj0/s1600/plat.jpg" /></a></div>
Terdapat empat ujian utama yang digunakan bagi melihat keupayaan pesakit untuk membentuk tinadakan pembekuan darah. Ianya adalah ujian penggumpalan (PT / INR dan PTT) dan ujian platelet (bilangan platelet dan ujian fungsi platelet). Bagaimana membuat anggaran kiraan platelet di bawah mikroskop.<br />
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Kiraan platelet<br />
Kiraan platelet secara manual boleh dilakukan menggunakan 'counting chamber'(seperti anda gunakan bagi RBC). Julat normal adalah diantara 150,000 - 300,000 per microliter.<br />
Anggaran kasar jumlah platelet dilakukan dengan cara melihat 'blood smear': anda seharusnya melihat antara 7 dan 21 platelet setiap bidang kuasa tinggi (melihat 10 bidang dan mendapatkan purata, kemudian darabkan dengan 15,000 untuk mendapatkan anggaran yang terbaik).<br />
Perkara penting yang perlu diingati. Apabila pesakit yang mengalami pendarahan secara berlebihan, anda sepatutnya perlu melihat samada pendarahan itu disebabkan oleh thrombocytopenia. Ingat, walaupu kiraan platelet yang diperolehi adalah SANGAT rendah (di bawah 20,000 atau lebih) sebelum pesakit mempunyai risiko pendarahan yang serius. Hanya kerana kiraan platelet agak berkurangan tidak akan cukup untuk menyebabkan pendarahan (sesuatu yang mudah lupa!).</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-89047281180733519232015-01-13T16:08:00.001-08:002015-01-13T16:09:31.596-08:00Plasmodium falciparum puzzle challenge<div class="separator" style="clear: both; text-align: left;">
Patient's history :</div>
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A 56-year old male had recent travel history to West Africa where he was involved with a group donating various foods and supplies to areas hard hit with the Ebola epidemic. He was there for approximately one month and had returned 2 weeks prior to the symptoms occurring.</div>
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After he was came back for Africa, he was in obvious distress, confused and lethargic. He was pallor and was sweating profusely. His responses to questions were incoherent and at times he would would not respond at all. His response to painful stimuli was poor.</div>
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He was febrile with a body temperature of 38 degrees celsius. Blood tests were significant for elevated liver enzymes; moderate thrombocytopenia; moderate anemia (8.6 g/dL); and a 2.4% reticulocyte count. He also had a urinalysis performed in which the color of the urine was described as dark amber with 20-30 RBCs; 3+ hemoglobin and 3+ protein. Blood cultures were negative.</div>
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Geimsa stained preparations were requested and made on freshly collected blood at the bed side for thick and thin smears. The smears were reviewed by the Pathologist. The diagnosis was made based on the smears seen below:</div>
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Picture 1</div>
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<a href="http://4.bp.blogspot.com/-_Y99HoNzi8c/VLWwhTA096I/AAAAAAAABgc/IojiKtgaXWE/s1600/case10-1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-_Y99HoNzi8c/VLWwhTA096I/AAAAAAAABgc/IojiKtgaXWE/s1600/case10-1.png" height="240" width="320" /></a></div>
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Picture 2</div>
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<a href="http://4.bp.blogspot.com/-HAYDpXMa8vg/VLWwjiaJBuI/AAAAAAAABgk/Mo8p4P2k1r8/s1600/case10-two.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-HAYDpXMa8vg/VLWwjiaJBuI/AAAAAAAABgk/Mo8p4P2k1r8/s1600/case10-two.png" height="240" width="320" /></a></div>
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<li style="box-sizing: border-box;">What significant form is seen in photo #1?</li>
<li style="box-sizing: border-box;">What significant form is seen in photo #2?</li>
<li style="box-sizing: border-box;">What would you expect to see on the stained thick smear?</li>
<li style="box-sizing: border-box;">What is the identification of this parasite?</li>
<li style="box-sizing: border-box;">Is this a mild, moderate, or severe infection?</li>
<li style="box-sizing: border-box;">Why is it important to make a rapidly correct diagnosis in this patient given the presentation and the travel history?</li>
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<span style="color: #444444; font-family: Verdana, Geneva, sans-serif;"><span style="font-size: 14px; line-height: 20px;"><br /></span></span></div>
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<span style="color: #444444; font-family: Verdana, Geneva, sans-serif;"><span style="font-size: 14px; line-height: 20px;">IDEA 1 :</span></span></div>
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<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Gametocyte in photo 1</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Ring form in photo 2</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Ring form trophozoites in thick smear</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Plasmodium falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Severe infection</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">This is the most fatal form of malaria, and patient cells are lysing. Treatment should begin as soon as possible.</span></div>
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IDEA 2 :<br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Photo 1 is gametocyte form</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Photo 2 is ring form</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">You would see both of these forms in thick smear</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">This is plasmodium falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">The infection is severe</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Plasmodium falciparum is the most severe and potentially deadly of the malarial parasites, and treatment must begin as soon as possible. This patient’s red cells are lysed.</span><br />
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<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">IDEA 3 :</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Photo # 1 Banana-shaped gametocyte</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Photo # 2 Trophozoites and applique forms</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Plasmodium falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Severe infection with Cerebral malarie via cytoadherence and sequestration</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Correct diagnosis is important to initiate the correct treatment immediately–high mortality rate with falciparum</span><br />
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<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">IDEA 4 :</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Gametocyte of plasmodium falciparum in photo 1;</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Ring stage of trophozoites in photo 2;</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">It is moderate to severe infection;</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Plasmodium falciparum is the type of malaria that most often causes severe and life-threatening malaria. According to the patient’ symptoms, such as high fever, mental confusion and dark ember urine, plus travel history, drop blood should be examined immediately to help diagnosis.</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;"><br /></span>
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">IDEA 5 :</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Photo 1 shows the typical banana-shaped gametocyt</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">Photo 2 shows typical trophozoietes for pl. Falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">In the thick smear I expect a great amount of thropozoietes like stars in the sky and some gametocytes</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">It’s a severe infection with Plasmodium falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">The importance of a quick diagnosis in this case is dual: 1) for the malaria diagnosis it is important because it is very important to treat it as soon as possible because of the high mortality; 2) in this specific case it is also important to rule out Ebola infection</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;"><br /></span>
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">IDEA 6 :</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">1- Photo #1 is mature macro gametocyte Plasmodium falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">2- photo #2 is trophozoites of single and double chromatin dots and ring of marginal form</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">3- Deformed of gametocytes and rings or young trophozoites without normal RBC and WBC</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">4- Diagnosis is Plasmodium falciparum</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">5- That would be a wild form according number RBC’s involved</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">6- This Malaria P.falciparum could be important because cause death of patient and may be resistant to treatment of anti-malaria drugs.</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;"><br /></span>
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">IDEA 7 :</span><br />
<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;">The patient has the ring forms (trophozoits)of falciparum species and the gametocyte stage giving the correct diagnosis of malaria infection.</span><br />
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<span style="background-color: white; color: #444444; font-family: Verdana, Geneva, sans-serif; font-size: 12px; line-height: 20px;"><br /></span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-75120671422073590662014-12-11T07:58:00.001-08:002021-10-16T01:52:34.940-07:00G6PD<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Masalah utama dalam G6PD</b><br />
Pesakit yang kurang glukosa-6-fosfat dehidrogenase akan mengalami ketidak upayaan menghasilkan glutation (co-faktor yang penting yang membantu meneutralkan radikal bebas dan perokside (H2O2).<br />
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<b>Apa kaitannya dengan sel darah merah?</b><br />
Ini bermakna bahawa apabila terdapat beberapa jenis tekanan oksida, sel-sel darah merah sukar untuk meneutralkan bahan oksida. "Oksida stress" disebabkan pelbagai faktor yang berbeza, seperti jangkitan (leukosit menghasilkan banyak radikal bebas), jenis dadah/ubat yang berbeza, dan makanan. Ia melindungi sel darah merah daripada pecah (hemolisis).Hemolisis juga berlaku apabila mereka termakan kacang parang atau penggunaan ubat gegat pada pakaian.<br />
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Oksidan menyebabkan rantai globin bergumpalan, membentuk apa yang dikenali sebagai "Heinz body". Heinz body melekat kepada bahagian dalam membran sel darah merah, dan apabila sel-sel merah melalui limpa, makrofaj akan "menggigit" keluar Heinz body. Jadi, anda anda akan melihat sel-sel merah yang menunjukkan tanda-tanda gigitan (mereka sebenarnya dipanggil "sel gigitan"), seperti ini:<br />
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<a href="http://2.bp.blogspot.com/-EcWqma3oBMQ/VIm-an55yUI/AAAAAAAABeI/6jrj0a0yjkE/s1600/unnamed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" src="http://2.bp.blogspot.com/-EcWqma3oBMQ/VIm-an55yUI/AAAAAAAABeI/6jrj0a0yjkE/s1600/unnamed.jpg" height="227" width="320" /></a><br />
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<b>Makanan dan herba yang perlu dielakkan</b><br />
Kacang parang (fava beans)<br />
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Ubat China<br />
Chuen Lin<br />
San Chi<br />
13 herbs<br />
12 herbs<br />
Ubat tradisi lain (dapatkan nasihat doktor)<br />
Bahan lain yang mesti dielakkan<br />
<br />
Ubat gegat (moth balls)<br />
Ubat nyamuk yang mengandungi pyrethium<br />
Ubat yang mesti dielakkan<br />
<br />
Acetanilide<br />
Doxorubicin<br />
Furazolidene<br />
Methylene Blue<br />
Nalidixic acid<br />
Niridazole<br />
Nitrofurantoin<br />
Phenozopyridine<br />
Primaquine<br />
Sulfamethoxazole<br />
Bactrim<br />
<br />
<b>Ubat yang boleh diberi dalam dos terapeutik</b><br />
Paracetamol<br />
Ascorbic acid<br />
Aspirin<br />
Chloramphenicol<br />
Chloroquine<br />
Colchicine<br />
Diphenhydramine<br />
Isoniazid<br />
Phenacetin<br />
Phenylbutazone<br />
Phenytoin<br />
Probenecid<br />
Procainamide<br />
Pyrimethamine<br />
Quinidine<br />
Streptomycin<br />
Sulfisoxazole<br />
Trimethoprim<br />
Tripelennamine<br />
Vitamin K<br />
Mefloquine</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-68992727727642804142014-11-09T08:39:00.004-08:002023-02-27T03:20:26.879-08:00Kristal Dalam Air Kencing<div dir="ltr" style="text-align: left;" trbidi="on">
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<div><h1 class="entry-title" itemprop="headline" style="background-color: white; border: 0px; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 35px; font-weight: 300; line-height: 1.2em; margin: 0px; padding: 0px;"><br /></h1><h1 class="entry-title" itemprop="headline" style="background-color: white; border: 0px; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 35px; font-weight: 300; line-height: 1.2em; margin: 0px; padding: 0px;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-WNCDtuQmyOw/YWqYSrrRzGI/AAAAAAAAD9Q/3osI0KxTrGc4_95u0glxqzG4yyzeq_QKQCLcBGAsYHQ/s800/Calcium-carbonate-crystals.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="800" height="393" src="https://1.bp.blogspot.com/-WNCDtuQmyOw/YWqYSrrRzGI/AAAAAAAAD9Q/3osI0KxTrGc4_95u0glxqzG4yyzeq_QKQCLcBGAsYHQ/w552-h393/Calcium-carbonate-crystals.jpg" width="552" /></a></div></div></h1></div></div><div class="MsoNormal" style="margin-bottom: 0in; margin-left: 41.15pt; margin-right: 0in; margin-top: 3.4pt; margin: 3.4pt 0in 0in 41.15pt;"><div><h1 class="entry-title" itemprop="headline" style="background-color: white; border: 0px; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 35px; font-weight: 300; line-height: 1.2em; margin: 0px; padding: 0px;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"><br /></span></div></div></h1></div></div><div class="MsoNormal" style="margin-bottom: 0in; margin-left: 41.15pt; margin-right: 0in; margin-top: 3.4pt; margin: 3.4pt 0in 0in 41.15pt;"><div><h1 class="entry-title" itemprop="headline" style="background-color: white; border: 0px; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 35px; font-weight: 300; line-height: 1.2em; margin: 0px; padding: 0px;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;">Types of Crystals in Urine</span></div></div></h1>
<br /><span style="background-color: white; color: #3a3a3a; font-size: 18px;"><span style="font-family: verdana;">Uric acid</span> </span><span style="background-color: white; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px;">crystals invariably form in acidic urine, typically with a urine pH < 5.5. Uric acid is soluble in alkaline urine, preventing the precipitation of urate crystals. The inability of uric acid to crystallize at urine pH > 7.0 is the rationale for urinary alkalinization in patients at risk for acute uric acid nephropathy. Uric acid crystalluria is not associated with significant amounts of hematuria, glycosuria or proteinuria.</span></div><div><span style="background-color: white; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-ZtIlQ4w4bGM/YWqYrvnh9mI/AAAAAAAAD9c/e2MEsoaJ850idpisjDJzXkjAItlK5-vdwCLcBGAsYHQ/s506/Urine-Crystals-Forms.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="377" data-original-width="506" height="309" src="https://1.bp.blogspot.com/-ZtIlQ4w4bGM/YWqYrvnh9mI/AAAAAAAAD9c/e2MEsoaJ850idpisjDJzXkjAItlK5-vdwCLcBGAsYHQ/w455-h309/Urine-Crystals-Forms.jpg" width="455" /></a></div><br />
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<br /><span style="font-family: verdana;">
Normal crystals in urine<br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;">1. Uric acid Crystal</span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;">2. Calcium Oxalate
Crystals</span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">3. Hippuric Crystals</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">4. Calcium Phosphate
Crystals</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">5. Triple Phosphate
Crystals</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">6. Calcium Carbonate
Crystals</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">7. Ammonium Biurate
Crystals</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><br /></span></span>
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="background-color: transparent;">Abnormal crystals in urine</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">1. Bilirubin Crystals </span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">2.
Cholesterol Crystals </span><span style="font-size: 10.5pt; line-height: 115%;"> </span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span style="font-size: 10.5pt; line-height: 115%;">3. Cysteine
Crystals</span> </span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;">4. Leucine Crystals </span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;">5.
Tyrosine Crystals </span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;">6. Sulfa Crystals</span></span></span><br />
<span face=""helvetica" , sans-serif" style="background: rgb(247, 247, 247); font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;"><span face=""helvetica" , sans-serif" style="font-size: 10.5pt; line-height: 115%;">7. Indinavir Crystals</span></span></span></span><br /></span>
<b><br /><br /><br /></b><b><span style="font-family: verdana; font-size: large;">Uric Acid Crystal.</span></b></div><div><b><span style="font-size: large;"><br /></span></b></div><div><b><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-o5ozm6784J4/YWqcx4lbMoI/AAAAAAAAD9k/Bd0zqV4tJJ41L9GzYLVSRVK-MXEjRopwQCLcBGAsYHQ/s226/uric%2Bacid.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="223" data-original-width="226" height="252" src="https://1.bp.blogspot.com/-o5ozm6784J4/YWqcx4lbMoI/AAAAAAAAD9k/Bd0zqV4tJJ41L9GzYLVSRVK-MXEjRopwQCLcBGAsYHQ/w256-h252/uric%2Bacid.jpg" width="256" /></a></div><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-LdZJHABSO2s/YWqc2FX6PNI/AAAAAAAAD9s/vlBk8AA0pDwjBTloq_6SMptXRzQnuFndgCLcBGAsYHQ/s300/uric%2Bacid3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="168" data-original-width="300" height="256" src="https://1.bp.blogspot.com/-LdZJHABSO2s/YWqc2FX6PNI/AAAAAAAAD9s/vlBk8AA0pDwjBTloq_6SMptXRzQnuFndgCLcBGAsYHQ/w374-h256/uric%2Bacid3.jpg" width="374" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-JYxj7-DYIkY/YWqc8d5xlTI/AAAAAAAAD9w/M14Lnm7bVxob5xJ2dCKM0kwc2zBBC1nCACLcBGAsYHQ/s1080/urine-clinical-uricacid-microscopy-nephrology-original.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="655" data-original-width="1080" height="302" src="https://1.bp.blogspot.com/-JYxj7-DYIkY/YWqc8d5xlTI/AAAAAAAAD9w/M14Lnm7bVxob5xJ2dCKM0kwc2zBBC1nCACLcBGAsYHQ/w379-h302/urine-clinical-uricacid-microscopy-nephrology-original.jpeg" width="379" /></a></div></b></div><div>
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<a href="http://1.bp.blogspot.com/-LNG3JXrlq7A/VkCcdKccObI/AAAAAAAACns/fcXJhOwEU4g/s1600/uricacid5.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="222" src="https://1.bp.blogspot.com/-LNG3JXrlq7A/VkCcdKccObI/AAAAAAAACns/fcXJhOwEU4g/w386-h222/uricacid5.jpg" width="386" /></a></div>
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<a href="http://2.bp.blogspot.com/-JKTih3aDKx8/VkCcevuVXII/AAAAAAAACn0/5NA8ScdKSZ4/s1600/uricacid6.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="272" src="https://2.bp.blogspot.com/-JKTih3aDKx8/VkCcevuVXII/AAAAAAAACn0/5NA8ScdKSZ4/s400/uricacid6.jpg" width="400" /></a></div>
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<span style="background-color: white; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px;">Uric acid crystals can vary in both size and shape, as can be seen in the slide above. They can look like barrels, rosettes, rhomboids, needles or hexagonal plates. They are usually amber in color, irrespective of the size or shape of the individual crystal. However, urate crystals may assume the color of any pigments (such as bilirubin or the medication pyridium) that are present in the urine. Urate crystals can occasionally be seen in normal subjects, although they are much more common in patients with urate nephrolithiasis or acute urate nephropathy.</span></div>
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<div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: large;"><b><br /></b></span></div><div class="MsoNormal"><span style="background-color: white; border: 0px; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px; font-weight: 700; margin: 0px; padding: 0px;">Calcium oxalate crystals</span><br /><br /></div></div><div class="MsoNormal"><span style="background-color: white; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px;">Calcium oxalate crystals are usually found in acidic urine. They may occur as either bihydrated or monohydrated calcium oxalate. Calcium oxalate bihydrate crystals appear as colorless bipyramids of various sizes (“envelope form”, above left). Calcium oxalate monohydrate crystals are colorless and can assume several shapes, including ovoids, biconcave disks, rods and dumbbells (above right, yellow arrows). They can be seen in normal individuals with high dietary oxalate ingestion, in patients with nephrolithiasis, and in patients with acute renal failure due to ethylene glycol ingestion.</span></div><div class="MsoNormal"><span style="background-color: white; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px;"><br /></span></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-2l-GXyHP8YU/YWqg9xtizQI/AAAAAAAAD-A/_aD-zS-VVwA2-x77jy3M7mxpVJirxxMiACLcBGAsYHQ/s907/Caloxalate.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="305" data-original-width="907" height="237" src="https://1.bp.blogspot.com/-2l-GXyHP8YU/YWqg9xtizQI/AAAAAAAAD-A/_aD-zS-VVwA2-x77jy3M7mxpVJirxxMiACLcBGAsYHQ/w606-h237/Caloxalate.jpg" width="606" /></a></div><br /><span style="background-color: white; color: #3a3a3a; font-family: -apple-system, system-ui, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol"; font-size: 18px;"><br /></span></div></div><div class="MsoNormal" style="margin-bottom: 0in; margin-left: 41.15pt; margin-right: 0in; margin-top: 3.4pt; margin: 3.4pt 0in 0in 41.15pt;">
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Foto : <span face=""open sans" , "helvetica" , "arial" , sans-serif"><span style="background-color: #f7f7f7; font-size: 14px; line-height: 22.4px;">Calcium Oxalate</span></span></div>
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<span face=""open sans" , "helvetica" , "arial" , sans-serif" style="background-color: #f7f7f7; font-size: 14px; line-height: 22.4px;">2 type of Calcium Oxalate : </span></div>
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<li><span face=""open sans" , "helvetica" , "arial" , sans-serif" style="background-color: #f7f7f7; font-size: 14px; line-height: 22.4px;">Kalsium oxalate Dehidrat - bentuk </span><span face=""calibri" , "sans-serif"" lang="MS" style="font-size: 11pt; line-height: 115%;">oktahedron
("sampul surat") adalah yang paling biasa</span></li>
<li><span face=""open sans" , "helvetica" , "arial" , sans-serif" style="background-color: #f7f7f7; font-size: 14px; line-height: 22.4px;">Kalsium monohidrat biasa di lihat dalam kes </span><span face=""open sans" , "helvetica" , "arial" , sans-serif" style="background-color: #f7f7f7; font-size: 14px; line-height: 22.4px;">ethylene glycol toxicity - </span><span face=""calibri" , "sans-serif"" lang="MS" style="font-size: 11pt; line-height: 115%;">halter,
bujur telur, atau segi empat tepat.</span><!--EndFragment--></li>
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<span style="font-size: large;"><b>Kristal <span style="background-color: white; line-height: 1.1em;"><span style="font-family: "times" , "times new roman" , serif;">Calcium carbonate </span></span></b></span><br />
Terdapat pelbagai saiz kristal yang dapat dilihat sebagai spheroids sebagai besar dengan striations jejarian. Mereka juga boleh dilihat sebagai kristal yang lebih kecil dengan bulat kepada bentuk bujur telur. tidak berwarna tapi ada yang berwarna kuning-coklat dan boleh memberikan warna coklat untuk air kencing jika ia hadir dalam jumlah yang tinggi. Ia biasanya merupakan kristal besar dan boleh dilihat dengan pada mudah di bawah pembesaran yang rendah (walau bagaimanapun, pengesahan identiti kristal perlu sentiasa dilakukan di bawah pembesaran yang tinggi dan varian lebih kecil daripada kalsium karbonat boleh terlepas pandang jika hanya pembesaran rendah digunakan).<br />
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<span style="font-size: large;"><b>Kristal Asid Hippuric</b></span><br />
Jarang dilihat - prisma kuning-coklat atau tidak berwarna memanjang atau bentuk pinggan dan boleh berbentuk begitu nipis menyerupai jarum dan sering dilihat berkumpul bersama-sama. Ia dilihat dalam urin pH berasid dan neutral dan larut dalam eter.<br />
Kehadiran kristal ini dalam urin tidak menunjukkan kepentingan klinikal tetapi ia mungkin dilihat sebagai kesan dari keracunan "etilena glikol *".<br />
Ia mudah dikelirukan dengan kristal Ca. Oxalate monohydrate atau kristal Triple Phosphate yang kecil.<br />
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<strong style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; color: rgba(0, 0, 0, 0.7); font-family: Georgia, serif; font-size: 18px; font-stretch: inherit; line-height: 27px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Triple phosphate, </strong><span color="rgba(0 , 0 , 0 , 0.701961)" style="border: 0px; box-sizing: border-box; font-family: "georgia" , serif; font-size: 18px; font-stretch: inherit; line-height: 27px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">atau</span><strong style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; box-sizing: border-box; color: rgba(0, 0, 0, 0.7); font-family: Georgia, serif; font-size: 18px; font-stretch: inherit; line-height: 27px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> struvite.</strong><br />
Ianya mempunyai bentuk seperti "penutup-keranda" . Kristal struvite terdiri daripada magnesium ammonium fosfat. Ia biasanya dilihat dalam air kencing yang beralkali, dengan pH air kencing> 7.0. Kristal <i>Triple phosphate</i> dilihat pada pesakit yang mengalami jangkitan saluran kencing yang disebabkan oleh bakteria yang mengurai urea, seperti Mirabilis Proteus, dan sering dijumpai di dalam air kencing pesakit yang dijangkiti calculi (batu struvite).<br />
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<span style="font-family: "times" , "times new roman" , serif;">Kristal Ammonium biurate</span></h1>
Kristal Ammonium biurate berwarna kuning-coklat dan dilihat dalam bentuk "epal berduri" (bulat dengan unjuran berduri) atau dalam bentuk sfera. Ada pada pH alkali.<br />
Kepentingan klinikal: kristal biurate Ammonium boleh dilihat dalam air kencing normal.<br />
- Walau bagaimanapun, kehadiran kristal biurate ammonium biasanya menunjukkan spesimen tersimpan lama atau penyimpanan yang tidak sesuai.<br />
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<b><span style="font-size: large;">Kristal Bilirubin</span> </b><br />
Adalah kristal yang tidak
normal di dalam air kencing.</div>
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Rupabentuk :
jarum kuning-coklat atau granul. Ia sering dilihat melekat pada permukaan
sel-sel. Kristal
bilirubin dapat dilihat dalam kebanyakan kes hepatik.</div>
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Kehadiran
kristal bilirubin dalam urin perlu disertakan dengan keputusan ujian biokimia
positif bilirubin.<o:p></o:p></div>
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<b><span style="font-size: large;">Kristal cystine</span><o:p></o:p></b></div>
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Kristal
cystine adalah abnormal di dalam air kencing.<o:p></o:p></div>
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Rupabentuk :
tidak berwarna, nipis, plat heksagon<o:p></o:p></div>
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Kristal
cystine diperolehi secara keturunan (cystinuria). Kristal cystine adalah punca
yang paling kerap terjadi batu karang pada kanak-kanak.<o:p></o:p></div>
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Kehadiran
kristal cystine perlu disahkan dengan ujian sianida-nitroprusside.<o:p></o:p></div>
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<b><span style="font-size: large;">Kristal tyrosine</span><o:p></o:p></b></div>
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Kristal
tyrosine adalah abnormal di dalam air kencing<o:p></o:p></div>
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Rupabentuk :
tidak berwarna atau kuning-perang dalam bentuk jarum tunggal. Juga dilihat
sebagai roset.<o:p></o:p></div>
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Kristal
tyrosine boleh dilihat dalam tyrosinemia dan penyakit berkaitan hati , di mana
metabolisma pembentukan amino asid terjejas.<o:p></o:p></div>
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Kehadiran
kristal tyrosine biasanya disertai dengan ujian biokimia positif terhadap bilirubin
dan sering disertai dengan kehadiran kristal leucine dalam mendapan.<o:p></o:p></div>
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<a href="http://3.bp.blogspot.com/-q4wQnmzmuXU/VkCrFsVpe8I/AAAAAAAACp0/1pV9f6-txlg/s1600/tyrosine6.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="217" src="https://3.bp.blogspot.com/-q4wQnmzmuXU/VkCrFsVpe8I/AAAAAAAACp0/1pV9f6-txlg/s320/tyrosine6.png" width="320" /></a></div>
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<b><span style="font-size: large;">Kristal kolesterol</span><o:p></o:p></b></div>
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Kristal
kolesterol adalah tidak normal di dalam air kencing<o:p></o:p></div>
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Rupa:
kepingan yang rata, kepingan rata dengan sudut bertakuk.<o:p></o:p></div>
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Kemunculan
kolesterol dikaitkan dengan Sindrom Nephrotic.<o:p></o:p></div>
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Kristal
kolesterol positif disertai dengan ujian biokimia positif protein. Ia biasanya
muncul selepas sampel air kencing telah dimasukkan dalam peti sejuk dan
disertai dengan keujudan bersama “oval fat bodies”, cast lemak, dan titisan
lemak bebas dalam mendapan urin.<o:p></o:p></div>
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<a href="http://1.bp.blogspot.com/-eJuOZ8m8s7U/VkCroKTba3I/AAAAAAAACp8/F5HZxi87cR8/s1600/cholesterol-crystal.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="207" src="https://1.bp.blogspot.com/-eJuOZ8m8s7U/VkCroKTba3I/AAAAAAAACp8/F5HZxi87cR8/s320/cholesterol-crystal.jpg" width="320" /></a></div>
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<b><span style="font-size: large;">Kristal Sulfanomide</span><o:p></o:p></b></div>
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Kristal Sulfanomide adalah dianggap tidak normal dalam air
kencing.<o:p></o:p></div>
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Rupabentuk : jarum rata, jarum kecil atau sebagai sferoid.
Selalunya berwarna perang.<o:p></o:p></div>
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Kehadiran kristal sulfanomide biasanya menunjukkan
penggunaan<o:p></o:p></div>
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dadah dan tidak
semestinya keadaan patologi. Walau bagaimanapun, kehadiran mereka juga
dikaitkan dengan pembentukan batu pada buah pinggang.<o:p></o:p></div>
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Contoh Kristal sulfadiazine terdapat pada pesakit yang
mengambil dadah berjadual Trimethoprim-sulfadiazine. Mereka sering dilihat
sebagai "<i>shocks of wheat</i>.<o:p></o:p></div>
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<a href="http://2.bp.blogspot.com/-jlmMnP0Kamw/VkCtJ9VFGLI/AAAAAAAACqQ/YIYQvVCZ1ZQ/s1600/sulfonimade1.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="316" src="https://2.bp.blogspot.com/-jlmMnP0Kamw/VkCtJ9VFGLI/AAAAAAAACqQ/YIYQvVCZ1ZQ/s320/sulfonimade1.jpg" width="320" /></a></div>
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<a href="http://3.bp.blogspot.com/-bujNmJfoBKs/VkCtQH27d6I/AAAAAAAACqo/ef_Ggx_X6S0/s1600/sulphadiazine.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://3.bp.blogspot.com/-bujNmJfoBKs/VkCtQH27d6I/AAAAAAAACqo/ef_Ggx_X6S0/s320/sulphadiazine.jpg" width="320" /></a></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><b>Kristal <span style="color: #333333; line-height: 28px;">Leucine</span></b></span><br />
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Rupabentuk: spheroids kuning-coklat dengan gelang sepusat sekitar luar tepi dan jejari berpusat di tengah.<br />
Kristal Leucine boleh dilihat dalam penyakit hati di mana metabolisme asid amino terjejas.<br />
Kehadiran kristal leucine sering disertai dengan positif bilirubin dalam ujian biokimia dan sering disertai dengan kristal tyrosine dalam sedimen yang sama.<br />
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<a href="http://2.bp.blogspot.com/-TnsRsjLjeao/VkFGiy5HqkI/AAAAAAAACso/bu1de3Ux3UQ/s1600/Leucine-Crystals.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="138" src="https://2.bp.blogspot.com/-TnsRsjLjeao/VkFGiy5HqkI/AAAAAAAACso/bu1de3Ux3UQ/s400/Leucine-Crystals.png" width="400" /></a></div>
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<span style="background-color: #f7f7f7; line-height: 16.1px;"><b><span style="font-family: "times" , "times new roman" , serif; font-size: large;">Kristal Indinavir </span></b></span><br />
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<a href="http://4.bp.blogspot.com/-OJzKRxSEoDQ/VkFM2CFLzEI/AAAAAAAACtA/dB7o1fJSvt8/s1600/indinavir.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://4.bp.blogspot.com/-OJzKRxSEoDQ/VkFM2CFLzEI/AAAAAAAACtA/dB7o1fJSvt8/s320/indinavir.jpg" width="267" /></a></div>
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Gambar Indinavir(a) Kadang-kadang diperhatikan berbentuk gelendong- kumpulan kristal indinavir menunjukkan struktur monomorphic dengan jelas menunjukkan bahagian tengah (lihat anak panah). (b) Dua kumpulan kristal dengan perbezaan ciri-ciri dipaparkan: (1) bentuknya menyerupai sayap burung dan (2) roset lebih kecil dan bentuk tidak jelas, mungkin mengandungi kristal metabolit indinavir kecil (tengah yang jelas dapat dilihat dalam beberapa kumpulan, ditandakan dengan kepala anak panah). Pembesaran x100.</div>
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<a href="http://1.bp.blogspot.com/-SL46Un0ZL1E/Ve8N1_YjrxI/AAAAAAAACXs/HtDthzp90K4/s1600/sulphadiazine.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif; font-size: small;"><img border="0" height="240" src="https://1.bp.blogspot.com/-SL46Un0ZL1E/Ve8N1_YjrxI/AAAAAAAACXs/HtDthzp90K4/s320/sulphadiazine.jpg" width="320" /></span></a></div>
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<a href="http://4.bp.blogspot.com/-wYWEuTDd0Fc/Ve8ODf5rAFI/AAAAAAAACX0/r01PkvSYeFs/s1600/sulfa2.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif; font-size: small;"><img border="0" height="240" src="https://4.bp.blogspot.com/-wYWEuTDd0Fc/Ve8ODf5rAFI/AAAAAAAACX0/r01PkvSYeFs/s320/sulfa2.jpg" width="320" /></span></a></div>
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<a href="http://1.bp.blogspot.com/-idXxQUuCXME/Ve8OS5R-DpI/AAAAAAAACX8/siOn7-QrP9M/s1600/sulfa3.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif; font-size: small;"><img border="0" height="240" src="https://1.bp.blogspot.com/-idXxQUuCXME/Ve8OS5R-DpI/AAAAAAAACX8/siOn7-QrP9M/s320/sulfa3.jpg" width="320" /></span></a></div>
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<a href="http://2.bp.blogspot.com/-5ae5SRUK_WQ/Ve8OcSIhA7I/AAAAAAAACYE/kxCst1opepI/s1600/sulfa4.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif; font-size: small;"><img border="0" height="240" src="https://2.bp.blogspot.com/-5ae5SRUK_WQ/Ve8OcSIhA7I/AAAAAAAACYE/kxCst1opepI/s320/sulfa4.jpg" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif; line-height: 48pt; text-align: left;">Contoh Kristal sulfadiazine terdapat pada pesakit yang mengambil dadah berjadual Trimethoprim-sulfadiazine. Mereka sering dilihat sebagai "</span><i style="font-family: times, "times new roman", serif; line-height: 48pt; text-align: left;">shocks of wheat</i><span style="font-family: "times" , "times new roman" , serif; line-height: 48pt; text-align: left;">.</span></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-40918367240448200542014-11-07T20:34:00.000-08:002014-11-07T22:29:41.946-08:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://3.bp.blogspot.com/-7psqEknvPXY/VF2S5xMCobI/AAAAAAAABZo/rkZzMkyoGM8/s1600/dipstik.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://3.bp.blogspot.com/-7psqEknvPXY/VF2S5xMCobI/AAAAAAAABZo/rkZzMkyoGM8/s1600/dipstik.jpg" height="320" width="320" /></a></div>
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<b><span lang="MS"><br /></span></b></div>
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<b><span lang="MS">URINALISIS<o:p></o:p></span></b></div>
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<span lang="MS">Istilah ini merujuk kepada ujian terhadap
sifat-sifat fizikal, kimia, dan
mikroskopik sesuatu sampel air kencing . Ia melibatkan beberapa ujian untuk
mengesan dan mengukur pelbagai unsur yang terkandung dalam air kencing.<o:p></o:p></span></div>
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<span lang="MS">Ujian air kencing dapat memberi petunjuk jenis
penyakit yang tidak menunjukkan
tanda-tanda atau gejala-gejala awal yang jelas. Contohnya seperti kencing manis, kerosakan pada fungsi buah
pinggang dan jangkitan saluran kencing yang kronik . Kaedah ‘microchemistry’
telah digunakan selama bertahun-tahun dahulu dan membolehkan analisis
kualitatif dan separa kuantitatif dilakukan dalam jangkamasa singkat dan
pemerhatian yang mudah. Perubahan warna
pada setiap segmen jalur dibandingkan dengan carta warna ‘rujukan’ untuk
mendapatkan keputusan.</span></div>
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<a href="http://2.bp.blogspot.com/-Y2VVRhsGSAc/VF2U5ziK76I/AAAAAAAABaE/7pMmQfieBA8/s1600/dipstik%2Bref..jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Y2VVRhsGSAc/VF2U5ziK76I/AAAAAAAABaE/7pMmQfieBA8/s1600/dipstik%2Bref..jpg" height="321" width="400" /></a></div>
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<a href="http://3.bp.blogspot.com/-REbN7tno_Ek/VF2UasMJKkI/AAAAAAAABZ0/CGVkGJJgv3I/s1600/dipstik2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-REbN7tno_Ek/VF2UasMJKkI/AAAAAAAABZ0/CGVkGJJgv3I/s1600/dipstik2.jpg" /></a></div>
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<b><span lang="MS">UJIAN
AIR KENCING makroskopik <o:p></o:p></span></b></div>
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<span lang="MS">Aspek pertama dalam ujian air kencing adalah
pemerhatian secara langsung terhadap warna dan kekeruhan. Air kencing segar berwarna
kuning pucat ,kuning gelap atau kuning pekat dan jernih. Isipadu air kencing yang
normal adalah dalam julat 750-2000 ml / 24 jam. <o:p></o:p></span></div>
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<span lang="MS">Air kencing yang keruh mungkin disebabkan oleh
bahan sel yang berlebihan atau protein dalam air kencing atau disebabkan
tindakbalas penghabluran atau pemendakan garam apabila diletakkan pada suhu
bilik atau di dalam peti sejuk. <o:p></o:p></span></div>
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<span lang="MS">Warna merah atau merah-coklat (tidak normal) mungkin dari disebabkan warna
makanan yang diambil, ubat-ubat yang nengandungi dadah, atau kehadiran sama ada
atau hemoglobin myoglobin. Jika sampel mengandungi banyak sel darah merah, ia
akan menjadi keruh dan juga berwarna merah.<o:p></o:p></span></div>
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<b><span lang="MS">ANALISIS
KIMIA AIR KENCING –Kaedah Dipstik <o:p></o:p></span></b></div>
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<b><span lang="MS">pH <o:p></o:p></span></b></div>
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<span lang="MS">Hasil turasan glomerular plasma darah biasanya
bersifat asidik. Ianya disalur ke salur pengumpul kencing menjadikan pH 6.0 - 7.4. Walau bagaimanapun, bergantung
kepada status asid-bes, pH kencing boleh berada pada paras pH 4.5 hingga pH 8.0.</span></div>
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<a href="http://3.bp.blogspot.com/-OKpeKJxNeBA/VF2UmymDRrI/AAAAAAAABZ8/aA5X6vlM9AY/s1600/urine%2Bdip.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-OKpeKJxNeBA/VF2UmymDRrI/AAAAAAAABZ8/aA5X6vlM9AY/s1600/urine%2Bdip.jpg" /></a></div>
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<b><span lang="MS">Specific
Gravity (SG) <o:p></o:p></span></b></div>
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<span lang="MS">Specific Gravity (ukuran osmolality air
kencing - yang mengukur kepekatan bahan larut) mengukur ketumpatan air kencing
atau keupayaan buah pinggang untuk mengawal kepekatan air kencing. Kaedah Dipsticks
boleh digunakan untuk mengukur anggaran SG. Cara lain mengukur SG ialah
menggunakan refractometer secara lebih tepat. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="MS">Bacaan SG normal berada di antara julat 1.002
dan 1.035 yang menunjukkan fungsi buah pinggang yang baik. Buah pinggang berfungsi
menentukan berapa banyak bahan larut seperti glukos dan elektrolit (garam)
patut berada dalam darah. Jika kandungan bahan tersebut terlalu banyak, buah
pinggang akan mengeluarkannya melalui air kencing. Jika buah pinggang gagal
berfungsi dengan baik, maka individu tersebut akan mudah terhidrat atau buah
pinggang akan mengeluarkan nutrien yang tidak sepatutnya seperti glukos. Dengan adanya kaedah anggaran SG ini,
ahli perubatan dapat menggunakannya untuk membuat diagnosis.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="MS">SG digunakan dalam diagnosis jika pesakit
disyaki :<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Dehydrasi/dehidrasi berlebihan<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Kegagalan fungsi jantung<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Terkejut<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Kegagalan buah pinggang<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Jangkitan buah pinggang<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Jangkitan saluran kencing<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="MS">Hyponatremia/hypernatremia<o:p></o:p></span><br />
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<a href="http://4.bp.blogspot.com/-XGGbLDQExDQ/VF2375fXCzI/AAAAAAAABbA/HpIVT8mz1lQ/s1600/refecrometerr.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-XGGbLDQExDQ/VF2375fXCzI/AAAAAAAABbA/HpIVT8mz1lQ/s1600/refecrometerr.jpg" /></a></div>
<span lang="MS"><br /></span></div>
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<b><span lang="MS">Protein
<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="MS">Ujian dilakukan dengan mencelup dipstik pada
air kencing, tetapi bagi ujian semi-kuantitatif protein, air kencing perlu diemparkan
dan bahagian mendakan digunakan untuk diagnosis. Sebahagian kecil protein
plasma ditapis di glomerulus dan diserap semula oleh tubul renal. Walau
bagaimanapun, sejumlah kecil protein plasma yang ditapis dirembeskan oleh
nefron (protein Tamm-Horsfall) yang boleh dikesan pada air kencing. Hasil
perkumuhan proteini biasanya tidak melebihi 150 mg/ 24jam atau 10 mg/100 ml. Kandungan melebihi
150 mg /24 jam ditakrifkan sebagai
proteinuria. Proteinuria > 3.5 gm / 24 jam dikenali sebagai sindrom
Neprotik. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="MS">Dipsticks mengesan kehadiran protein dalam
urin dengan perubahan pewarna penunjuk, Bromphenol biru, yang paling sensitif terhadap
albumin, tetapi ia mengesan juga globulins dan protein Bence-Jones dalam urin (kelemahan
kaedah ini). <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="MS">Keputusan ‘Trace’ protein pada dipstik adalah bersamaan dengan
10 mg / 100 ml atau kira-kira 150 mg / 24 jam. Positive 1+ anggaran kira-kira
200-500 mg / 24 jam, 2 + anggaran kepada
0.5-1.5 gm / 24 jam, 3+ anggaran untuk 2-5 gm / 24 jam, dan 4 + mewakili 7 gm /
24 jam atau lebih.<o:p></o:p></span></div>
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<b><span lang="MS">Glukosa
<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="MS">Kandunga glukosa yang ditapis oleh glomerulus dikesan
dalam air kencing kurang dari 0.1% (<130 24="" air="" amnya="" balas="" baru="" bayi="" benedict="" berlebihan="" bermakna="" boleh="" clinitest="" dalam="" dan="" dari="" daripada="" digunakan="" dipsticks="" dipstik="" diubahsuai="" fruktosa="" gagal="" galaktosa.="" glukosa="" glycosuria="" gula="" ini="" itu="" jam="" jenis="" kadangkala="" kaedah="" kehadiran="" kencing="" lahir="" lain="" manis.="" mengesan="" menggunakan="" mg="" o:p="" oksidase="" oleh="" sebab="" secara="" selain="" seperti="" sesuai="" tetapi="" tidak="" tindak="" ujian="" untuk="" urin="" yang=""><!--130--></130></span></div>
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<b><span lang="MS">Ketones</span></b></div>
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<b><a href="http://4.bp.blogspot.com/-qenEOJbiujQ/VF2b9llZEvI/AAAAAAAABaU/rcxGiUjFgu0/s1600/compR.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-qenEOJbiujQ/VF2b9llZEvI/AAAAAAAABaU/rcxGiUjFgu0/s1600/compR.jpg" height="240" width="320" /></a></b></div>
<b>
<o:p></o:p></b>
<div class="MsoNormal">
<span lang="MS">Ketones (acetone, asid aceotacetic,
beta-hydroxybutyric acid) sama ada ketosis kencing manis atau beberapa bentuk
lain kalori kekurangan (kebuluran), mudah dikesan menggunakan sama ada
dipsticks atau tablet ujian yang mengandungi natrium nitroprusside. Ketones
dihasilkan secara normal oleh hati hasil dari metabolisma asid lemak. Ia
dimetabolisma secara lengkap, oleh itu hanya sedikit dikesan pada urin. Jika
tubuh kita kekurangan glukos sebagai sumber tenaga, ia akan menggunakan lemak
badan sebagai sumber tenaga menyebabkan peningkatan penghasilan ketones. Ini
dapat dikesan pada darah dan air kencing.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span lang="MS">Nitrit <o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="MS">Nitrit di dalam urin terhasil akibat
penguraian nitrat oleh bakteria tertentu. Ujian nitrit positif menunjukkan
kandungan bakteria yang tinggi di dalam air kencing. Kebanyakan bakteria Gram
negatif seperti E. coli selalunya memberi kesan ujian yang positif. Ujian yang
positive menunjukkan jangkitan pada salur kencing (UTI).<o:p></o:p></span></div>
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<b><span lang="MS">Leukocyte
Esterase <o:p></o:p></span></b></div>
<br />
<div class="MsoNormal">
<span lang="MS">Hasil ujian positif menunjukkan kehadiran sel
darah putih sama ada sebagai sel-sel keseluruhan atau serpihan sel darah.
Kehadiran sel darah putih dalam urin (pus cell) menunjukkan jangkitan salur
kencing. Keputusan in disokong kuat dengan keputusan positive bagi nitrit. Keputusan
ujian negatif untuk leukocyte esterase tidak bermakna tiada UTI, pemeriksaan
lanjut diperlukan untuk mengesahkan UTI seperti pemeriksaan mikroskopik dan /
atau pengkulturan air kencing perlu dilakukan untuk mengesahkan bacteriuria.<o:p></o:p></span></div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-4160499124436243182014-08-28T20:03:00.001-07:002014-08-28T20:03:40.822-07:00HIGH WHITE CELLS COUNT<div dir="ltr" style="text-align: left;" trbidi="on">
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High white counts always make me think of leukemia (maybe I just always think of the worst possible scenario). But there are a ton of benign things that can make one's white count go up. Fortunately, these benign conditions are much more common than leukemia.</div>
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<strong>Neutrophils</strong>: bacterial infection, inflammation, metabolic disease (e.g., diabetes), stress (even the anxiety of being in the ER can make your neutrophils demarginate; the neutrophil count can double in this setting!)</div>
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<strong>Lymphocytes</strong>: Viral infection (e.g. infectious mononucleosis, hepatitis), immune disease, stress (lymphocytes don't marginate along the inside of blood vessels - so the count doesn't go up as dramatically as the neutrophil count can)</div>
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<strong>Eosinophils</strong>: skin diseases, drug reaction, parasite infection, asthma</div>
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<strong>Basophils</strong>: chronic myeloid leukemia. Okay, this is not a benign thing. But if you see a basophilia, this is the first thing that should come to mind. There are very few, if any, other causes of basophilia.</div>
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<strong>Monocytes</strong>: infection, solid tumors (rarely, the monocyte count goes up when a patient has a solid tumor somewhere), autoimmune disease</div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-10611890103628082172014-08-26T16:35:00.002-07:002014-08-26T16:35:34.929-07:00NEUTROPENIA<div style="background-color: white; color: #555555; font-family: Helvetica, Verdana, Arial, sans-serif;">
There are two main categories that inhibit the production of neutrophils, and things that remove neutrophils from the circulation.</div>
<div style="background-color: white; color: #555555; font-family: Helvetica, Verdana, Arial, sans-serif;">
Things that inhibit the production of neutrophils:</div>
<ul style="background-color: white; color: #555555; font-family: Helvetica, Verdana, Arial, sans-serif;">
<li style="margin-left: 15px;">Hematopoietic stem cell suppression (e.g., aplastic anemia, infiltrative bone marrow diseases). Note: in these settings, you'd see anemia and thrombocytopenia too (good diagnostic clues).</li>
<li style="margin-left: 15px;">Drug reaction (This is the most common cause of neutropenia! The list of drugs is looooong; check out Robbins page 582.)</li>
<li style="margin-left: 15px;">Ineffective hematopoiesis (like that seen in megaloblastic anemia and myelodysplasia). </li>
<li style="margin-left: 15px;">Congenital disorders (rare, rare, rare) like Kostmann syndrome, in which patients have defects in genes involved in granulocyte differentiation.</li>
</ul>
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Things that remove neutrophils from the circulation:</div>
<ul style="background-color: white; color: #555555; font-family: Helvetica, Verdana, Arial, sans-serif;">
<li style="margin-left: 15px;">Immunologic processes (like lupus, or drug exposure).</li>
<li style="margin-left: 15px;">Splenomegaly (a big spleen sequesters neutrophils - as well as red cells and platelets).</li>
<li style="margin-left: 15px;">Overwhelming infection (the patient is using up all the neutrophils by calling them out of the blood into the tissues).</li>
</ul>
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<div align="justify">
<span style="text-align: -webkit-auto;">For more on causes of neutropenia, see Robbins Pathologic Basis of Disease ("big Robbins") 9th edition, page 582 (or 8e, page 593).</span></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-44781357666599822332014-07-14T22:24:00.002-07:002021-10-15T19:50:04.606-07:00 Haematology Analyser : 5-parameter atau 3-parameter: Apa bezanya?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<b><span lang="EN-MY" style="font-size: 16.0pt; line-height: 115%;">The Lab Guy: 5-parameter atau 3-parameter: Apa bezanya?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-MY">Terdapat 2 jenis mesin penganalisa <i>Haematologi</i> yang kerap di gunakan samada di makmal perubatan atau di klinik-klinik kesihatan. Antara pengeluar utama produk ini ialah Sysmex GmbH, Abbott Diagnostics, Mindray, Horiba Medical, Nihon Kohden, Beckman Coulter International dan lain-lain. </span></div>
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<a href="http://2.bp.blogspot.com/-BVwumH75q5k/U8S41U1bWNI/AAAAAAAAA8A/waAvb4W8ItE/s1600/beckman.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-BVwumH75q5k/U8S41U1bWNI/AAAAAAAAA8A/waAvb4W8ItE/s1600/beckman.jpeg" /></a></div>
<br />
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<span lang="EN-MY">Syarikat Pengeluar telah mencadangkan mesin penganalisa 3-parameter adalah mencukupi untuk menganalisa di POC (point of care) kerana kos yang rendah dan mudah dikendalikan. Tetapi para doktor lebih berminat menggunakan mesin penganalisa 5-parameter kerana fungsi menganalisa yang lebih tepat.</span></div>
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<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="MsoNormal">
<b><span lang="EN-MY">Sejarah<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-MY">"5-part" merujuk kepada lima jenis sel-sel darah putih yang dapat dilaporkan dalam CBC. Sel-sel darah putih berfungsi melawan segala jenis jangkitan. Sebelum adanya mesin penganalisa “haemato”, semua pengiraan jenis sel dilakukan secara manual menggunakan mikroskop, MLT akan mengira 100 sel-sel darah putih dan membezakannya kepada 5 jenis sel yang berbeza : neutrofil, limfosit, monosit , eosinofil dan basophils . Setiap satu dikira dalam bentuk peratusan.</span></div>
<div class="MsoNormal">
<span lang="EN-MY">Kaedah manual ini masih dilakukan untuk mengesahkan keputusan yang tidak normal dari mesin automatik. Ia mengambil masa lebih kurang 10 minit atau lebih berbanding dengan mesin auto yang dapat memberikan keputusan kira-kira 1 minit. Kaedah ini dapat mengurangkan kos dan masa untuk mendapatkan sesuatu keputusan ujian darah.</span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-zqHyrC7G6WI/U8S53qvEGfI/AAAAAAAAA8g/9ZGKF6NgISU/s1600/wbc.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-zqHyrC7G6WI/U8S53qvEGfI/AAAAAAAAA8g/9ZGKF6NgISU/s1600/wbc.jpg" /></a></div>
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<div class="separator" style="clear: both; text-align: center;">
</div>
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<div class="MsoNormal">
<b><span lang="EN-MY">Biologi<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-MY">Dalam ujian darah yang normal ,kira-kira 60% (atau kurang dari dua per tiga) sel-sel darah putih adalah neutrofil . Limfosit membentuk lebih kurang 30% (atau kurang daripada satu pertiga) . Selebihnya adalah sel-sel darah putih yang membentuk (monosit , eosinofil dan basophils). Jumlah keseluruhan ,adalah 100%.</span></div>
<div class="MsoNormal">
<span lang="EN-MY">Peratusan setiap sel menunjukkan gejala atau penyakit. Sebagai contoh, fungsi neutrofil adalah melawan jangkitan bakteria. Julat normal adalah 50 - 70 %. Peningkatan (85%) adalah menunjukkan jangkitan bakteria. Bagi limfosit pula, ia fungsi melawan jangkitan virus . Kehadiran peratusan limfosit yang tinggi bermakna jangkitan selsema atau jangkitan virus lain.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-MY">Jadi bagaimana pentingnya maklumat ini kepada pengamal perubatan? Andaikan pesakit datang dengan keadaan demam. Kemungkinan jangkitan disebabkan oleh bakteria( % neutrofil lebih tinggi), di mana pesakit perlu diberikan antibiotik. Atau ia boleh menjad jangkitani virus ( % limfosit yang lebih tinggi ), di mana ubat tertentu diberikan dan diberikan rehat yang mencukupi. Ia keadah yang amat mudah, dalam menentukan bentuk rawatan yang diperlukan. Peratusan monosit dan basophil pula digunakan untuk diagnosis yang lebih khusus. Peratus eosinofil yang tinggi menunjukkan tindakbalas alahan atau jangkitan parasit.</span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-KHk2Hb4Zzm0/U8S56KXDflI/AAAAAAAAA8s/U9Z1opkEkcc/s1600/lympho.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-KHk2Hb4Zzm0/U8S56KXDflI/AAAAAAAAA8s/U9Z1opkEkcc/s1600/lympho.jpg" height="213" width="320" /></a></div>
<br />
<div class="MsoNormal">
<span lang="EN-MY">5 bahagianatau 3 bahagian ?</span></div>
<div class="MsoNormal">
<span lang="EN-MY">Seperti yang anda ketahui ,sel-sel yang penting untuk dikira adalah neutrofil dan limfosit. Analisa “3- part “ memberikan jumlah neutrofil ,limfosit dan monosit . Bagi mesin peganalis “<i>5-part” </i>kos akan meningkat dua hingga tiga kali lebih daripada kos penganalisa “<i>3-part”</i>. Kos bagi setiap ujian pula menjadi dua kali ganda bagi penganalisa “<i>5-part”</i>. Oleh itu di klinik/pusat kesihatan yang kecil, memadai dengan penggunaan penganalisa “<i>3-part” </i> yang dapat manfaat dari segi kos yang lebih rendah.</span></div>
<div class="MsoNormal">
<span lang="EN-MY">Apakah keperluan mengadakan penganalisia ”<i>5-part”</i> ? </span></div>
<br />
<div class="MsoNormal">
<span lang="EN-MY">Ini diperlukan bagi Hospital kecil, jabatan yang khusus seperti klinik alergi, atau mana-mana tempat dimana doktor memerlukan analisa untuk eosinofil dan basophils <a href="https://www.blogger.com/null" name="_GoBack"></a>dimana kajian lanjutan dan pemeriksaan yang lebih teliti diperlukan.</span></div>
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<span lang="EN-MY"><br />
</span></div>
<div class="MsoNormal">
<span lang="EN-MY"><br />
</span></div>
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<span lang="EN-MY"><br />
</span></div>
<div class="MsoNormal">
<span lang="EN-MY"><i>**Artikel sumbangan Amim Rahmat MLT.</i></span></div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-20806038467375609352014-04-03T09:11:00.000-07:002014-04-03T09:11:45.485-07:00Differential blast counts obtained by automated blood cell analyzers.<div dir="ltr" style="text-align: left;" trbidi="on">
<h1>
Differential blast counts obtained by automated blood cell analyzers.</h1>
<div class="auths">
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Jung%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Jung S</a><sup>1</sup>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Chae%20H%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Chae H</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Lim%20J%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Lim J</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Oh%20EJ%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Oh EJ</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Kim%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Kim Y</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Park%20YJ%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Park YJ</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Han%20K%5BAuthor%5D&cauthor=true&cauthor_uid=21157136">Han K</a>.</div>
<div class="afflist">
<h3>
<a class="jig-ncbitoggler ui-widget ui-ncbitoggler" href="http://www.ncbi.nlm.nih.gov/pubmed/21157136#" role="button" title="Open/close author information list"><span class="ui-ncbitoggler-master-text">Author information </span><span class="ui-icon ui-icon-triangle-1-e"></span></a></h3>
</div>
<div class="abstr">
<h3>
Abstract</h3>
<div class="">
<h4>
BACKGROUND: </h4>
Automated
blood cell analyzers often read leukemic blasts as normal cells. In
this study, we evaluated the 5-part differential patterns of blasts
using automated analyzers to determine if they can differentiate among
blast types.<br />
<h4>
METHODS: </h4>
Blood samples containing 10% or
more blasts were collected from patients with acute leukemia (N=175).
The 5-part differential count was conducted using DxH 800 (Beckman
Coulter, USA) and XE-2100 analyzers (Sysmex Co., Japan), and the results
were compared with manual differential counts, which was used as a
reference method.<br />
<h4>
RESULTS: </h4>
The DxH 800 reported the
5-part white blood cell differential count in 98.9% of the cases. The
XE-2100 provided an invalid automated differential count in 72% of the
cases. Both analyzers counted most lymphoblasts as lymphocytes and most
myeloblasts as monocytes. In 11 cases, the DxH 800 reported a 5-part
differential count without a blast flag.<br />
<h4>
CONCLUSIONS: </h4>
Some
automated analyzers are able to recognize and count blasts according to
their characteristic cell types. Therefore, complete blood counts
obtained automatically can provide valuable data for making provisional
decisions regarding the lineage of leukemia cells before further
investigation.<br />
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-5570473647988638742014-02-22T04:20:00.002-08:002014-02-22T04:20:26.768-08:00Acute Lymphocytic Leukemia (ALL)<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b>Acute lymphocytic leukemia (ALL)</b> adalah sejenis kanser
darah dan sum-sum tulang ( tisu lembut
di dalam tulang di mana sel-sel darah dihasilkan). <o:p></o:p></div>
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<br /></div>
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<a href="http://3.bp.blogspot.com/-CVekil8aWJc/UwiVuUmg3II/AAAAAAAAA5s/0JuCxapOPyU/s1600/ALL.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-CVekil8aWJc/UwiVuUmg3II/AAAAAAAAA5s/0JuCxapOPyU/s1600/ALL.jpg" /></a></div>
<br />
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Perkataan "akut" bermaksud, penyakit ini merebak dengan cepat dan menghasilkan lebih
sel-sel darah yang tidak matang berbading yang matang. "Lymphocytic" dalam Acute
lymphocytic leukemia merujuk kepada sel-sel darah putih yang dikenali sebagai
limfosit. Lymphocytic leukemia akut juga
dikenali sebagai “lymphoblastic leukemia akut”. <o:p></o:p></div>
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<br /></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-OQ2H0z0h9Ug/UwiVu8j_Y4I/AAAAAAAAA50/2gOadjhxeP8/s1600/ALL2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-OQ2H0z0h9Ug/UwiVu8j_Y4I/AAAAAAAAA50/2gOadjhxeP8/s1600/ALL2.jpg" /></a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://1.bp.blogspot.com/-mGa2CDy-hvk/UwiVv-OVSiI/AAAAAAAAA58/V4IzkIQ4qMg/s1600/all3.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-mGa2CDy-hvk/UwiVv-OVSiI/AAAAAAAAA58/V4IzkIQ4qMg/s1600/all3.jpg" /></a>Lymphocytic leukemia akut adalah jenis kanser yang paling
biasa pada kanak-kanak, dan mempunyai peluang yang baik untuk sembuh dengan secara
rawatan. Lymphocytic leukemia akut juga boleh berlaku pada orang dewasa, walaubagaimanapun
peluang untuk sembuh adalah lebih rendah.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b>Symptom</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Tanda-tanda
dan lymphocytic leukemia akut termasuk: <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
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</div>
<ul style="text-align: left;">
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">Pendarahan pada gusi</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">sakit tulang</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">demam</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">jangkitan yang kerap</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">Hidung kerap berdarah atau teruk berdarah</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">Benjolan yang disebabkan oleh nod limfa yang
bengkak di sekitar leher, ketiak, atau pangkal paha atau abdomen</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">kulit pucat</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">Sesak nafas</span></li>
<li><span style="font-family: Symbol; text-indent: -0.25in;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><span style="text-indent: -0.25in;">Selalu lemah, keletihan atau kurang bertenaga</span></li>
</ul>
<div style="text-indent: -24px;">
<br /></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-73493125575094792072014-02-22T02:57:00.002-08:002014-02-22T02:57:18.253-08:00SEL DARAH PUTIH<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<b>Peningkatan Bilangan Sel
Darah Putih<o:p></o:p></b></div>
<div class="MsoNormal">
<b>Punca-punca :<o:p></o:p></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-AjEcqEPTHS4/UwiCBL1-mlI/AAAAAAAAA5c/uODASFHWNVs/s1600/wbc.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-AjEcqEPTHS4/UwiCBL1-mlI/AAAAAAAAA5c/uODASFHWNVs/s1600/wbc.jpg" height="320" width="320" /></a></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Peningkatan penghasilan sel-sel darah putih
untuk melawan jangkitan <o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Reaksi terhadap ubatan yang diambil bagi meningkatkan
penghasilan sel darah putih <o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Penyakit sum-sum tulang, menyebabkan penghasilan sel
darah putih yang luar biasa banyaknya <o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Gangguan sistem imun yang meningkatkan penghasilan
sel darah putih <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sebab spesifk penghasilan sel darah putih yang tinggi
termasuk:<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Acute lymphocytic leukemia<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Acute myelogenous leukemia (AML)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Tindakbalas terhadap alahan yang teruk<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Chronic lymphocytic leukemia<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Chronic myelogenous leukemia<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Kesan dadah seperti corticosteroids dan
epinephrine<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Myelofibrosis<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Jangkitan bakteria yang tertentu<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Jangkitan virus tertentu<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Polycythemia vera<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Rheumatoid arthritis<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Merokok<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Tekanan, seperti tekanan emosi atau fizikal yang teruk <o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Tuberculosis<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Batuk kokol<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Punca-punca
yang dinyatakan di atas adalah berkaitan dengan symptom pada pesakit. Oleh itu
maklumat yang diberikan oleh doktor dapat membantu Juruteknologi Makmal membuat
diagnosis dengan lebih tepat lagi.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<i>*Artikel akan datang ==> Kenali Sel Leukemia</i></div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-11942812638524055752014-02-11T06:23:00.002-08:002014-02-11T06:24:15.329-08:00Why am I having a high ESR?<div dir="ltr" style="text-align: left;" trbidi="on">
<span id="ctl00_MainContentArea_DlquestAns"><span valign="top"></span></span><br />
<h2 class="n_text" style="margin: 0;">
<span class="georgia_18">Q.</span> <span class="n_text">I am a 36 years old male weighing 64 kg. My blood report showed ESR: 110, haemoglobin (Hb): 9.90, WBC: 9.90 and RBC: 3.20. <b>I suffered from urinary tract infection (UTI) last month (pus cell were 70-80/ hpf) and took highend antibiotics</b>. What is the reason behind high ESR? I have got low-grade fever at night and fatigue also.</span></h2>
<br />
<div align="justify" class="n_text" style="text-align: justify;">
<h3 class="n_text" style="margin: 0;">
<span class="georgia_18">A.</span>
High ESR is a marker of infection or inflammation in
the body. It should be normally below 20 mm in 1st hour. In your case,
the ESR could have gone up due to urine infection but should have come
down substantially after intake of appropriate antibiotics as per urine
culture. High esr could mean an ongoing UTI or any other infection which
may be causing this to be persistently high. Meet a physician and get
evaluated including cause of your anemia and also low grade fever. Get a
fresh urine culture, chest x-ray-pa, usg abdomen, mantoux test etc as
per the advice of your physician.</h3>
</div>
<br />
<div style="position: fixed;">
<div id="new_selection_block0.2449741736538713" style="background-color: transparent; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">
<br />
<br />
Read more at: <a href="http://doctor.ndtv.com/faq/ndtv/fid/0061162/Why_am_I_having_a_high_ESR.html?cp" target="_blank_">http://doctor.ndtv.com/faq/ndtv/fid/0061162/Why_am_I_having_a_high_ESR.html?cp</a></div>
</div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-21786061744392416472014-02-11T06:08:00.001-08:002014-02-11T06:08:09.722-08:00Why do the INR and PTT measure different pathways?<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">How come the PT measures the extrinsic pathway
and the PTT measures the intrinsic pathway?</span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"> </span>
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">Why<em></em> the INR only measured the extrinsic
pathway and the PTT measured only the intrinsic pathway. As what we know, the substance added to the test tube in each test, and the
pathway the test measured. Later on, though, we didn’t have a
clue as to why the tests measured the pathways they did.</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="line-height: 1.5em;">Before we get into the reasoning behind the tests, a quick correction is in order. We <em>don’t</em>
add thromboplastin in both the INR and PTT. In the INR, you add
thromboplastin, and in the PTT you add phospholipids (not
thromboplastin). It turns out thromboplastin is a substance that
contains both phospholipids AND a tissue-factor-like substance. That’s
why they call the assay the “partial thromboplastin time” – because you
only need to add <em>part</em> of the thromboplastin reagent (the phospholipid part) to get this test to run.</span></span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">
</span></span><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="line-height: 1.5em;">To understand why
the PT measures just the extrinsic pathway and the PTT measures just the
intrinsic pathway, you need to know what activates these pathways in
the body. The extrinsic pathway is activated by tissue factor. The
intrinsic pathway can be activated by a bunch of things, the most
important of which is thrombin. </span></span></span><br />
<br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><span style="font-family: Georgia,"Times New Roman",serif;"><strong>Why the INR measures the extrinsic pathway</strong><br />
To get blood in a test tube to form fibrin along the extrinsic pathway,
you need to add some tissue-factor-like substance. Also, since you
removed the platelets and calcium before running the test, you need to
add those things back into the test tube (the coagulation system needs a
phospholipid surface, normally provided by platelets, and calcium to
run). Thromboplastin is a substance that contains both phospholipids and
a tissue-factor-like substance. Add thromboplastin and some calcium,
and the blood in the test tube will form fibrin via the extrinsic
pathway.</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><span style="font-family: Georgia,"Times New Roman",serif;"><strong>Why the PTT measures intrinsic pathway</strong><br />
To get blood in a test tube to form fibrin along the intrinsic pathway,
you don’t need to add any tissue-factor-like substance (if you do, the
extrinsic pathway will be activated!). All you need to do is add back
what you took out of the blood (phospholipids and calcium), as well as
something like silica or kaolin to activate the intrinsic pathway
(normally, thrombin does this job in vivo), and you’ll form fibrin along
the intrinsic pathway. This is actually why the intrinsic pathway was
named the way it was: everything you need to get the pathway to run is
“intrinsic” to the blood. The extrinsic pathway requires something
“extrinsic” to the blood (tissue factor) for it to run.</span><br />
<br />
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><span style="font-family: Georgia,"Times New Roman",serif;"><strong>Bottom line</strong><br />
The INR activates the extrinsic pathway because in this test you add
thromboplastin (which contains both a tissue-factor-like substance and
phospholipids) to the test tube. The PTT activates the intrinsic pathway
because in this test you add just phospholipids to the test tube – and
without tissue factor around, fibrin is formed along the intrinsic
pathway.</span></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-4357593092735026412014-02-08T22:35:00.002-08:002014-02-08T22:35:45.438-08:00PROTOZOA<div dir="ltr" style="text-align: left;" trbidi="on">
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Protozoa adalah organisma eukariot unisel. Protozoa yang
menyebabkan jangkitan kepada manusia biasanya disebarkan oleh serangga atau
melalui najis dan kebanyakannya menjangkiti usus dan darah .</div>
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<br /></div>
<div class="MsoNormal">
Berikut adalah 15 protozoa yang penting dalam bidang kajian
makmal perubatan (dan penyakit yang berkaitan).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Entamoeba
histolytica (disentri amebic, bernanah hati</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Balantidium coli
(kolitis)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Giardia lamblia
(penyakit cirit-birit malabsorptive)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Isospora belli
(enterocolitis kronik)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Cryptosporidium
sp. (penyakit cirit-birit)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Trichomonas
vaginalis (urethritis, vaginitis)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Naegleria fowleri
(meningoencephalitis)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Acanthamoeba sp.
(meningoencephalitis, ophthalmitis)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Plasmodium sp.
(malaria)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Babesia sp.
(babesiosis)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Trypanosoma sp.
(Penyakit tidur Afrika)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Trypanosoma cruzi
(penyakit Chagas)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Leishmania
donovani (Kala-Azar)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Leishmania sp.
(kulit leishmaniasis)</div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Toxoplasma gondii
(toksoplasmosis)</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-DVuwCfk-f-Y/UvchoaB1qrI/AAAAAAAAA3Q/TSRePqjwShU/s1600/protozoa.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-DVuwCfk-f-Y/UvchoaB1qrI/AAAAAAAAA3Q/TSRePqjwShU/s1600/protozoa.gif" height="640" width="452" /></a></div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-12724095387231292122013-11-02T21:04:00.001-07:002013-11-02T21:04:12.633-07:00Kontaminasi Sampel Darah<div dir="ltr" style="text-align: left;" trbidi="on">
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<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Satu sampel tiba di makmal anda. Ia ambil oleh staf yang
berkelayakan , semestinya ia mempunyai kualiti yang baik, bukan? Tetapi
beberapa faktor perlu diambil kira. Selain memastikan prestasi<span style="mso-spacerun: yes;"> </span>dan keupayaan instrumen untuk menjalankan
analisis, MLT juga perlu melihat<span style="mso-spacerun: yes;"> </span>kepada
faktor spesimen yang perlu dikompromi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Malangnya , integriti sampel boleh dipertikai dalam beberapa
cara yang tidak begitu jelas . Ini termasuk sampel diambil pada suhu yang tidak
betul , dimana ianya tidak sesuai untuk ujian yang diperlukan, atau sampel
" tercemar " dengan sesuatu yang boleh mengganggu ujian tertentu.
Walaupun ianya jarang dibincangkan, dua daripada jenis pencemaran yang lebih
biasa ditemui ialah pencemaran melibatkan <i>ethylenediaminetetraacetic acid</i>
(EDTA) dan pencemaran cecair intravena (IV).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>EDTA</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
EDTA adalah antikoagulan yang biasa digunakan dalam ujian
makmal. EDTA digunakan untuk ujian-ujian yang khusus ke atas sampel tersebut. EDTA
selalunya digunakan sebagai antikoagulan pilihan untuk ujian hematologi. Ia ditambahkankan
ke dalam tiub sampel semasa proses pengambilan darah. Pencemaran boleh berlaku
jika darah tidak dipindah menurut susunan tiub yang betul (tiub dengan tambahan
antikoagulan disediakan sebelum tiub serum ), jika sampel dengan antikoagulan
tertuang ke dalam jenis tiub yang berbeza, atau jika jarum digunakan untuk
memindahkan sampel antara jenis tiub yang berbeza ianya akan tercemar dengan
antikoagulan tersebut. <span style="mso-spacerun: yes;"> </span>Tiada petunjuk visual
bahawa sampel yang dibawa ke makmal telah terkontaminasi dengan EDTA, yang
boleh menjejaskan keputusan makmal. Ini bermakna bahawa MLT mestilah pandai
atau berpengalaman dalam mentafsir petunjuk yang menunjukkan kemungkinan pencemaran
EDTA berlaku.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-LFLNSxNbFa4/UnXKAAEIggI/AAAAAAAAA2E/4gyaOzh_hWk/s1600/blood-sample.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="217" src="http://3.bp.blogspot.com/-LFLNSxNbFa4/UnXKAAEIggI/AAAAAAAAA2E/4gyaOzh_hWk/s320/blood-sample.jpg" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Kehadiran EDTA boleh menjejaskan beberapa analisa kimia ,
menyebabkan sama ada bacaan meningkat atau menurun. Kalium boleh meningkat
dengan kehadiran EDTA , kerana komposisi ion kalium pada struktur fomula EDTA
(K2 atau K3EDTA ). EDTA bertindak sebagai satu antikoagulan yang mengikat ion
kalsium, oleh itu ia akan menjejaskan paras kalsium jika sampel tercemar. Ion
lain juga terikat bersama EDTA , termasuk magnesium , zink dan besi , oleh itu
penurunan bacaan terhadap ujian melibatkan unsur-unsur ion ini dapat
diperhatikan. EDTA juga boleh mengurangkan aktiviti enzim seperti alkaline <i>phosphatase
alkali</i> atau <i>creatine kinase</i> , disebabkan ikatan terbentuk daripada
kofaktor yang diperlukan.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Mengalpasti Pencemaran Sampel.</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Cara yang paling biasa untuk mengenal pasti pencemaran
sampel adalah dengan mengenali corak analisa / keputusan ujian normal yang dapat
menunjukkan kehadirannya. Analisa Kalium dan Kalsium banyak diuji dalam ujian
rutin. Oleh itu, kedua-dua keputusan sering terdapat di dalam spesimen yang
sama. Satu corak hyperkalemia dengan hypocalcemia yang melampau harus
mencetuskan persoalan berkaitan pencemaran EDTA. Di samping itu, kehadiran
hypomagenesemia , hypozincemia dan penurunan aktiviti alkaline phosphatase juga
boleh menguatkan syak wasangka ini. Walaupun ini adalah sebahagian daripada
analisa kimia yang terjejas oleh pencemaran EDTA, beberapa keputusan ujian lain
juga boleh dipengaruhi oleh kehadiran EDTA.</div>
<div class="MsoNormal">
Andaian kesan pencemaran EDTA hanya dibuat jika keputusan
yang tidak normal diperolehi, sebaliknya sukar untuk mengenal pasti kesan pencemaran
jika keputusan ujian yang diperolehi adalah dalam julat yang normal. Sebagai
contoh , peningkatan kalium akibat pencemaran K2EDTA dalam pesakit hypokalemic yang
meningkatkan paras kalium mereka kepada normal. Pada kes ini, perhatian yang
klinikal yang berkaitan dengan analytes lain, seperti kalsium dan magnesium ,
boleh memberikan penunjuk kehadiran EDTA.</div>
<div class="MsoNormal">
<br /></div>
<b>
</b><div class="MsoNormal">
<b>Kontaminasi oleh cecair IV <i>(IV fluid</i>)</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Satu lagi sumber pencemaran sampel darah makmal adalah
kehadiran cecair IV. Ini boleh berlaku apabila sampel diambil dari “IV line”garis
tanpa membuang darah pada aliran yang awal, atau mengambil dari venipuncture
langsung di bahagian atas tapak IV.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-6AyiOiRWarU/UnXKSMh4b_I/AAAAAAAAA2U/23xYHipXWiM/s1600/blood-sample2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/-6AyiOiRWarU/UnXKSMh4b_I/AAAAAAAAA2U/23xYHipXWiM/s320/blood-sample2.jpg" width="207" /></a></div>
<div class="MsoNormal">
Analisa kimia tertentu dalam darah boleh
terjejas dengan kandungan cecair IV. Sebagai contoh , klorida, kalium dan
glukosa yang terkandung dalam cecair IV akan meningkatkan kandungannya dalam
analisa darah. Jika sampel yang telah dicairkan dengan jumlah yang agak besar dengan
cecair IV, banyak perubahan secara keseluruhan dalam keputusan analisa kimia
mungkin berlaku. Kebanyakan nilai analisa akan menurun pada masa yang sama ,
termasuk elektrolit dan kepekatan protein.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-6Qx_TJnGpzI/UnXKewZImHI/AAAAAAAAA2c/PpP90u4aKto/s1600/IV+fluid.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://1.bp.blogspot.com/-6Qx_TJnGpzI/UnXKewZImHI/AAAAAAAAA2c/PpP90u4aKto/s320/IV+fluid.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-Z0bLRCDt7oc/UnXKIdrcITI/AAAAAAAAA2M/MPheFYLb6uI/s1600/iv-fluids.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-Z0bLRCDt7oc/UnXKIdrcITI/AAAAAAAAA2M/MPheFYLb6uI/s1600/iv-fluids.jpg" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Bahan-bahan Cemar lain.</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
EDTA dan cecair IV adalah hanya dua contoh bahan cemar yang
boleh memberi kesan kepada keputusan makmal . Contoh lain termasuk antikoagulan
tambahan, seperti citrat atau heparin, yang boleh mengganggu ujian makmal
tertentu.</div>
<div class="MsoNormal">
Selain mengenalpasti corak umum analisa kimia dalam sampel
yang terjejas , langkah-langkah lain yang boleh digunakan untuk membantu
mengenal pasti kemungkinan sampel tercemar, seperti “delta check”, peraturan
middleware, atau perbandingan dengan ujian tambahan dijalankan serentak pada
spesimen tambahan. Meskipun tiada tanda-tanda sampel tercemar di makmal, MLT perlu
sentiasa berwaspada dengan corak analisa yang ekstrem yang mungkin akibat
pencemaran sampel. Ini membantu memastikan bahawa semua sampel mempunyai
kualiti yang tinggi dan hanya keputusan yang tepat yang dilaporkan.</div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-9164690539951959942013-07-20T10:00:00.000-07:002013-07-20T10:00:04.800-07:00LEFT SHIFT<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;"><span style="font-size: x-large;"><b><span style="color: red;">LEFT SHIFT </span></b></span></span></span></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-d8oXzR-1O-4/UdIohh4dseI/AAAAAAAAAw4/gSttadSlJIU/s1024/leftshift.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="426" src="http://4.bp.blogspot.com/-d8oXzR-1O-4/UdIohh4dseI/AAAAAAAAAw4/gSttadSlJIU/s640/leftshift.jpg" width="640" /></a></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;"><span style="font-size: x-large;"><b><span style="color: red;"> </span></b></span></span></span></span></div>
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<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;">Istilah "</span> <span style="color: #0070c0;">left shift " bermakna populasi beberapa sel-sel
"beralih" ke arah prekursor belum matang (bermaksud bahawa terdapat
lebih prekursor belum matang daripada yang biasa anda lihat). Jika anda lihat
siri neutrophil, sebagai contoh. Dalam darah normal, hampir kesemua neutrofil
adalah matang (bersegmen). Dalam " left shift ", anda dapat lihat
neutrofil yang matang tetapi juga neutrofil yang tidak matang (band,
metamyelocytes, myelocytes, dll). Lihat gambar " left shift ", di
atas: kebanyakan sel-sel tidak matang.</span></span></span></div>
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<br /></div>
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<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;"><span style="color: black;"><b><span style="font-size: small;">Rajah : Diagram "Left Shift"</span></b></span> </span></span></span></div>
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<a href="http://2.bp.blogspot.com/-p0H5X7SV57M/UdInnBw149I/AAAAAAAAAwk/BA1Wo1cIZxU/s954/diagramleftshift.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="456" src="http://2.bp.blogspot.com/-p0H5X7SV57M/UdInnBw149I/AAAAAAAAAwk/BA1Wo1cIZxU/s640/diagramleftshift.jpg" width="640" /></a></div>
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<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;">
</span></span><div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;">Istilah " left shift "
adalah merujuk kepada siri neutrophil. Ianya mula digunakan dahulu apabila pengiraan
sel-sel dilakukan secara manual. Kedudukan sel-sel yang paling matang (neutrophil
bersegmen) diletakkan untuk butang yang paling kanan, sel-sel kurang matang (myeloblasts)
telah diletakkan kepada butang yang paling kiri, dan peringkat sel-sel yang lain
terletak diantaranya. Dalam PBF darah yang normal, hampir semua neutrofil terletak
di bawah butang paling kanan dalam pengiraan, tetapi kadang-kadang terdapat juga
precursor yang awal (contohnya, myelocytes, metamyelocytes, atau
promyelocytes). Dalam keadaan ini, sel-sel telah "shifted" ke arah
kiri.</span></span></span></div>
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;">
</span></span><div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;">Bagi kebanyakan kes, apabila terdapat
situasi " left shift ", selalunya pesakit mempunyai jangkitan bakteria.
Kadang-kadang " left shift " <span> </span>juga berlaku apabila terdapat keradangan atau
nekrosis. </span></span></span></div>
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;">
</span></span><div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;">Berhati-hati, jika anda melihat “nucleated
RBC” bersama keadaan " left shift ". Ini dipanggil tindak balas
leukoerythroblastotic, ia mungkin menunjukkan masalah yang lebih serius.
Kadang-kadang, satu tindak balas leukoerythroblastotic adalah <i>psikologic</i>.
Jika hemoglobin adalah sangat rendah (untuk apa jua sebab - kekurangan zat besi
yang teruk, kehilangan darah secara besar-besaran), sum-sum tulang akan cuba
sedaya upaya untuk menghasilkan sel-sel merah baru dan menghantar mereka keluar
ke dalam salur darah secepat mungkin. Keperluan mendesak ini kadang-kadang
menyebabkan beberapa prekursor sel darah merah (<i>nucleated RBC</i>) terlepas
dari sum-sum tulang. Dan ia juga mula membiarkan prekursor neutrophil
(metamyelocytes, myelocytes, promyelocytes) dikeluarkan. Ini adalah tindak
balas yang normal kepada kes <span> </span>anemia yang
teruk.</span></span></span></div>
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;">
</span></span><div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;">Tindak balas
leukoerythroblastotic juga berlaku jika sumsum penuh dengan sesuatu selain tisu
hematopoietik - sebagai contoh, carcinoma, atau leukemia - maka sel-sel
hematopoietik tidak akan mempunyai ruang yang cukup untuk matang secara
sempurna. Sel-sel ini akan keluar meninggalkan sum-sum sebelum mereka matang,
dan anda akan melihat kedua-dua sel “nucleated RBC” dan prekursor neutrophil
dalam darah. Ini bukanlah sesuatu yang baik..</span></span></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;"><span style="color: #0070c0;"><span style="color: black;"><b><span style="font-size: small;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><strong>Figure 1:</strong> Haematopoiesis cell development pathways.</span></span></b></span> </span></span></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-xn3l6sVly94/UdIn8CEhPPI/AAAAAAAAAws/g9gjoO3EWdM/s954/haematopoiesis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="528" src="http://3.bp.blogspot.com/-xn3l6sVly94/UdIn8CEhPPI/AAAAAAAAAws/g9gjoO3EWdM/s640/haematopoiesis.jpg" width="640" /></a></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Verdana,sans-serif;"><span style="font-size: large;">
<span style="color: #0070c0; line-height: 115%;">Salah satu cara untuk
menentukan sama ada tindak balas leukoerythroblastotic <span> </span>membimbangkan adalah dengan melihat
hemoglobin. Jika kandunga hemoglobin adalah sangat rendah (katakan, di bawah
6), maka tindak balas leukoerythroblastotic mungkin adalah secara fisiologi.
Walau bagaimanapun, jika hemoglobin adalah normal, atau hanya sedikit menurun,
maka tidak ada sebab untuk pesakit untuk mempunyai reaksi
leukoerythroblastotic, dan anda perlu lebih memahami apakah penyebabnya</span></span></span></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-496368996658662325.post-73657101132832464382013-07-18T01:41:00.000-07:002013-07-18T01:41:00.060-07:00STUDY SLIDE 6 (july)<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span class="smalltext"><br /><b>Question</b> : The blood film of an apparently healthy
female aged 20 years who attended a health screening centre where she
was found to have a palpable spleen. Hb = 13.7g/dl.‚ red cells
7.21x10^12/l‚ MCV 61.7fl.</span></span><br />
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-6gf2E0p6UqA/UdFCJGrVGcI/AAAAAAAAAwU/ADqGExItgVE/s749/basophillic+stippling.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="420" src="http://4.bp.blogspot.com/-6gf2E0p6UqA/UdFCJGrVGcI/AAAAAAAAAwU/ADqGExItgVE/s640/basophillic+stippling.JPG" width="640" /></a></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>Answer :</b> <i>The red cell indices are consistent with a
thalassaemia trait. From the Hb and red cell count you will have
determined that the MCH is 19pg‚ and this value x100 divided by the MCV
gives the MCHC‚ approximately 31g/dl. The red cells are small‚ and in
the film many of them show punctate basophilia </i></span><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><i><b>(<span style="color: blue;"><span style="font-size: x-small;">Basophilic stippling</span></span></b><span style="color: blue;"><span style="font-size: x-small;"> aka <b>Punctate basophilia</b> refers to an observation found when observing a blood smear in which <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Erythrocytes" title="Erythrocytes">erythrocytes</a>
display small dots at the periphery. These dots are the visualization
of ribosomes and can often be found in the peripheral blood smear, even
in some normal individuals</span></span>). The usual explanation of
such findings is a thalassaemia. At this age further investigation into
the type of thalassaemia may be required and consideration given to
future genetic implications.
</i></span></div>
Unknownnoreply@blogger.com