Tesis

Profil hematologi pasien malaria dan hubungannya dengan densitas parasitemia di daerah hipoendemis di Sulawesi Utara. = Hematological Profile of Malaria Patients and Its relation with Parasite Density in Hypoendemic Area of North Sulawesi.

Malaria masih menjadi masalah di Indonesia termasuk di Sulawesi Utara dengan Annual parasite incidence(API) 0,35. Parasitemia dapat menyebabkan perubahan profil hematologi.Adanya asosiasi antara parasitemia dengan profil hematologi,sehingga kegunaannya sebagai indikator pemeriksaan laboratorium malaria perlu diteliti.Penelitian ini bertujuan untuk mengetahui profil hematologi (Hb, hitung leukosit dan trombosit) pada penderita malaria rawat inap di daerah hipoendemis ) dan hubungannya dengan hitung parasit. Penelitian ini potong lintang menggunakan data rekam medis pasien malaria rawat inap dari tiga RS di kota Manado, kota Bitung and kab Minahasa Tenggara, Sulawesi Utara yang positif P. vivax atau P. falciparum dan memiliki data hematologi serta hitung parasit. Analisis data dan asosiasi menggunakan uji statistik bivariat pada perangkat lunak SPSS. Sebanyak 65 rekam medis pasien malaria berusia 1 bulan – 67 tahun dianalisis dan didapatkan 28 pasien (43,1%) terinfeksi Plasmodinum falciparum, 37 pasien (56,9%) terinfeksi P. vivax; pasien anak terdiri dari 10.8% balita dan 9,2% anak SD yang tinggal di kota Manado, Bitung dan kab Minahasa tenggara. Kelainan hematologi yang dominan adalah trombositopeni (90,3%), diikuti oleh anemia (61,6%). Sedangkan hitung lekosit umumnya normal, 15,4% lekopeni dan 12,3% lekositosis. Penderita malaria falciparum mengalami trombositopenia sedang-berat sedangkan malaria vivax ringan-berat, perbedaan ini bermakna pada uji statistik (p=0.034, p0,05). Pada penghitungan parasitemia, 64,6% pasien dengan hitung parasit sedang, proporsi parasitemia sedang lebih banyak pada penderita malaria vivax dibanding malaria falciparum (78,4% versus 46,4).Pada P. vivax kadar trombosit berbanding terbalik dengan hitung parasit walaupun secara statistik tidak signifikan. Pada P. vivax kadar Hb dan leukosit tidak ada perbandingan terbalik dengan hitung parasit.Pada Plasmodinum falciparum kadar Hb,trombosit dan leukosit tidak ada perbandingan terbalik dengan hitung parasit.Tombositopenia merupakan parameter hematologi yang dapat menjadi indicator untuk penegakkan diagnosis malaria lebih lanjut.
Kata kunci: Plasmodium falciparum, Plasmodium vivax, profil hematologi, densitas parasit hipoendemis.


Malaria is still a problem in Indonesia, including in North Sulawesi with an annual parasite incidence (API) of 0.35. Parasitemia can cause changes in the hematological profile. There is an association between parasitemia and the hematological profile, so its use as an indicator for malaria laboratory tests needs to be studied. This research aims to determine the hematological profile (Hb, leukocyte and platelet count) in hospitalized malaria sufferers in hypoendemic areas) and relationship with parasite count.This crosssectional study used medical record data from inpatient malaria patients from three hospitals in Manado city, Bitung city and Southeast Minahasa district, North Sulawesi who were positive for P. vivax or P. falciparum and had hematology data and parasite counts. Data and association analysis used bivariate statistical tests in SPSS software. A total of 65 medical records of malaria patients aged 1 month – 67 years were analyzed and it was found that 28 patients (43.1%) were infected with Plasmodinum falciparum, 37 patients (56.9%) were infected with P. vivax; Pediatric patients consist of 10.8% toddlers and 9.2% elementary school children living in the cities of Manado, Bitung and southeast Minahasa district. The predominant hematological disorder was thrombocytopenia (90.3%), followed by anemia (61.6%). Meanwhile, the leukocyte count was generally normal, 15.4% leukopenia and 12.3% leukocytosis. Patients with falciparum malaria experienced moderate-severe thrombocytopenia while vivax malaria had mild-severe, this difference was significant in statistical tests (p=0.034, p0.05). In calculating parasitemia, 64.6% of patients had a moderate parasitemia count, the proportion of moderate parasitemia was greater in vivax malaria sufferers than falciparum malaria (78.4% versus 46.4). statistically insignificant. In P. vivax there is no inverse comparison of Hb and leukocyte levels with the parasite count. In Plasmodinum falciparum there is no inverse comparison of the Hb, platelet and leukocyte levels with the parasite count. Thrombocytopenia is a hematological parameter that can be an indicator for further diagnosis of malaria.
Key words: Plasmodium falciparum, Plasmodium vivax, hematological profile, hypoendemic parasite density.