Tesis

Korelasi Jumlah Trombosit dan Immature Platelet Fraction dengan Fungsi Agregasi Trombosit Pada Pasien Trombositopenia = Correlation between Platelet Count and Immature Platelet Fraction with Platelet Aggregation Function in patient with thrombocytopenia.

Latar Belakang: Risiko perdarahan tidak berkorelasi linear dengan jumlah trombosit pada kondisi trombositopenia. Diasumsikan terdapat perbedaan fungsi trombosit pada trombositopenia akibat gangguan produksi dengan trombositopenia akibat destruksi perifer. Pada kondisi trombositopenia hasil pemeriksaan fungsi agregasi trombosit dengan light transmission aggregometry (LTA) tidak valid. Diperlukan pemeriksaan fungsi trombosit yang dapat dikerjakan pada kondisi trombositopenia. Tujuan: Mengkaji fungsi agregasi trombosit pada pasien trombositopenia akibat gangguan produksi dan akibat destruksi perifer. Metode: Studi potong lintang terhadap 60 pasien trombositopenia akibat gangguan produksi dan akibat destruksi perifer di Rumah Sakit Cipto Mangunkusumo selama periode Desember 2023 sampai April 2024. Dilakukan pemeriksaan jumlah trombosit, immature platelet fraction (IPF), dan fungsi agregasi trombosit dengan menggunakan Plateletworks ADP Kit pada cell counter berbasis impedans. Hasil: Terdapat perbedaan fungsi agregasi antara trombositopenia akibat gangguan produksi dengan akibat destruksi perifer (40% vs 77,7%), meskipun secara statistik tidak bermakna. Didapatkan perbedaan nilai IPF antara trombositopenia akibat gangguan produksi dengan akibat destruksi perifer (5,65% vs 21%). Tidak didapatkan korelasi antara jumlah trombosit dengan fungsi agregasi trombosit pada trombositopenia akibat gangguan produksi maupun akibat destruksi perifer (r=0,214, p=0,231; r=0,364, p=0,062). Tidak didapatkan korelasi antara IPF dengan fungsi agregasi trombosit pada trombositopenia akibat gangguan produksi maupun akibat destruksi perifer (r=-0,139, p=0,498; r=-0,282, p=0,171). Untuk membedakan trombositopenia akibat gangguan produksi atau akibat destruksi perifer, didapatkan titik potong IPF 10,25% dengan sensitivitas 80,8% dan spesifisitas 68%. Kesimpulan:Fungsi agregasi trombosit pada trombositopenia akibat destruksi perifer lebih baik daripada trombositopenia akibat gangguan produksi. Fungsi agregasi trombosit tidak berkorelasi dengan jumlah trombosit maupun dengan IPF.
Kata kunci: Trombositopenia, Fungsi Agregasi Trombosit, Immature Platelet Fraction.


Background: The risk of bleeding does not linearly correlate with platelet count in thrombocytopenia. It is thought that there is difference between platelet function in thrombocytopenia due to decreased production and thrombocytopenia caused by peripheral destruction. The result of platelet aggregation performed by light transmission aggregometry (LTA) is not valid in thrombocytopenia. Another method for platelet aggregation assay that can be performed in thrombocytopenia is needed. Objective: To assess platelet function in thrombocytopenia patients due to decreased production and thrombocytopenia due to peripheral destruction. Methods: A cross-sectional study was conducted on 60 thrombocytopenic patients due to decreased production and due to peripheral destruction at Cipto Mangunkusumo Hospital from December 2023 to April 2024. Platelet count and immature platelet fraction (IPF) were done by automatic blood cell counter (Sysmex XN 3000, Kobe, Japan) while platelet aggregation was performed by Plateletworks ADP Kit (Helena Laboratories, Beaumont, TX, USA) Results: There was a difference in platelet aggregation function between thrombocytopenia due to decreased production and thrombocytopenia due to peripheral destruction (40% vs 77.7%). A difference in IPF values was found between thrombocytopenia due to decreased production and thrombocytopenia due to increased destruction (5.65% vs 21%). There was no correlation between platelet count and platelet aggregation function in thrombocytopenia due to decreased production and peripheral destruction, respectively (r=0.214, p=0.231; r=0.364, p=0.062). No correlation was found between IPF and platelet aggregation function in thrombocytopenia due to decreased production and due to increased destruction, respectively (r=-0.139, p=0.498; r=-0.282, p=0.171). The cut-off value of IPF was 10.25% with sensitivity of 80.8% and specificity of 68% to distinguish thrombocytopenia due to decreased production from peripheral destruction. Conclusion: Platelet aggregation function in thrombocytopenia due to peripheral destruction was better than thrombocytopenia due to decreased production. Platelet aggregation function did not correlate neither platelet count nor IPF.
Keywords: Thrombocytopenia, Platelet Aggregation Function, Immature Platelet Fraction