Jounal Reading Ppt Pas
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8/3/2019 Jounal Reading Ppt Pas
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Using iron profile to identifyUsing iron profile to identifyanemia of chronic disease inanemia of chronic disease inanemic children withanemic children withtuberculosistuberculosis
dr. RANTI ADRIANI
JOURNAL READING
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INTROD UC TION
y Anemia of chronic disease ( ACD) iscommonly found in patients with chronicinfection.
y ACD pathogenesis commonly referred
to as anemia of inflamationy Differentiate ACD from iron deficiencyanemia ( IDA) important, cause theyhave different in treatments.
backg round
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y Few studies have been reportedy Profile iron less expensive, less invasivey B
one marrow iron gold standar, butinvasive and impracticaly O ther test (s TR) : expensive,not yet
applicable
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y TB is a chronic infection disease indeveloped in developing countries.
y almost 80% childreny Indonesia third highesty Anemia in TB IDA, as malnutrition
commonly occury Recent research : ACD is more common
in TB patientsy Research on ACD in TB cases has not
been widely reported and is generallyperfomed on adult TB patients ratherthan children.
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ME THODSME THODS
y To use iron profiles of children with TB inorder to determine the etiology of anemia and the prevalence of ACD
y Cross sectional study was done in CiptoM angunkusumo Hospital and Tebet HC
y September ² November 2010y Children with TB based on Paediatric TB
scoring system
O bjective
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y
Anemia children having a hemoglobinvalue in the less than normal rangey Excluded criteria :
Treated with anti TB drugs for more 2months
Had received anti inflammatory drugs oriron supplementation
With other condition causing anemia With other chronic disease
M eth ods.. c on tinu e
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y
Iron profile were measured at the ClinicalPathology Laboratory C M Hy Parameter tested :
SI,TIBC, transferin saturation, SF
C reaktif protein inflamation marker diagnosis childhood TB scoring system organ specific TB specialist consultant Type of anemia : Table 1
Statical analysis: SPSS 17,0Normally distrubuted data : M ean ( SD)Non Normally distrubuted data : median
(range )
M eth ods.. c on tinu e
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RESULTRESULTy 81 children as sample of study, anemia
was found in 66 children.
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M edian serumM edian serum ferritinferritin levels andlevels andmedian C RP wasmedian C RP was hingerhinger in thein the
organorgan spesificspesific TBTB
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y O nly 10 children with below normalserum iron levels
y O nly 1 child was diagnosed with pureACD, while 5 children combinationanemia ( ACD and IDA)
y 9 % subject with ACD
R e sul t .. c on tinu enu e
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DISCU SSIONDISCU SSIONy Profile of iron reserve obtained from
subject were not compared with actuallevel of iron the body shoud used thelatest technic
y Serum iron level in this study cannot helpdistinguish between ACD and IDA
y Normal TIB C levels may be due to fewsubject having ACD or combinationanemia
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y Diagnosis of IDA should be considered in
subject group with lower serum ferritinlevely O rgan spesific TB patients had lower
serum iron levels, lower TIB C, similartransferin saturation, higher serum ferritinlevels and higher C RP levels thanchildhood TB patients
y O nly 9 % of subject with ACD smallerthan the result was reported in adult TB patients
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y Patients taking more than 2 months
of anti TB drugs exlusion criteria of patients. This is caused have affectedthe result of the study possibility
that inflamation has subsided couldnot be ruled out
y This is the first study in Indonesia oniron profiles in anemic children withchronic infection disease.
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y Result of this research should befollowed up correct diagnosis isimportantpatient management
y Iron deficiency in anemic child withTB should be proven before ironsuplementation is given, although theincidence of IDA is high in Indonesia
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CON CLUSIONCON CLUSIONy M ost subjects had normal serum iron
levels, normal TIB C, low transferrinsaturation, normal serum ferritin levels.
y The proportion of ACD diagnosed byusing iron profile was not as high asprevious finding in adult TB patients
y Further research using newer technic isneeded to detect ACD in anemic childrenwith TB