Preface

Praise be to Allah, Lord of the worlds. Our blessings and greetings do not forget to say to
our lord the Great prophet Muhammad. We are grateful to Allah SWT for providing guidance and
guidance to us so that we can complied a scientific paper entitled “Hemoglobin Examination in
Patients with Anemia Using a Centrifuge”, as the assignment of English, the authors convey my
gratitude to English lecturer Anik Aniqoh, M.Pd. Finally, the authors pray that Allah SWT always
gives an abundance of His grace and guidance to all of the parties mentioned above, and hopefully
this paper is useful for readers. Thus we complied this paper. Hope it can be useful all of us. Ameen

Semarang, 29 October 2019

Author

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 Chapter I
Introduction
1.1 Background of Study
Anemia becomes a serious problem in the world of health. Data from the World Health
Organization (WHO) shows that the number of people with anemia globally reaches 2.3 billion
people. The highest prevalence is recorded in Asia and Africa, which is 85%. Most sufferers are
women and children.
Indonesia is listed as one of the countries with quite a lot of sufferers. According to data
from the Basic Health Research (Riskesdas) in 2013, the number of people with anemia consisted
of 26.4% of children, 12.4% of men ages 13-18 years, 16.6% of men over 15 years, 22.7% of
women aged 13-18 years, 22.7% of women aged 15-49 years, and 37.1% of pregnant women.
The causes of anemia are very diverse, from those affected by bleeding, iron deficiency,
folic acid, vitamin B12, to hemolytic disorders. Anemia can be known by physical examination
and laboratory examination. Physically the patient looks pale, weak, and the laboratory is found a
decrease in hemoglobin (Hb) levels in the blood from the normal price. Low levels of hemoglobin
(Hb) in the blood are influenced by the ability of the blood to deliver oxygen needed for optimal
body metabolism.
1.2 Statement of the Problem
In this paper we would to discuss. We are going to explain why we choose this topic, they
are :
a. Why does someone have to do a blood test?
b. How can hemoglobin be categorized as anemic disease?
c. What is the method used in Hb inspection with a centrifuge?
1.3 Reasons of Choosing the Topic
In this paper we would to discuss. We are going to explain why we choose this topic,
they are :
a. To find out someone has to do a blood test.
b. To find out Hb levels can be categorized as anemia.
c. To find out the method used in Hb inspection with a centrifuge.

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1.4 Benefits of the Study
a. For author
It is hoped that the results of this research can be developed more broadly and be further
refined for further research in order to add insight to researchers.
b. For university
It is expected that the results of this study can be a contributor to the development of
health sciences, especially about the examination of hemoglobin in patients with anemia using a
centrifuge.
c. For further researcher
It is hoped that this research can be a reference for the public about the importance of Hb
examination.
1.5 Outline of Paper
Chapter I Introduction
1.1 Background of Study
1.2 Statement of the problem
1.3 Reasons of choosing the topic
1.4 Benefits of the study
1.5 Outline of paper
Chapter II Related Literature
2.1 Hemoglobin
2.2 Anemia
2.3 Hemoglobin Examination in Patients with Anemia
Chapter III Methodology
3.1 Discussion
3.2 Result
Chapter IV Closing
4.1 Conclusion
4.1.1 Implication
4.1.2Recomendation

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 CHAPTER II

Related Literature

2.1 Hemoglobin

Hemoglobin is a protein that is rich in iron. It has an affinity (combining power) to oxygen
and with oxygen it forms oxihemoglobin in red blood cells. Through this function, oxygen is
carried from the lungs to the tissues (Evelyn, 2000). Hemoglobin is a molecule that consists of
heme (iron) and globin polypeptide chains (alpha, beta, gamma, and delta), which are in
erythrocytes and are responsible for transporting oxygen. Blood quality is determined by
hemoglobin levels. The Hb structure is stated by stating the number and types of globin chains that
exist. There are 141 amino acid molecules in the alpha chain and 146 amino acid molecules in the
beta, gamma and delta chains. The function of hemoglobuin is to transport oxygen from the lungs
and in the circulation of blood to be carried to the tissues. The level of hemoglobin with oxygen is
called HbO2 (Oxyhemoglobin). In addition to oxygen, hemoglobin also carries carbon dioxide and
with carbon monoxide forms carbon monoxide bonds forming HbCO bonds (Oxyhemoglobin).
carbonmonoxihemoglobin), also plays a role in blood pH balance. Hemoglobin synthesis occurs
during the erythropoysis process, the maturation of red blood cells will affect the function of
hemoglobi. (Tarwoto and Wartona, 2008: 12).

Hemoglobin is a molecule that consists of heme (iron) and globin polypeptide chains
(alpha, beta, gamma and delta), are in erythrocytes and have the task of transporting oxygen. Blood
quality is determined by hemoglobin levels. Hemoglobin deficiency causes anemia, which is
characterized by symptoms of fatigue, shortness of breath, pale and dizzy. Excess hemoglobin will
cause blood viscosity if the level is around 18-19 gr / ml. Which can lead to stroke. Hemoglobin
levels can be influenced by the availability of oxygen in a place to live, for example, Hb increases
in people who live at a high place above sea level. In addition, Hb is also influenced by the position
of the patient (standing, lying), diurnal variation (morning highs).

a. Hemoglobin levels

Hemoglobin level is a measure of respiratory pigment in red blood granules. The amount of
hemoglobin in normal blood is about 15 grams per 100 ml of blood and this amount is usually
called "100 percent". The normal limit of hemoglobin values for a person is difficult to determine

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because hemoglobin levels vary between each ethnic group. The results of hemoglobin levels can
also be influenced by the examination equipment used. Between the simple Sahli method and the
more modern way with a photometer there are certainly differences in the results displayed.
However, the WHO has established normal hemoglobin levels based on age and sex. Table: 11-1
Normal hemoglobin (hb) rate (g / dl) Men 14-18 Women 12-16 Children 11-13. (Tarwoto and
Wartonah, 2008: 30).

b. Hemoglobin structure

Hemoglobin is a metallic protein that carries oxygen from the lungs to tissues throughout the
body and takes carbon dioxide from that tissue and is carried to the lungs to be discharged into the
air. Hemoglobin molecule consists of globin, apoprotein, and four heme groups of organic
molecules with one iron atom. Mutations in the hemoglobin protein gene cause a group of diseases
called hemoglobinopathy, among which the most frequently encountered is sickle cell anemia and
thalassemia. The function of hemoglobin is to transport oxygen from the lungs and in the
bloodstream to below the tissue. Hemoglobin binding with oxygen mention oxyhemoglobin
(HbO2). Besides oxygen, hemoglobin also carries carbon dioxide and with carbon monoxide to
form carbon monoxide bonds carbon bonds mooksihemoglobin (HbCO), also plays a role in the
balance of blood Ph (Tarwoto, Ns, s.Kep, et al, 2008: 12).

2.2 Anemia

Anemia is a condition with levels of hemoglobin, hematocrit and red blood cells that are
lower than normal, as a result of deficiency of one or several essential food elements that can
influence the onset of the deficiency (Arisman, 2010).

Anemia is a condition of insufficient iron reserves so that the reduction in iron distribution
to body tissues. The level of iron deficiency is more severe associated with anemia which is
clinically determined by a decrease in hemoglobin levels to less than 11.5 gr / gl (Miller, 2008).

Anemia is characterized by low concentrations of hemoglobin or hematocrit due to low

production of red blood cells and hemoglobin, increased damage to erythrocytes or hemolysis, or
excessive blood loss. Fe deficiency plays a major role in the incidence of anemia (Fatmah, 2010).
Iron deficiency anemia is anemia arising from reduced supply of iron for erythropoesis, due to
bare metal reserves which ultimately result in reduced hemoglobin formation (Sudoyo, 2006).

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2.3 Hemaglobin Examination in Patients with Anemia

Anemia is a condition in which the mass of erythrocytes and the mass of circulating
hemoglobin cannot fulfill its function of providing oxygen for body tissues (Bakta, 2006). Health
consequences caused by iron deficiency include premature birth, low birth weight, infection, and
an increased risk of death. Later there will be disruption in physical and cognitive development
which results in poor school performance.

Zulaekha research results (2014), said that the condition of anemia can reduce the growth rate
of children. Anemia occurs due to several factors including bleeding due to menstruation,
infectious diseases, chronic diseases, physical activity, and most commonly is due to inadequate
intake of iron in the body one of the consequences of consuming foods that inhibit the absorption
of iron or inhibitors for example tannins and oxalate, but iron can also be well absorbed when
consuming food source enhancers such as vitamin C.

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 Chapter III
Discussion and Reasult
3.1. Discussion
A centrifuge is a piece of equipment that puts an object in rotation around a fixed axis (spins
it in a circle), applying a force perpendicular to the axis of spin (outward) that can be very strong.
The centrifuge works using the sedimentation principle, where the centrifugal acceleration causes
denser substances and particles to move outward in the radial direction. At the same time, objects
that are less dense are displaced and move to the center. In a laboratory centrifuge that uses sample
tubes, the radial acceleration causes denser particles to settle to the bottom of the tube, while low-
density substances rise to the top.
There is type of centrifuge one of which is haematocrit centrifuges are used to measure the
volume percentage of red blood cells in whole blood. This examination will be used to determine
hemoglobin levels.
a. Tools and Materials
As for the supporting tools, spuit of syringe for taking blood samples and also a test tube to
place blood.
b. Procedur
first is sampling blood, a medical provider will need a small sample of blood to test
hematocrit. This blood can be drawn from a finger prick or taken from a vein in arm.
If the hematocrit test is part of a CBC, a lab technician will draw blood from a vein,
typically from the inside of elbow or from the back of hand. The technician will clean the surface
of skin with an antiseptic and place an elastic band, or tourniquet, around upper arm to help the
vein swell with blood.
They’ll then insert a needle in the vein and collect a blood sample in one or more vials.
The technician will remove the elastic band and cover the area with a bandage to stop the bleeding.
next, sample will be sent to a lab for analysis.
Put blood into the tube then connect the centrifuge cable to the power source, open the
outer cover of the centrifuge then insert the hematocrit tube into the centrifuge in a balanced way,
close the centrifuge cover. after that press the ON button, set the time and speed then press the
start button. the tool will stop itself in accordance with the specified time. After the centrifuge
stops, press the off button.

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3.3 Result
From laboratory blood tests found :
Hb ↓ MCV ↓
Ht ↓ dengan MCH ↓
E↓ MCHC ↓
→ MCV < 40 fl
Blood flows throughout the body, acting as a medium that carries nutrients and oxygen to
tissues and all cells. Blood also carries waste products back to the excretion system for disposal.
Blood flow in the body affects or is affected by many medical conditions. For this reason, a blood
test is one of the most common tests to do.
To detect anemia, one of the methods of examination is to do a blood test. to find out the
hemoglobin level in a person's blood. when blood levels are low blood is not optimal in delivering
oxygen throughout the body. therefore the examination is very important to do in order to know
the condition of a person's body
In the laboratory, your hematocrit is evaluated using a centrifuge, which is a machine that
spins at a high rate to cause the contents of your blood to separate. A lab specialist will add a
special anticoagulant to keep your blood from clotting.
When the test tube is taken out of the centrifuge, it will have settled into three parts:
1. red blood cells
2. anticoagulant
3. plasma, or the fluid in your blood
Each component will settle in a different part of the tube, with the red blood cells moving
to the bottom of the tube. The red blood cells are then compared to a guide that tells what
proportion of your blood they make up.
Decreased HB levels in red blood cells is a cause of someone suffering from anemia.
hemoglobin (Hb) in red blood cells which functions to transport oxygen throughout the body so
that tissue oxygen demand is not met. hemoglobin (Hb) so low may be associated with any disease
or condition that causes blood to have very few red blood cells (erythrocytes). This happens if the
body produces only a little, if the blood cells are destroyed faster than the level of production, or
if the body experiences blood loss.

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 Chapter IV
Conclusion, Implication, and Recomendation

4.1 Conclution
To detect anemia, one of the methods of examination is to do a blood test. to find out the
hemoglobin level in a person's blood. when blood levels are low blood is not optimal in delivering
oxygen throughout the body. therefore the examination is very important to do in order to know
the condition of a person's body
low levels of hemoglobin (Hb) in red blood cells that function to carry oxygen throughout
the body so that tissue oxygen demand is not met, this causes anemia.
4.2 Implication
a. Theoretical
It is hoped that the results of this study will be able to contribute to the development
of health sciences, especially in the area of health analysts.
b. Practical
It is expected that the results of this study can be used as a reference for the public
to be able to know the importance of health checks, especially hemoglobin levels that refer
to anemia regularly.
4.3 Recommendation
a. For college teacher
Give appreciation for this research to a better result in the further
b. For other Researcher
It is hoped that this research can be developed more broadly and be useful to readers
c. For the Goverment
The government is expected to provide wider socialization about anemia to the
public so that people can know the importance of blood tests, especially hemoglobin to
find out anemia

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 REFERENCES
Book and Jurnal :
Argana,G., Kusharisupeni dan Utari Diah . 2004. Vitamin C Sebagai Faktor Dominan
Untuk KadarHemoglobin Pada Wanita Usia 20 - 35 Tahun. Jurnal Kedokteran Trisakti, 23 (1).
Basith, A., Agustina, R., & Diani, N. (2017). Faktor-faktor yang berhubungan dengan
kejadian anemia pada remaja putri. Dunia Keperawatan, 5(1), 1–10.
Briawan, Dodik.dkk. 2007. Efikasi Suplemen Besi-Multivitamin Untuk Perbaikan Status
Besi Remaja Wanita. Fakultas Kedokteran Bandung.
Evelyn 2000. Anatomi dan fisiologi untuk parameter, cetakan ke 23 gramedia pustaka
utama . Jakarta.
Tarwoto dan Wartonah. (2008) Keperawatan Medical Bedah Gangguan System
Hematologi, Jakarta: Trans info Media.
Zulaekah, Siti., Purwanto, Setiyo dan Hidayati, Listyani. 2014. Anemia Terhadap
Pertumbuhan dan Perkembangan Anak Malnutrisi. Jurnal kemas, 9(2) (2014) 106- 114.
Internet :
https://www.hematology.org/Patients/Basics/#,
https://www.webmd.com/heart/anatomy-picture-of-blood#1
https://en.wikipedia.org/wiki/Centrifuge,
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anaemia
https://www.alodokter.com/kenali-jenis-dan-fungsi-tes-darah
https://www.bumrungrad.com/indonesia-healthpoint/August-2017/anemia-hilangnya-sel-darah-
merah

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