PERAN PEMERIKSAAN HEMATOLOGI

PADA PENANGANAN COVID-19

PDS PatKLIn -
 LATAR BELAKANG
 Situasi Terkini

 Gambar Update COVID-19

Di Indonesia (Pasien
Positif, Sembuh dan
Meninggal)

Sumber: https://www.covid19.go.id/
 CORONA VIRUS INFECTIOUS DISEASE (COVID-19)
Coronaviruses are a family The virus is now known as
of viruses that can cause the severe acute
illnesses such as the respiratory syndrome
common cold, severe acute coronavirus 2 (SARS- CoV-
respiratory syndrome (SARS) 2). The disease it causes
and Middle East is called coronavirus
respiratory syndrome disease 2019 (COVID-19).
(MERS). In 2019, a new In March 2020, the World
coronavirus was identified Health Organization (WHO)
as the cause of a disease declared the COVID-19
outbreak that originated outbreak a pandemic.
in China.

https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963
MEKANISME PENULARAN VIRUS
 GEJALA KLINIK

• Tiredness
• Aches
• Runny nose
• Sore throat
• Headache
• Diarrhea
• Vomiting
• Loss of smell
or taste
https://www.mayoclinic.org/covid-19-self-assessment-tool
 TREATMENT

RISK COMPLICATIONS
CAUSES
FACTORS

https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963
 LABORATORIUM COVID-19

Clinical Screening &

CBC Diagnostic
Chemistry
Hematologi Rutin: ANTIBODI (ANTISARS
❏ Hb, Ht, Jumlah CRP
COV2)
Sel, Indeks LFT RAPID TES
Eritrosit, Hitung RFT ANTIGEN: Deteksi
CK Antigen/Virus Atau
Jenis, LED Materi Genetik Berbasi
❏ HFC PROCALCITONIN
Molekuler

NEJM 2020, Clinical Characteristic of Corona Virus Disease 2019

HEMATOLOGI
 HEMATOLOGI

 Routine blood test White blood cell

count is usually normal or reduced,
CBC with decreased lymphocyte count,
progressive lymphocytopenia in
severe cases.
 NLR is Neutrophil to Lymphocyte count
Ratio, it’s calculated from CBC result,
NRL easy-to-use parameter.
 Study6 in Beijing showed that cut-off
value of NLR is 3.13, sensitivity is 0.875
and specificity is 0.717
PERUBAHAN PARAMETER HEMATOLOGI
 CBC
LIMFOPENIA &
• PASIEN • GGO
CRP
RESPIRATIF
• PENURUNAN • RT PCR SWAB
• TANPA HIPOKSIA
LIMFOSIT <
1100/uL
PENCITRAAN &
CBC & CRP • PENINGKATAN CRP MOLEKULER
DIAGNOSTIK
 LIMFOPENIA
MEKANISME SARS-
COV2
(LIMFOSIT T)
PROGNOSIS BURUK APOPTOSIS

LIMFOPENIA
MEKANISME LIMFOPENIA-SARS COV

APOPTOSIS

KELELAHAN
FUNGSIONAL
(NKG2A)

KAITAN
PASIEN
PEDIATRIK
 HEMATOLOGI
N L R
The NLR was the Calculated
early automatically (band NLR is meaningful
identification of neutrophil + parameters for
risk factors for segmented prognosis and risk
2019-nCoV severe neutrophil)/ stratification
illness. Patients lymphocyte management, which
with age ≥ 50 and would be helpful to
NLR ≥ 3.13 alleviate
facilitated severe insufficient
illness and they medical resources.
should rapidly
access to
intensive care
unit if
necessary.
NLR SEBAGAI PENENTU TINDAKAN

RS Umum atau
Isolasi Mandiri

Ruang Isolasi Umum

Kamar Isolasi dengan

alat bantu Pernapasan

ICU dengan alat bantu

pernapasan invasif

Hematology Covid-19 related Mindray

NLR NEUTROPHIL TO LYMPHOCYTE RATIO

Parameter NLR adalah

parameter yang
mudah dan efisien
untuk pemantauan
inflamasi rutin.

Hematology Covid-19 related Mindray

 HEMATOLOGI

H F C
MENGGUNAKAN MENDETEKSI SEL MENGGAMBARKAN
METODE DENGAN TINGKAT ATIPIKAL
FLUORESENSI KEMATANGAN LIMFOSIT & SEL
DGN RESOLUSI RENDAH BLAST
TINGGI (EKSPRESI
DNA/RNA)
 HEMATOLOGI
DIFF
Atypical scattergram
Lymp. &
Blast HFC IMG*

Monocyt Band
e

Lymphoc
Neu &
yte
Bas

Eosinop
NRBC hil

HEMATOLOGY ANALIZER MINDRAY PLT Clump Infected RBC

 PARAMETER LAIN

PENANDA INFALAMASI (CRP,

LED, PCT, DLL)

KOAGULASI

RANTAI GLOBIN PADA

HEMOGLOBIN??
PANDEMI COVID 19 – MASALAH GLOBAL
PENAPISAN SECARA LABORATORIUM
PENINGKATAN
JUMLAH PERAN
CBC
KASUS COVID LABORATORIUM LAIN
(LEUKOSIT,
19 LIMFOSIT) PENANDA
(TANTANGAN INFLAMASI
PENANGANAN) NLR
KOAGULASI
HFC
RANTAI
GLOBIN
PROMINENT CHANGES IN BLOOD COAGULATION OF
COVID 19 PATIENTS
1. Kadar D dimer, FDP, dan Fibronogen lebih
tinggi bermakna
2. D dimer dan FDP meningkat seiring dengan
makin beratnya penyakit
3. Tidak ada perbedaan signifikan pada
parameter PT< APTT, dan TT
 DISSEMINATED INTRAVASCULAR COAGULATION
(DIC)
• DIC is an acquired syndrome characterized by intravascular activation of
coagulation arising from different causes
• It can originate from and cause damage the microvascular which if
sufficiently severe can produce organ dysfunction
• Minimal clinical criteria for DIC:

• Bleeding or thrombosis or both

• Underlying disease
 KRITERIA LAB MINIMAL DIC
1. Bukti adanya aktivasi koagulasi
a. Peningkatan prothrombin fragment 1,2
b. Peningkatan TAT (Thrombin-antitrombin complex)
c. Peningkatan fibrinopeptide A
d. Peningkatan D dimer
2. Bukti adanya aktivasi fibrinolysis
a. Peningkatan D dimer
b. peningkatan FDP
c. peningkatan plasmin dan
d. Plasmin-antiplasmin Complex (PAP)
3. Bukti adanya konsumsi inhibitor
4. Bukti adanya kerusakan end organ
MARI DIAM DI RUMAH!

https://www.covid19.go.id/download/gembira-dan-sehat-dengan-gizi-yang-seimbang/
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