sebagaimana telah diketahui, dillustrasikan pada gambar 13-1, Mekanisme utama koagulast in vivo melalui “jalur extrinsik” juga berperan sebagai jalur faktor jaringan. Faktor jaringan (TF) dilepaskan oleh jaringan vaskuler yang mengalami trauma dan bertindak sebagai cofaktor untuk aktivasi faktor Vil. Faktor VII yang sudah aktif mengaktivasi faktor x dan IX. Paparan faktor sirkulasi XIl secara negatif menyerang konstituten dinding pembuluh darah yang rusak menimbulkan aktivasi “jalur intrinsik”. Faktor XII, prekallikrein, dan kininogen berat molekul tinggi, bersama-sama bertindak sebagai sistem penghubung, merupakan umpan balik positif yang lebih lanjut mengaktivasi sistem intrinsik. Sistem intrinsik “proximal” faktor XI diyakini memiliki peranan kecil dalam hemostasis, efeknya pada faktor penghubung tidak berhubungan dengan kecenderungan perdarahan. alae intresik PTT) ne Xi Faktor Xita 2 Faltor Xt > Falter Xa Sabur ekstrinsik (PT) v Tentepiatn Falter ip Faktori rma Fag vt Faaer va I I ca Fate Fate —~ et FalaorXatt wo ae Powembin | Thomihin aires reowoyn 4 sonienen / sent ten Gambar 45. Mekanisme pembekuan darah Lintasan intrinsik, ekstrinsik, dan lintasan terakhir melibatkan banyak macam protein yang dapat diklasifikasikan sebagai berikut: zimogen protease, kofaktor, fibrinogen, transglutaminase, dan protein pengatur. 1 Hemostatisfoes Thrombophilia testing in the era of direct oral anticoagulants Authors: Jennifer Darlow"* and Holly Mould®* ‘Venous thromboembolism (VTE) is increasingly recognised {in primary and secondary care practice. The arival of direct ‘oral anticoagulants (DOACS) has made the management of ‘VTE easier and more convenient. Some patients established ‘on DOAC: may need sereening For underying thrambophilias ‘ascertain thrombophilic conditions are known to confer]a higher thrombosis sk, although the guidelines for when and hhow to test for a thrombophilia, especially in «patient taking ‘a DOAC, are unclear. This literature review aims to examine ‘when thrombophilia screening should take place in apatient ‘already taking a DOAC, the effect of DOACS on thrombophilia tests, and analyse whether DOACs are safe and effective in ‘both inherited and acquired thrombophilios. KEYWORDS: thrombophilia testing, thrombophilia, rect ‘ral anticoagulants, DOAC, venous twombaembalsm, VTE ‘antiphosphalipid syndrome, APS, DOAC-Stop DOL: 10.7861/cinmed. 2020-1008 Introduction eer comemaent ‘beng a venous thromboembolism (VTE) Despite the increased risk of thromboses ‘in patients iti a thrombophia, there's nolo general consensus ‘on when testing for thrombophiias should be performed. Dect ‘ra anticoaguiant (DOAC) use has seen an exponential rise over the past decade! yet DOACs have been shown tocffect the cltting assays used to test for thrombophilia,” especially those sed to test for antiphospholipid syndrome (APS). This review ‘evaluates the lterature avaiable on cuitent recommendations for thrombophilia testing in relation to DOAC usage. ‘Types of thrombophilia. Inherited thrombophillas can be categorised into high andlow tisk Kigh sk thombophilas ore due to inherited deficiencies {nv endogenous anticoagulants, eluding deficiencies of ‘Authors: "haemotoogy ‘costa, Manchester Royal nfirmery, ‘Manchester, UK; *medical student, University of Manchester, Manchester Uk equal frst authors (© RoyalCotege of Physicians 202, ght served Protein C (PC), Protein (PS) and antithrombin (AT), and also cmbined thromophilc defects“ Other examples include paroxysmal nocturnal hoemogjobinuta (PNH) and patients with JAK2 positive myeloneoplasms.° Low risk thrambophillas Include Factor V Leiden (FVL) mutation and prothrombin time (PT) 6202108 gene mutations “ Elevated foctor VII. IX and Xl levels: plasminogen activator nbibtor dysfibxinagenaemia ‘and hypethomacysteinaeria are also examples of lowisk thrombophilics, Butarenot routinely tested for in athrombophita screen? and are therefore not discussed in detall here, APS is ‘an acquired thrombophilia and confers a hig risk for both VTE as wellas rterial thrombosis.” Its charoctersed by the presence of lupus anticoagulant (LA), beta2 glycoprotein and anticarcholipin antibodies. APS patients who have all three antibodies have the highest VTE rik* Who needs thrombophilia testing? Teisof general consensus that the majarity of patients presenting With VTE should nat be tested fora thrombophilia,” and instead only selected patients should be tested. thos been proposed that inherited thrombophitas can be screened for through ‘examination of family and personal histay of VTE, without the need fora laboratory test. Patients with inherited thrombaphilas often have key features in thei history Box 1), Connors suggested ‘that all pauents with a personal history of VTE at $0 years of ‘ge of younger, alongside a strong family history of VTE should be tested forathrombophila * However, guidelines from the National Institute for Clinical Excelence (NICE), the American Socety of Haematelogy and American College of Chest Physicians suggest others. Peano @ patient with thrombophilia, which can be used to identify Pomoc nee eetPeran Kadar Hemoglobin pada Kebugaran Jasmani Remaja Fadillah, Adriani p-ISSN 0853-7720; e-ISSN 2541-4275, Volume 8, Nomor 2, halaman 199-214, Juli 2023, OI: ttosi/co\ org/10.25105/pdkvBi2.14312 aS Bee Ll PO Cv htips:le journal risakt.ac idindex.phpvlemit PERAN KADAR HEMOGLOBIN PADA KEBUGARAN JASMANI REMAJA. Tersanova Fadilah?, Donna Adriani™” *Program Studi Pendidikan Dokter, Fakultas Kedokteran Universitas Trisakti Bagian Fisiologi, Fakultas Kedokteran Universitas Trisakti, Jakarta, Indonesia 2Program Studi Pendidikan Dokter, Fakultas Kedokteran Universitas Trisakti Bagian Fisiologi, Fakultas Kedokteran Universitas Trisakti, Jakarta, Indonesia **Penulis koresponden: donna.adriani@trisakti ac.id ABSTRAK Kebugaran jasmani merupakan salah satu masalah Kesehatan di Indonesia karena termasuk ke dalam kategori kurang, terutama pada remaja berusia 10- 19 tahun. Remaja diharapkan memilki kebugaran jasmani yang balk karena ‘akan memasuki usie produktif. Kebugaran adalah kemampuan iseseorang, dalam melakukan tugas kejasmanian sehari-hari secara optimal, bahkan masih dapat melakukan kegiatan jasmani tambahan lainnya tanpa menimbulkan kelelahan yang berarti. Faktor yang memengaruhi kebugaran jesmani seseorang terdiri dari faktor internal dan faktar eksternal. Faktor internal yaitu yang sudah menetap dari dalam tubuh seperti genetik, usia, jents kelamin, sedangkan faktor eksternal adalah aktivitas fisik, status gizi, status kesehatan, kecukupan istirahat, kebiasaan merckok dan kadar hemoglobin. Hemogslobin merugakan kompleks proteinyang terdiri dari heme dan globin, kaya aken zat besi dan salah satu fungsinya iuntuk membawa oksigen dari paru ke jaringan ‘tubuh atau seluruh tubuh. Ketika kadar hemoglobin di dalam darah seseorang, lebih rendah dari kadar normal, berarti orang tersebut mengalami anemia. Anemia masih menjadi permasalahan di masyarakat yang tersebar di seluruh unia, terutame pada negara berkembang seperti Indonesia. Berdasarkan data Kemenkes Ri tahun 2013, prevalensi anemia pada semua kelompok umur adalah 21,70%. Gejala jika kadar hemoglobin rendah adalah lemah, mudah lelah, produktivitas kerja buruk, dan berkonsetrasi. Mekanisme ini disebabkan oleh penurunan ambilen oksigen dan berkurangnya kapasitas oksigen yang. ‘akan di transpor ke jaringan tubuh sehingga berdampak pada kebugaran jasmani. Kajian pustaka ini membahas faktor yang dapat memengeruhi kebugaran jasmani dan peran kadar hemoglobin pada kebugaran jasmani, sehingga dapat meningkatkan kebugeran jasmani ABSTRACT Physical fitness becomes a problem in indonesia because it is categorized in the poor category, especially for adolescents aged 10-19 years. Adolescents ‘are expected to have good physical fitness as they are about to enter productive age. Physical fitness is defined as the ability of a person to perform daily physical tasks optimally, even doing several additional physical activities 199 SEJARAH ARTIKEL Diterima 3 Agustus 2022 Revisi 28 September 2022, Disetujui 29 Oktober 2022 Terbit online 8 Februari 2023 KATA KUNCL © Kebugaran jasmani, kadar hemoglobin, © anemia, © remaja. KEYWORDS * Physical fitness, * hemogiobin level, © anemia, © adclescence.Fadillan, Adriani 7720; e-ISSN 2541-4275, Volume 8, Nomor 2, halaman 193-214, Jul 2023, DOI : httns.//dol ore/10.2510S/pdk vsi2.14312 prISSN 085: Sintesis heme diawali dengan kondensasi dari suksinil K-oA dan glisin untuk membentuk 5- Aminolevulinic acid (ALA) yang dikatalisis oleh ALA synthase (ALAS) yang kemudian akan diangkut melalui dua membran mitokondria di sitosol dan dikonversikan menjadi coproporphyrinogen II (CPgenill) melalui reaksi enzimatis. Secara singkat, enzim aminolevulinate defydratase (ALAD) mengkatalisis kondensasi dari dua molekul ALA untuk membentuk satu molekul dari monopyrrole porphobilinogen. Kemudian hydroxymethylbilane synthase (HBS) mengketalisis sintesis dari empat molekul porphobilinogen untuk membentuk linear tetrapyrrole hydroxymethylbilane yang dikonversi menjadi uroporphyrinogen il! oleh uroporphyrinogen synthase (UROS). Langkah sitoplasmik terakhir yaitu sintesis CPgenill yang dikatalisis oleh uroporphyrinogen decarboxylase (UROD). CPgenill dikonversikan menjadi protopophyrinagen IX oleh coproporphyrinogen oxidase (CPOX) yang kemudian dioksidasi menjaci protoporphyrin IX (PPIX) oleh proteporphyrinagen oxidase (PPOX) yang berlokasi di kondria, Aki permukaan luar dari Wa, besi bergabung dengan PPIX untuk membentuk heme yang dikatalisa oleh ferrochelatose (FECH) didalam matriks mitokondria." Tabel 1. Karakteristik Subjek Penelitian Populasi ‘Anemia (g/dL) Ringan Sedang Anak 6-59 bulan 10-109 7-99 Anak 5-11 tahun 11-114 8-109 Anak 12-14 tahun 11-119 8-109 Perempuan di atas 15 tahun 11-119 8-109 (tidak hamil) Perempuan hamil Lelaki diatas 15 tahun Kadar hemoglobin di dalam tubuh seseorang akan berbeda-beda, tergantung dengan usia, jenis kelamin, dan faktor lainnya. Diperlukan juga gizi baik makro misalnya protein maupun gizi mikro misalnya zat besi untuk pemibentukan kadar hemoglobin di dalam tubuh. Asupan yang baik dan cukup ini yang dapat _mempertahankan kadar hemoglobin agar tetap dalam batas normal sehingga mendapatkan kesehatan yang optimal." Kadar hemoglobin di dalam darah sangat penting dalam menentukan kerampuan tubuh seseorang untuk memproduksi energi yang akan digunakan untuk aktivitas fisik atau kegiatan sehari-hari. Jika kadar hemoglobin di dalam darah baik, oksigen yang di 206Peran Kadar Hemoglobin pada Kebugaran Jasmani Remaja Fadillah, Adriani 1-4275, Volume 8, Nomor 2, halamen 199 ~214, Juli 2023, OI: httasid/do\.org/10:25105/pckvBi2.14312 ISSN 0853-7720; e1SSN transporkan akan semakin banyak, sedangkan jika kadar hemoglobin yang rendah, oksigen yang dibutuhkan tidak terpenuhi sehinggga energi yang dihasilkan juga tidak optimal.(°> Radar hemoglobin) \yarig Korarig éarlbatas horn iaksleisebut dengan seh, nilai anemia untuk umurS-11 tahun < 11,5 e/dl, 11-14 tahun < 1 2,0 g/l, Faia Sistas taHiin| UREUK peremipuan = 12)0]g/Alldan anak lakiaki <13,0g/dL7 Untuk pengukuran kadar hemoglobin dapat dilakukan dengan beberapa metode diantaranya metode tallquist, sahli, kupersulfat, dan cyanmethemoglobine. Metade dengan cyanmethemoglobine merupakan gold standard untuk pengukuran kadar hemoglobin seseorang. Selain metode berikut, saat ini terdapat Hb meter untuk mengukur kadar hemoglobin seseorang, metode ini bayak dipilih kerena penggunaannya yang praktis, hasil yang didapatkan cepat, dan mudah dilakukan tanpa harus tenaga terlatih.® Terdapat beberapa faktor yang memengeruhi kadar hemoglobin seseorang diantaranya ialah 1) Tablet tambah darah : Seseorang yeng mengkonsumsi teblet tambah darah (TTD) yang mengandung 60 img Fe elemental dan 0,4 mg asarn folat dan akan mempengaruhi kadar hemoglobin di dalam darah.=9 2) Jenis kelamin : Kadar hemoglobin pada wanita lebih rendah dibandingkan pria, karena wanita ‘mengalami berbagai kondisi yang salah satunya adalah menstruasi sehingga akan banyak darah yang keluar. Hormon androgen pads pria yang menstimulasi produksi eritropoietin dari ginjal menyebabkan proses pembentukan sel darah merah atau eritropviesis lebih tinggi, sebaliknya hormon estrogen pada wanita yang memiliki efek inhibisi pembentukan sel darah merah menyebabkan kadar hemoglobin pada wanita akan lebih rendah dibandingkan pria.°*! 3) Trauma : Trauma yang mengakibatkan perdarshan ‘akan menyebabkan turunnya kadar hemoglobin di dalam darah karena terjadinya pemindahan cairan tubuh kedalam pembuluh darah sehingga mengakibatkan pengenceran darah.” 4) Umur: Kader hemoglobin di dalam darah akan berbeda pada neonatus, anak-anak, dan orang dewase, hal ini disebabkan karena umur berpengaruh pada kadar dan aktivitas zat yang terdapat pada darah,* 5) Kehamilan : Selama kehamilan terjadi beberapa hal misalnya induksi kehamilan, hemodelusi, volume tubuh yang meningkat, dll yang akan menyebabkan perubahen kadar bes! dan ferritin di dalam tubuh.®" Anemia merupakan keadaan dimana kadar hemoglobin dalam darah lebih rendah dari nilai normainya. Selain itu, anemia juga dapat ditandai dengan nilai ambang batas hematokrit yang rendah. Kejadian anemia dapat disebabkan oleh beberapa hal diantaranya adalah: 1) kekurangen atau produksi dari sel darah merah yang abnormal, 2) pemecahan sel darah merah berlebih, 3) Kurangnya gizi yang dapat berkaitan dengan asupan makanan, kualitas makanan, sanitasi, den perilaku kesehatan, 4) akses kepada pelayanan kesehatan, dan 5) kemiskinan.”! Anemia dapat menimbulkan gejala awal berupa badan lemah, lelah, nafsu makan kurang, kurang energi, daya konsentrasi menurun, sakit kepala, mudah 207[LMAS ~ Indonesian Joumal On Medical Slenee ~ Volume 5 No. 2~ Ju 2018 Faktor-Faktor yang Berhubungan dengan Kadar Hemoglobin (Hb) Pada Mahasiswa Keperawatan Angkatan 2013 Universitas Respati Yogyakarta Factors Associated With Hemoglobin (Hb) Levels in Nursing Class 2013 Respati Yogyakarta University Siti Fadiilah sites Respati Yogyakarta siti_fadiilan10@yahoo.com Abstract: Hemoglobin is an iron-containing oxygen transporting protein. The content of hemoglobin in the body is influenced by many factors including age, sex, activity, nutntional status, lifestyle. Studies show caffeine consumption of peptic ulcers, erosive esophagitis, gastroesophageal reflux, impair iron absorplion, and cause iron deficiency anemia. Girls have higher hemoglobin levels than men, bul women fare more likely to experience a decrease in hemoglobin levels. Regular physical activity can increase hemogiobin levels, but excessive physical activity can cause hemolysis and decrease the amount of hemoglobin. The purpose of this study was to know the relationship between age, sex, caffeine consumption, end physical acliviy with hemoglobin level in the nursing students of 2013 UNRIYO. Quantitative research type of analytic observation with cross sectional design. The sample is nursing student of 8th semester with Probability Proportionate to Size technique. The research instrument is questionnaire. Analysis of research data using independent T Test. Most respondents aged 22 years and female gender are 33 people (45.2%) and 41 people (60.3%). Most of the light physical activity and ‘moderate caffeine consumption were 34 people (50%) and 25 people (36.8%). There is a significant felationship between age with hemoglobin level with p-value 0.002 <0,005. There is a significant relationship between sex with hemoglobin level with p-value 0,001 <0,005 There is no relationship of caffeine consumption with hemogiobin level with p-vaiuve 0,195> 0,05. There was no physical activity ‘elationship with hemoglobin level with p-value 0.363> 0.05. Keyword : caffeine consumption, physical activity, hemoglobin Abstrak ‘Hemoglobin merupakan suatu protein pengangkut oksigen yang mengandung besi. Kandungan hemoglobin di dalam tubuh dipengaruhi oleh banyak faktor diantaranya usia, jenis kelamin, aktvilas, status gizi, gaya hidup. Studi menunjukkan konsumsi kafein ulkus peptikum, esophagitis erosif, gastroesophageal refluka, mengganggu absorbsi besi, dan menyebabkan anemia defisiensi besi. Anak perempuan mempunyai kadar hemoglobin lebih tinggi dibandingkan dengan laki-laki, tetapi Perempuan lebih mudah mengalami penurunan kadar hemoglobin. aktivitas fisik yang teratur dapat meningkatkan kadar hemoglobin, tetapi aktivitas fisik yang berlebihan dapat menyebabkan hemolisis dan menurunkan jumiah hemoglobin. Tujuan peneittian ini mengetahui hubungan usia, jenis kelamin, konsumsi kafein, dan aktivitas fisik dengan kadar hemogiobin pada mahasiswa keperawatan angkatan 2013 UNRIYO.Jenis penelitian kuantiatifobservasianalitk dengan rancangan cross sectional Sampel adalah mahasiswa keperawatan semester 8 dengan teknik Probability Proportionate to Size. instrumen penelitian adalah kuesioner. Analisis data penelitian meggunakan T Test independen.Sebagian besar responden berusia 22 tahun dan berjeniss kelamin perempuan yaitu 33 orang (48,2%) dan 41 orang (80,3%). Sebagian besar aktivtas fisik ringan dan konsumsi kafein sedang yaitu 34 orang (50%) dan 25 orang (36,8%). Ada hubungan signifikan antara usia dengan kadar hemoglobin dengan p-value 0,002 < 0,005. Ada hubungan signifikan antara jenis kelamin dengan kadar hemoglobin dengan p-value 0,001 < 0,005. Tidak ada hubungan konsumsi kafein dengan kadar hemoglobin dengan p-value 0,195 > 0,05. Tidak ada hubungan aktivitas fisik dengan kadar hemoglobin dengan p-value 0,363 > 0,05. Kata kunei : konsumsi kafein, aktivitas fisik, Hb 1. PENDAHULUAN coxinemogiobin didalam sel darah merah. Dengan Hemoglobin adalah pigmen yang dapat melalui fungs! ini maka oksigen akan dibawa dari membuat sel darah berwarna merah yang pada paru-paru_-ke jaringan-jaringan (Evelyn, 2009 akhimya akan membuat darah~ manusia dalam Nurdiana, 2015). Sutejdo (2009) dalam berwama merah (Herawati, 2009). Hemoglobin Nugrahani (2013), mengatakan—bahwa memilki afiitas (daya gabung) terhadap oksigen hemoglobin adalah molekul yang terdiri dari dan dengan oksigen tersebut membentuk empat kandungan haem (berisi zat besi) dan TSSN 2365-1318 (Prat) 2628-0038 (One) msbr.org Teeempat rantai globin (alfa, bete, gamma, dan delta) berada didalam eritrosit’ dan bertugas, uilama untuk mengangkut oksigen Zat_ besi merupakan Komponen dari hemoglobin, mioglobin, stokran enzim katalase, dan peroksidase (Hidayah & Anasari, 2012)Zat besi dalam tubuh berperan penting dalam berbagai reaksi biokimia, seperti dalam memproduksi sel darah merah Zat besi sangat diperlukan untuk mengangkut oksigen ke seluruh Jafingan tubuh.Zat bes! juga berperan sebagal pembawa oksigen, bukan Saja _oksigen Pemapasan menuju Jaringan, tetapi juga dalam jaringan atau dalam sel (Brock dan Mainou- Flower 1986; King 2006 dalam Arifin 2008). Kekurangan zat besi dapat mengakibatkan gangguan atau hambatan pada pertumbuhan, baik sel tubun_maupun se! otak. Kekurangan kadar hemoglobin’ dalam — darah dapat menimbulkan gejala leth, lesu, lemah, lelah, dan cepat capai. Akibatnya dapat menurunkan prestasi belajar, olahraga, dan produktivtas kerja. Selain itu juga, daya tahan tubuh penderita kekurangan zat besi akan menurun, selanjutnya penderita mudah terkena infeksi (Direkiorat Gizi Masyarakat, 2003 dalam Sanudin, 2013). Kate memberikan efek —positif _ataupun _efek samping.Kandungan kafein dan guia pada minuman. energi merupakan sumber energi ‘tama untuk meningkatkan aktivitas (Jacob et al, 2013).Etek positif bila_mengonsumsi kopi ‘ataupun khasisat bagi Kesehatan adalah mampu mengurangi risiko terserang berbagai penyakit berbahaya seperti diabetes, jantung, batu empedu dan kanker (Sarr, 2074) Selain itu, jika mengonsumsi kafein secara reguler dapat menimbulkan efek ketergantungan. Studi deskriptif oleh Bawazeer dan Alsobahi (2013), menunjukkan bahwa 34.3% peminum minuman enetgi yang mengandung kafeinmengaku mengalami efek samping di antaranya palpitasi, insomnia, nyeri kepala, tremor, gelisah, serta mul dan muntah, serta efek negatifnya adalah ulkus —peptikum, esophagitis. erosif, yang bekerja dalam tubuh dapat TSSN 2355-1315 (Prat) 2623-0038 (Onin) msbm.o7y gastroesophageal refluka, mengganggu absorbs! besi, dan menyebabkan anemia defisiensi besi. si (Nugrahani, 2013). ‘Sedangkan faktor lain yang berhubungan dengan kadar hemoglobin adalah aktivitas fisik. Aktivtas fisik adalah segala gerakan yang berasal dari olot rangka yang membutuhkan engeluaran energi.Manfaat aktivitas fisik yang dilakukan—teratur— adalah membantu meningkatkan dan menjaga kesehatan otot dan tulang, membantu mengurangi resiko terjadinya obesitas dan penyakit kronik Aktivtas fisik juga dapat menunjang perasaan psikologis seseorang menjadi semakin baik.Pentingnya —_fungsi hemoglobin pada tubuh manusia dan pentingnya seseorang melakukan aklivilas fisik secara Hal ini menyedabkan hemoglobin melepaskan lebih banyak oksigen sehingga meningkatkan pengiriman oksigen ke otot. Menurut Guyton (2012), aktivias fisk yang teratur dapat meningkatkan kadar hemoglobin, I METODE PENELITIAN Jenis penelitian adalah kuantitatif observasi analitik. Tujuan peneitian mengetahui hubungan sia, jenis kelamin, aktivitas fisik, dan konsumsi kafein dengan kadar hemoglobin. Pengambilan data dilaksanakan di Prodi S-1 limu Keperawatan Universitas Respati Yoayakarta pada 26 dan 28 April 2017. Sampel yang digunakanadalah seluruh mahasiwa keperawatan angkatan 2013, sesuai dengan kriteria inklusi dan ekskiusi Kriteria inkiusi: status aktif,_mengkonsumsi kafein, dan bersedia jad responden. Kniteria ceksklusi: cuti/nonaktf, mempunyai "penyakit kronis, anemia, gangguannutrisi, dan mengkonsumsi zat besi. Teknik pengambilan sampel_adalah_ Probability Proportionate_to 1698% CLGHAI C7) ew *JAYPEE© Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Lid 4838/24, Ansari Road, Daryaganj New Delhi 110 002, india Phone: +91-11-43574357 Fax: +91-11-49574314 Email: jaypee@ jaypeebrothers.com Overseas Offices JAP. 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Inquiries for bulk sales may be solicited at: jaypee @jaypeebrothers.com This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. A Textbook of Practical Physiology Fist Edition: 1983 ‘Second Editon: 1985 Third Edition: 1987 Fourth Edition: 1990 Fifth Eoition: 1999 Sixth Eciton: 2005 Reprint: 2006 ‘Seventh Edition: 2007 Eighth Edition: 2013 ISBN 978-98-5025-932-0 Printed atHematology the red cells, releasing their Hb into the solution (hemolysis). The acid acts on the Hb and converts it into acid hematin which is deep golden brown in color. * The color of acid hematin does not develop fully immediately, but its intensity increases with time, reaching a maximum, after which it starts to decrease. An adequate time, usually 6-8 minutes, must be allowed before its dilution is started. Too little time and all Hb may not be converted into acid hematin. And, waiting too long, may result in fading of color. In either case, the result will be falsely low. 6. Diluting and matching the color. The next step is to dilute the acid hematin solution with distilled water (preferably buffered water, if available) till its color matches the color of the standard tinted glass rods in the comparator. Note Each time you compare the color, lift and hold the glass stirrer against the side of the Hb tube above the solution (rather than taking it out completely) thus allowing it to drain fully back into the tube. (If the stirrer is left in the solution when comparing the color, the solution will appear lighter). 7. Take the Hb tube out of the comparator and add distilled water drop by drop (or larger amounts depending on the experience), stirring the mixture each time and comparing the color with the standard. 8. Hold the comparator at eye level, away from your face, against bright but diffused light. Read the lower meniscus (lower meniscus is read in colored transparent solutions). Sources and Degree of Error OBSERVATIONS AND RESULTS. Compare your color matching with that of your work- partner and record the observations in your workbook. Take the average of 3 readings as shown below, and report your result as: Hb .9/dl. Ast reading, when the color is slightly darker than the standard... g/dl. 2nd reading, when, after adding a few drops of distilled water, the color exactly matches the standard: g/dl 3rd reading, when, after adding some more drops, the color becomes a little lighter than the StaNdArd: woucennnnes G/le For report. Express your result as: Hb .9/dl. * Oxygen carrying capacity: Knowing your Hb concentration, and that 1.0 9 of Hb can carry 1.34 ml of O>, calculate its oxygen-carrying capacity as snneuntMl O7/d. * 100 % Saturation. When blood 1s equilibrated with pure (100 %) oxygen at a PO2 of 120 mm Hg, the Hb gets 100 % saturated, i.e. it picks up as much O; as it possibly can. For report: *© Oxygen carrying capacity * 100% saturation. Normal Values The levels of Hb in normal Indian adults, especially in the economically deprived population, are on the lower side of those reported from affluent countries. ‘The reason may be the poor intake of grade 1 proteins and other nutrients. The average levels and their ranges are as follows: Males: 14.5 g/dl (13.5-18 9/dl). Females: 12.5 g/dl (11.5-16 g/dl).‘A Textbook of Practical Physiology Advantages of Sahli Method The method is simple, fairly quick, and accurate. It does not require any costly apparatus, since it needs only direct color matching. Its running cost is minimal and can, therefore, be used in mass surveys. Disadvantages of Sahli Method Since the acid hematin is not in true solution, some turbidity may occur. The method estimates only the oxyHb and reduced Hb, other forms, such as carboxyHb and metHb are not estimated. Also the degree of error may be high if proper precautions are not taken, OTHER METHODS OF ESTIMATING HEMOGLOBIN A. Spectrophotometric methods. In these methods, a photoelectric colorimeter is employed to measure the amount of light absorbed by a derivative of Hb. 1, Cyanmethemoglobin method. All forms of Hb normally present in blood (i.e. oxyHb, reduced Hb, carboxyHb, and metHb) are converted into a stable compound— cyanmetHb, The sample of blood is treated with modified Drabkin's reagent (it contains potassium cyanide, potassium ferricyanide, and potassium phosphate—the last replacing sodium bicarbonate of Drabkin’s reagent). The modified reagent speeds up the conversion, reduces turbidity, and enhances RBC lysis. The amount of light absorbed with yellow- green filters (peak at 450 nm) is compared with a standard solution in a photoelectric colorimeter. This method is the most accurate method of estimating Hb. 2. Wu's alkaline hematin method. The blood is treated with N/10 NaOH, which converts all forms of Hb into alkaline hematin, which is in true solution. There are two methods: the standard method and the acid-alkaline method. 3. Haldane’s carboxyHb method. The red cells are hemolysed in distilled water to release Hb. Carbon monoxide is then passed through the c solution to form carboxyHb that is bright red in color. The color is then compared with that of the standard. 4, OxyHb method. The blood is treated with ammonium hydroxide or sodium carbonate. The red cells are hemolyzed and the Hb is converted immediately and quickly into ‘oxyHb. The solution is then compared with a standard gray screen in photoelectric colorimeter. Iron content. The iron in blood is separated with sulphuric acid, and its amount measured. Since 1 g of Hb contains 3.35 mg iron, the amount of Hb can be calculated. Copper sulphate falling drop method. It is a rapid method for estimating the approximate level of Hb, and is used in large surveys. It was used extensively during World War II where an indication of the necessity for blood transfusion was immediately required (see Expt 1-21). PRECAUTIONS 1 All precautions mentioned for collecting finger- prick blood, and filling the pipette must be observed. The finger should not be squeezed, and there should not be any blood sticking to the outside of the pipette tip. Only the recommended time should be allowed for the formation of acid hematin by the action of acid on Hb. When diluting the color of acid hematin solution, avoid over-dilution because the color cannot be concentrated, When matching the color, the solution should be uniformly golden brown throughout the solution.Tests for hemostatic disorders Bleeding time Duke bleeding time Ivy bleeding time Simplate method Capillary fragility test Clot lysis time Prothrombin time Other tests Questions Relevance Bleeding after injury is a common experience for most of us. However, suspicion of a disease arises when there is frequent and prolonged bleeding with minor injuries, such as during shaving, cutting of nails, ora fall on the knees. In others, there may be spontaneous bleeding (without any apparent trauma) in the skin, gums, or into joints, and muscles, etc. Itis in all such cases that various tests are carried out. Hemostasis |. Hemostasis, which is a homeostatic mechanism to prevent loss of blood, is a result of a complex, natural, physiological response. The term is also used for surgical arrest of bleeding. ‘Thus, hemostasis has a high degree of survival value, Hemostasis involves the following 4 interrelated steps: 1, Vasoconstriction (contraction of injured blood vessels). 2. Platelet plug formation. 3. Formation of a blood clot. 4. Fibrinolysis (dissolution of the clot). PHYSIOLOGICAL BASIS OF BLEEDING DISORDERS Excessive and prolonged bleeding with smalll injuries, or spontaneous bleeding my result from defects of: A. Platelets B Blood vessel walls C Coagulation of blood. A Textbook of Practical Physiology A,B. DEFECTS OF PLATELETS AND VESSEL WALLS Defects of platelets (i) and vessel walls (ii) typically cause spontaneous bleeding from small vessels, or during cuts and bruises (e.g. pinpoint or petechial hemorrhages and purpuric lesions in the skin (blue red patches), and bleeding in the gums. C. DEFECTS OF CLOTTING Defects of clotting are of 2 types: a. Excessive bleeding into tissues (muscles, Joints, viscera, etc) is usually due to injury to relatively large vessels. The delay in the formation of a clot fails to support the normal action of platelets in checking blood loss. Deficiency of clotting factors—inherited or in liver disease (hepatitis, cirrhosis, vitamin K deficiency) are the usual causes. b. Thrombosis. It is clotting of blood that occurs within unbroken blood vessels. A roughened endothelium due to arteriosclerosis, infection, or injury is the common cause. Bleeding Disorders. Bleeding disorders may be in- herited or acquired—the acquired defects being more common. Disorders due to platelet and vessel wall defects are more common than coagulation disorders that are due to deficiencies of clotting factors. TESTS FOR HEMOSTASIS Bleeding time (BT). Ivy bleeding time (hemostasis bleeding time). Capillary fragility test of Hess (tourniquet test). Platelet count. Clotting time. Clot retraction time (CRT). Clot lysis time. . Prothrombin time. Other tests. These include: platelet aggregation and adhesiveness tests, prothrombin consumption test, partial thromboplastin test, thrombin time (TT), plasma recalcification time (PRT), activated partial thromboplastin time (APT), kaolin cephalin clotting time (KCCT), and special tests, including assaying of clotting factors. PNOMaYNEGUYTON AND HALL TEXTBOOK OF WW Sp) eANE PHYSIOLOGY THIRTEENTH EDITION JOHN E. HALLELSEVIER 1600 John F. Kennedy Blvd See 1800 Philadelphia, PA 19103-2899 GUYTON AND HALL TEXTBOOK OF MEDICAL PHYSIOLOGY, ISBN: 978-1-4557-7005-2 ‘THIRTEENTH EDITION INTERNATIONAL EDITION ISBN: 978-1-4557-7016-8 ‘Copyright © 2016 by Elsevier, Inc, AU rights reserved. No pattof this publication may be reproduced or transmitted in any form or by any mesns, electronic of mechanical, including photocopying, recording, or any information storage and rettieval system, without ‘permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found st our website: worwelseviercomn/ permissions This hook and the individual contributions contained init are protected under copyright by the Publisher (other than as may be noted herein) Nottces Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using ary infor-nation, methods, compounds, or experiments described herein. In using such Information or methods they should be mindful of their own safety and the safety of others, including parues for whom they have a professional responsibility. ‘With respect to any drug or pharmaceutical products identified, readers are advised to check the ‘most current information provided () on procedures featured ot (i) by the manufacturer of each product to be administered, to verify the recommended éose or formula, the method and duration ‘f administration, and conteaindications. Its the responsibility of practitioners, relying on their own, ‘experience and knowledge of thei patients, co make diagnoses, to determine dosages snd the best tweatment foreach individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, conteibutors, or editors, assume any liabilty for any injury andior damage to persons or property as a matter of products Tiabilty, negligence or otherwise, or feom any use oF operation of any wnethods, products, instructions, ‘or ideas contained in the material herein Previous editions copyrighted 2011, 2006, 2000, 1996, 1991, 1986, 1981, 1976, 1971, 1966, 1961, 1956 by Saunders, an imprint of Elseviet, Ine Library of Congress Cataloging-in-Publication Data Hall, John €, (John Edvard), 1946., author Gayton and Hall textbook of medical physiology / John £. Hall Thirteenth edition picm. ‘Textbook of medical physiology Includes bibliographical references and index. ISBN 978-1-4557-7005-2 (hardcover: alk. paper) I."Tile. I, Tide: Textbook of medical physiology [DNUM: 1. Physiological Phenomena. QT 103) pais de 2015002552, Sentor Content Seratetst Elyse O'Grady Semior Content Develapent Manager: Rebecea Grulow Publishing Services Manager: Patil Tennian Senior Project Manager: Carte Stetz Design Direction: Jl Dame, Working together to grow libraries in fall developing countries Printed in ‘The United States of America Last digit isthe peint number: 9 8 7 6 5 4.3.21Unit VI Blood Cells, Immunity, and Blood Coagulation plasmin isformed, itcan cause lysis of a clot by destroying many of the clotting factors, thereby sometimes even causing hypocoagulability of the blood ‘Activation of Plasminogen to Form Plasmin, Then Lysis of Clots. When a clot is formed, a large amount of plasminogen is trapped in the clot along with other plasma proteins. This will not become plasmin or cause lysis of the clot until itis activated. The injured tissues and vascular endothelium very slowly release a powerful acti- vator called tissue plasminogen activator (t-PA); a few days later, after the clot has stopped the bleeding, t-PA eventually converts plasminogen to plasmin, which in turn removes the remaining unnecessary blood clot. [n fact, many small blood vessels in which blood flow has been blocked by clots are reopened by this mechanism. ‘Thus, an especially important function of the plasmin system is to remove minute clots from millions of tiny peripheral vessels that eventually would become occluded ‘were there no way to clear them. CONDITIONS THAT CAUSE EXCESSIVE |LEEDING IN HUMANS Excessive bleeding can result from a deficiency of any ‘one of the many blood-clotting factors. Three particular types of bleeding tendencies that have been studied to the greatest extent are discussed here: bleeding caused by (2) vitamin K deficiency, (2) hemophilia, and (3) throm- bocytopenia (platelet deficiency). DECREASED PROTHROMBIN, FACTOR VII, FACTOR IX, AND FACTOR X CAUSED BY VITAMIN K DEFICIENCY With few exceptions, almostaall the blood-clotting factors are formed by the liver, Therefore, diseases of the liver such as hepatitis, cirrhosis, and acute yellow atrophy (ie. degeneration of the liver caused by toxins, infections, or other agents) can sometimes depress the clotting system so greatly that the patient experiences the development of a severe tendency to bleed. ‘tamin K is continually synthesized in the intes- tinal tract by bacteria, so vitamin K deficiency seldom 490 occurs in healthy persons as a result of the absence of vitamin K from the diet (except in neonetes before they establish their intestinal bacterial flora). However, in persons with gastrointestinal disease, vitamin K defi- Giency often occurs as a result of poor absorption of fats from the gastrointestinal tract because vitamin K is fat soluble and is ordinarily absorbed into the blood along with the fats. ‘One of the most prevalent causes of vitamin K deficiency is failure of the liver to secrete bile into the gastrointestinal tract (which occurs either as a result of obstruction of the bile ducts or as a result of liver disease). Lack of bile prevents adequate fat digestion and absorp- tion and, therefore, depresses vitamin K absorption as well. Thus, liver disease often causes decreased produc tion of prothrombin and some other clotting factors both because of poor vitamin K absorption and because of the diseased liver cells. Asa result, vitamin K is injected into surgical patients with liver disease or with obstructed bile ducts before the surgical procedure is performed, Ordinarily, if vitamin K is given to a deficient patient 4 to 8 hours before the operation and the liver parenchymal calls are at least one-half normal in function, sufficient clotting factors will be produced to prevent excessive bleeding during the operstion. HEMOPHILIA Hemophilia is a bleeding disease that occurs almost exclusively in males. In 85 percent of cases, it is caused by an abnormality or deficiency of Factor Vill this type of hemophilia is called hemophilia A or classic hemophilia, About 1 of every 10,000 males in the United States has classic hemophilia. In the other 15 percent of patients with hemophilia, the bleeding tendency is caused by defi ciency of Factor IX. Both of these factors are transmitted ‘genetically by way of the female chromosome. Therefore, a woman will almost never have hemophilia because at least one of her two X chromosomes will have the appro- priate genes. If one of her X chromosomes is deficient, she will be a hemophilia carrier, transmitting the disease to half of her male offspring and transmitting the carrier state to half of her female offspring, ‘The bleeding trait in hemophilia can have various degrees of severity, depending on the genetic deficiency. Bleeding usually does not occur except after trauma, but in some patients, the degree of trauma required to cause severe and prolonged bleeding may be so mild that it is hardly noticeable. For instance, bleeding can often last for days after extraction of a tooth Factor VIII has two active components, a large com- ponent with a molecular weight in the millions and a smaller component with a molecular weight of about 230,000. The smaller component is most important in the intrinsic pathway for clotting, and itis deficiency of this partof Factor VII that causes classichemophilia, Another bleeding disease with somewhat different characteristics,BLOOD COAGULATION TESTS BLEEDING TIME ‘When a sharp-pointed knife is used to pierce the tip of the finger or lobe of the ear, Hise hn pnd eeh on bed ie wound and the degree of hyperemia in the finger or ear lobe at the time of the test. Lack of any one of several of the clotting factors ean prolong the bleeding time, but itis especially prolonged by lack of platelets. CLOTTING TIME Many methods have been devised for determining blood clotting times. The one most widely used is to collect blood in a chemically clean glass test tube and then to tip the tube back and forth about every 30 seconds until the blood has clotted. tubes have also been devised for determining clotting, time more accurately. ‘Unfortunately the clotting time varies widely, depend- ing on the method used for measuring it so it isno longer used in many clinics. Instead, measurements of the clot- ting factors themselves are made, using sophisticated chemical procedures PROTHROMBIN TIME AND INTERNATIONAL NORMALIZED RATIO Prothrombin time gives an indication of the concentra- tion of prothrombin in the blood. Figure 37-5 shows the relation of prothrombin concentration to prothrombin time, The method for determining prothrombin time is the following Blood removed from the patient is immediately oxa- lated so that none of the prothrombin can change into thrombin, Then, a large excess of calcium ion and tissue factor is quickly mixed with the oxalated blood. ‘The excess calcium nullifies the effect of the oxalate, and the tissue factor activates the prothrombin-to-thrombin reaction by means of the extrinsic clotting pathway. ‘The time required for coagulation to take place is known as the prothrombin time. The shortness of the time is deter- mined mainly by prothrombin concentration. The normal prothrombin time is about 12-seconds. In each laboratory, a curve relating prothrombin concentration to prothrom- bin time, such as that shown in Figure 37-5. is drawn for the method used so that the prothrombin in the blood can be quantified “The results obtained for prothrombin time may vary considerably even in the same individual if there are differences in activity of the tissue factor and the analyti- cal system used to perform the test. Tissue factor is fsolated from human tissues, such as placental tissue, and different batches may have different activity. The Chapter 37 Hemostasis and Blood Coagulation 100 Concentration (percent of nome g 250 425 625 ° 0 1 2 90 40 50 6 Prothrombin time (seconde) Figure 37-5. Relation of prothromtin concertration in the blood to prothrombin time. international normalized ratio (INR) was devised asa wey to standardize measurements of prothrombin time. For each batch of tissue factor, the manufacturer assigns an international sensitivity index (ISI), which indicates the activity of the tissue factor with a standardized sample. ‘The ISI usually varies between 1.0 and 2.0. The INR is the ratio of the person's prothrombin time (PT) to a normal control sample raised to the power of the ISK: Flies)" we (rra] The normal range for INR in a healthy person is 09 to 1.3. A high INR level (eg, 4 oF 5) indicates a high risk of | bleeding, whereas a low INR (et, 0.5) suggests that there isa chance of having a clot. Patients undergoing warfarin therapy usually have an INR of 2.0 to 30. ‘Tests similar to that for prothrombin time and INR. have been devised to determine the quantities of other blood clotting factors. In each of these tests, excesses of calcium ions and all the other factors besides the one being tested are added to oxalated blood all at once. Then the time required for coagulation is determined in the same ‘manner as for prothrombin time. Ifthe factor being tested is deficient, the coagulation time is prolonged. The time itself can then be used to quantitate the concentration of the faetor. Bibliography Baron TH, Kamath PS, MeBane RD: Management of antithrombotic therapy in pabents undergoing invasive procedures. N Engl J Med 368:2113, 2013. BerntompE, Shapto AD: Modern haemophiis cre. Lancet 379:1447, 2012, Blombery ® Scully M: Management of thrombotic thrambocytopenic pura current perspectives. J Blood Med 5:15, 2014 frase LF, Zhu L, Staker Th Minding the gaps to premote thrombus grow and stabi, J Clin est 115.3385, 2006. 493 ee)untuk Mahasiswa Farmasi, Keperawatan dan Kebidanan Hanna Goenawan, dr., M.Kes., AIFO, PhD. Rizky Abdulah, Apt., PhD. EDITORFISIOLOGI DASAR UNTUK MAHASISWA FARMASI, KEPERAWATAN DAN KEBIDANAN Ronny Lesmana Hanna Goenawan Rizky Abdulah Editor : Dr. Vita M. Tarawan, dr, SpOG., M.Kes., IFO, Desain Cover : Dwi Novidiantoko Vata Letak Isi: Haris Asi Ssuato Cetakan Pertama: Mei 2017 Hak Cipta 2017, Pada Penulis Ii diluar tanggun jawab perc Copyright © 2017 by Deepublish Publisher Al Right Reserved Hak cipta dilindungi undang-undang Dilarang keras menerjemahkan, memfotokopi, atau -memperbanyak sebagian atau selueuh isi buku ini canpa izin wetubs dari Penerbit. PENERBIT DEEPUBLISH (Grup Penerbitan CV BUDI UTAMA) Anggota IKAPI (076/DIY/2012) JLRajawali, G. lang 6, No 3, Drono, Sardonoharjo, Ngaglik, Sleman JuKaliurang Km.9,3 — Yogyakarta 55581 Help /Faks: (0274) 4533427 Website: www.deepublish.co id ‘www penerbitdeepublish.com E-mail: deepublish@ymail.com Katalog Dalam Terbitan (KDT) LESMANA, Ronny Fisiolog’ Dasar untuk Mahasiswa Faemasi, Keperawatan dan Kebidanan oleh Ronny Lesmana, Hanna Goenawan & Rizky Abdolah Hd 1, Cet. 1+ Youyakart: Deepabish, Mc: 2017 svi, 274 him, Uk:17.5x25 em ISBN 978-602-853-106-5 1. Tima Kedolteran L Judul aulI. Tes Pembekuan Darah Waktu perdarahan Perdarahan biasanya berlangsung 1-6 menit. Lama perdarahan sangat bergantung pada dalamnya luka dan derajat hiperemia di jari pada saat tes dilakukan. Waktu perdarahan akan memanjang bila kekurangan faktor-faktor pembekuan, dan sangat memanjang bila kekurangan trombosit. Waktu pembekuan Cara yang paling banyak dipakai antuk menentukaan waktu pembekuan ialah dengan menempatkan darah dalam tabung reaksi yang bersih, kemudian menggoyangkan tabung itu setiap 30 datik sampai terbentuk bekuan. Denagan cara ini, waktu pembekuan normal adalah 6-10 menit. Prosedur yang menggunakan tabung reaksi dapat menentukan waktu pembekuan secara lebih teliti. Waktu pembekuan juga bergantung pada kondisi gelasnya sendiri dan bahkan juga bergantung pada ukuran tabung, sehingga diperlukan standarisasi yang tepat untuk memperoleh hasil yang teliti, Contoh spesifik dari keadaan yang menimbulkan Pemanjangan waktu pembekuan ialah hemofilia, tetapi defisiensi salah satu faktor pembekuan dalam jalur intrinsik dapat merupakan faktor penyebab. Waktu protrombin Waktu protrombin memberi petunjuk tentang jumlah total protrombin dalam darah. Gambar 15. 8 Hubungan antara kadar protrombin dalam darah dengan waktu protrombin Cara untuk menentukan waktu protrombin adalah sebagai berikut; * Darah yang diambil dari pasien segera diberi oksalat agar tidak ada protrombin yang berubah menjadi trombin. Kemudian, sejumlah besar ion kalsium dan faktor jaringan w &Perbedaan Hasil Pemeriksaan Hemoglobin Antara Metode Point of Care Testing Dengan Metode Sianmethemoglobin Pada Ibu Hamil Puspitasari', Andika Aliviameita', Evi Rinata’, Rizka Afifah Yonika Yasmin', Sukma Nur Saidah' * Program Studi D IV Teknologi Laboratorium Medis Universitas Muhammadivah Sidoarjo ? Program Studi DIlI Kebidanan Universitas Mubammadiyah Sidoarjo Abstrak Pemeriksaan kadar hemoglobin pada ibu hamil merupakan faktor yang penting Karena sering ditemukan kondisi kurangnya zat besi selama masa kehamilan. Berbagai metode pemeriksaan hemoglobin digunaksn pada faslitas pelayanan kesehatan, Penelitian ini bertujuan untuk mengetahui perbedaan hasil pemeriksaan hemoglobin antara metode Point of Care Testing (POCT) menggumakan darah kapiler dan darah vena dengan metode sianmethemoglobin menggunakan darah vena pada ibu hamil, Penelitian ini merupakan penelitian cksperimental laboratorium dengan desain studi observasi analitik cross sectional, Penelitian dilakukan di Laboratorium Puskesmas Sukodono Kabupaten Sidoarjo pada Maret - April 2020. Sampel yang digunakan yaitu pasien ibu hhamil di Puskesmas Sukodono berumur 15-34 tahun sebanyak 30, Hasil analisis menggunakan uj t tes sampel bebas didapatkan nilait hitung scbesar 1,543 dengan p- value sebesar 0,128. Hasil analisis menggunakan uji t tes berpasangan didapatkan nilai t hitung sebesar 2,736 dengan p-value sebesar 0,011. Dapat disimpulkan behwa tidak terdapat perbedaan yang signifikan socara statistik antars rata-rata hasil pemeriksaan hemoglobin metode POCT darah kapiler dengan metode sianmetiemoglobin darah vena dan terdapat perbedaan yang signifikan secara statistik antara rata-rata basil pemeriksaan hemoglobin metode POCT darah vena dengan metode sianmethemoglobin darah vena. Kata Kunei : hemoglobin, POCT, sianmethemoglobin, ibu hamil The difference in Hemoglobin Test Results Between Point of Care Testing Method with the Cyanmethemoglobin Method in Pregnant Women. Abstract Test of hemoglobin levels in pregnant women is one important factor because itis often found the condition of Jack of iron during pregnancy. Various hemoglobin testing methods are used in health care facilities. This study aims to determine differences in the results of hemoglobin tests between the Point of Care Testing (POCT) method using capillary blood and venous blood with the cyanmethemoglobin method using venous blood in pregnant women. This research is an experimental laboratory study with a cross-sectional analytic observational study design. The study was conducted at the Puskesmas Sukodono Laboratory- Sidoarjo Regency in March - April 2020, The sample used was pregnant women patients at the Puskesmas Sukodono aged 15-34 years as many as 30, The results of the analysis using the free sample t-test obtained a t-value of 1.543 with a p-value amounted to 0,128. The results of the analysis using. a paired t-test obiained a t-value of 2.736 with a p-value of 0.011. It can be concluded that there is no statistically significant difference between the average results of hemoglobin test of capillary blood POCT methods with venous blood cyanmethemoglobin method and there is @ statistically significant difference between the average results of hemoglobin test of venous blood POCT methods with eyanmethemoglobin venous blood method. Keywords : hemoglobin, POCT, eyanmethemoglobin, pregnant women, Korespondensi : Puspitasati, Program Studi D IV Teknologi Laboratorium Medis, Universitas Mubaramadiyah Sidoarjo, Jalan Raya Rame Pilang No 4 Wonoayu Sidoarjo, mobile 081333060714, e-mail puspitasari@umsida.ac.id 4 Jurnal Analis Kesehataa : Volume 9, Nomor 1, Ju 2020