AKTIVASI LIMFOSIT PADA PREPARAT DARAH HAPUS PENDERITA DEMAM BERDARAH DENGUE

Abstract

Objective. To understand the activation process of lymphocytes in peripheral blood smears of DHF / DSS patients. Design. Cross sectional study which observation in 7 days admission. Methode. 50 children with clinical suspicion of DHF admitted at Dr. Kariadi General Hospital commencing July 2001 were studied. The clinical diagnosis of of DHF was confirmed by serological assay. The periferal blood smear were taken from every patient on day 0,2 and 7 and the lymphocytes activation on zone 6th were examined. The total amount and morfological changes were compared between DHF and DSS patient. We also note the value of hemostasis changes according to the increasing number of activated lymphocytes. Result. From 50 patient there are 27 children with DSS and 23 DHF non shock. Two patients died on day 2 admission due to DIC and profound shock. The total amount of activated lymphocytes were incresad significantly on DSS patients compared with non DSS patients ( p < 0,05 ), with cut off point according to ROC curve was 4,5% ( RR 5,3, CI 95% 1,85 — 15,37 ). The maximum increased that activated lymphocytes happened on day 2 and tend to decrease on day 7 admission. The morfology of activated lymphocyte changed into blastoid, plasmositoid and monositoid form but didn't have any corelation with severity of the disease. Among this population, undernourished and young children ( between 3-6 years old ) with DSS seems have more relative risk to suffer lymphocytes activation higer than the others. Conclusion. The process of lymphocytes activation was increased higher in DSS compared with non DSS patients. Further study should be done using more indicator such as IL-8, IL-10 and IL-13 to prove the lymphocyte activation in DEW patients. Tujuan. Mengetahui proses aktivasi limfosit yang dilihat melalui gambaran limfosit di darah tepi pada penderita DBD/SSD. Desain. Penelitian memakai pendekatan belah lintang dengan pengamatan selama periode 7 had perawatan. Metode. 50 anak dengan diagnosis klinis DBD menurut kriteria WO yang dirawat mulai Juli 2001 masuk dalam penelitian. Konfirmasi diagnosis DBD memakai pemeriksaan serologi dengan uji ELISA. Pengambilan darah untuk pemeriksaan laboratorium dan darah apus tiap pasien dikerjakan pada hari 0,2,dan 7 perawatan. Preparat apus dicat dengan giemsa, pembacaan dilakukan pada zone 6 dan dihitung dalam 100 lekosit. Perubahan bentuk dan jumlah dinilai dan dibandingkan antara penderita SSD dan DBD non syok. Dilihat juga perubahan nilai parameter hemostasis pada penderita dengan peningkatan aktivasi limfosit. Hasil. Dad 50 pasien terdapat 27 anak dengan SSD and 23 dengan DBD non syok. Terdapat 2 anak meninggal pada perawatan had ke-2 akibat komplikasi DIC dan syok yang berkepanjangan. Jumlah aktivasi limfosit meningkat lebih tinggi pada penderita SSD dibanding non SSD ( p < 0,05 ), dengan titik potong menurut kurva 4,5% ( RR 5,3, interval kepercayaan 95% 1,85 — 15,37 ). Peningkatan aktivasi limfosit tertinggi didapatkan pada hari perawatan ke-2 dan cenderung turun ke normal pada hari ke-7. Perubahan bentuk limfosit yang teraktivasi menyerupai bentuk plasmosit, monosit dan blastosit, tetapi tidak didapatkan hubungan bermakna dengan derajat DBD. Kesimpulan. Proses aktivasi limfosit meningkat lebih tinggi pada penderita SSD dibanding non SSD. Diperlukan penelitian lebih lanjut menggunakan parameter mediator-mediator kimia untuk membuktikan aktivasi limfosit pada penderita DHF.