KESESUALAN DIAGNOSIS MORFOLOGI PENGECATAN ROMANOWSKY, SITOKIMIA, DAN IMUNOSITOKIMIA TERHADAP PENGECATAN KONVENSIONAL PADA LEUKEMI AKUT

Abstract

Conventional stainings on pheripheral blood smears and bone marrow smears in Dr. Kariadi General Hospital : Giemsa & Sudan Black B. ( SBB ) makes many confusions in confirming which serial group cells are, to get a more accurate diagnoSis as a tool to bring a better outebme of therapy furtheimore cytochemical an.d immunocylochemical stainings do not need expenSive and too sophisticated metode and apparatus, there are only a, few study, for combined Romanowsky, cytochemical and immunocytochemical stainings in Indonesia. Descriptive analitical study with cross sectional approach and consecutive sampling from March until september 1997 to all age , men and women , to whom cytostatic had not been aiven , from 17 hospitalized patients in Dr. Kariadi General Hospital, Tplogorejo Hospital and Elisabeth Hospital with Gienisa and Mieloperoxidase ( MPO ), Naphthol AS-D Chloroacetate ( CLE ) , a - Naphthyl Butyrate Esterase ( BLE ) , immunocytochemical staining : Terminal Deoxynucleotidyl Transferase ( TdT ). 5 patient with conventional stainings are described as ANTI : 2 patients are suspected M4, and combined staining 'confirms they are the same type. - 1 patient is suspected M5 but after combined staining they are M4 - 1 patient is suspected M2 and the result with combined staining is the same. - 1 patient is suspected M5 but after combined staining it is confirmed as acute undefferentiated leukemia. 10 patient with conventional stainings are described as ALL after study they confi•m 9 are described as ALL and 1 is' described as ANLL 2 patients with conventional stainings are described as CML in blastic crisis. But after our study they are CML, in blastic crisis with limfoblastic predominant. • After Kappa for degree of agreement with Mc Nemar test MPO, CLE, HUE, TdT should be used to confirm LNLA subtypes compare to Giemsa & SBB ( PABAK =0,80 and BAK =0,80 ) although there is still Acute Undifferentiated Leukemia ( 1 in 17 patients = 5,8 % ) . Giemsa & SBB are good to confum acute leukemia as ANLL or ALL but not good enough to confirm ANLL subtypes acurately. Cytochemical and imunocytochemical are need to be done routinely in getting an acurate diagnostic. Conventional stainings alone are not enough to confum ANLL subtypes. Pengecatan konvensional pacla hapus darah tepi dan sumsum tulang yang dilakukan di RSUP Dr..Kariadi yaitu Giemsa & Sudan Black B ( SBB ) masih menimbulkan banyak keraguan. Guna mendapat diaviosis yang lebih akurat sebagai salah satu cara yang bermanthat didalam keberhasilan terapi serta pertimbangan bahwa pengecatan sitokimia clan imunositokimia ticlak meinerlukan peralatan yang mahal dan canggih clan masih jarangnya penelitian mengenai pengecatan kombinasi Romanowsky, sitokirnia dan imunositokimia di Indonesia , maka dilakukan penelitian mengenai mengenai hal tersebut secara deskriptif analitik clengan pendekatan belah lintang terhaclap penderita yang klinis dan pemeriksaan darah rutin dicurigai leukemia akut secara consecutive sampling clan bulan Maret sampai September 1997 terhadap semua usia baik pria maupun wanita yang belum menclapat terapi sitostatika. Dari 17 penderita ( 5 LNLA, 10 LLA, 2 CIVIL dalam krisis blastik ) rawat Map di bagian Anak dan Penyakit Dalam RSUP Dr. Kariadi, RS. Telogorejo dan RS Elisabeth dengan menggunakan pengecatan Giemsa dan Mieloperoksidase ( MPO ) , Naphthol AS-D Chloroacetate ( CLE ), a - Naphthyl Butyrate Esterase ( BUE ) dan imunositokimia Terminal Deoxynucleotidyl Transferase ( TdT.) dengan hasil sebagai berikut : * 5 pendenm dengan pengecatan konvensional tnenunjukkan LNLA ternyata setelah penelitian : 2 M4 tetap M4 - 1 M5 berubah menjadi M4 - 1 M2 tetap M2 - 1 M5 merupakan Acute undifferentiated leukiraia 10 penderita dengan pengecatan konvensional menunjukkan LLA ternyata setelab penelitian menunjukkan 9 LLA , kecuali 1 sebagai LNLA. 2 penderita dengan pengecatan konvensional menunjukkan CML dengan krisis blastik, setelah penelitian hasilnya menunjukkan CML krisis blastik pre-dominan limfoblast. Analisa statistik derajat kesesuaian ( Kappa ) dengan tes Mc Nemar menyatakan pengecatan NUJ:), CLE, BUE, TdT dapat digunakan menentukan subtipe LNLA dibandingkan Giemsa dan SBB PABAK=0,80 dan BAK =0,80 ) walaupun masili ada yang tidak terdeferensiasi dengan pengecatan N4PC), CLE, • BUE, TfdT ( 1 dari 17 penderita = 5,8 % ) . Pengecatan Gieinsa & SBB sangat baik menentukan leukemi akut termasuk LNLA atau LLA (PABAK = 0387, BAK = 0,86) . Pengecatan 1\00, CLE, BUE, TdT sebaiknya dilakukan secara rutin untuk menentukan diagnosis lebih akurat karena pengecatan Giemsa & SBB saja tidak cukup untuk menentukan subtipe LNLA.