Yulia Nadar Indrasari
@spesialis1.pk.fk.unair.ac.id
Hematology Division, Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga
Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga
EDUCATION
2015: graduated specialization of Clinical Pathology, Faculty of Medicine, Universitas Airlangga.
2023: graduated sub-specialization of Hematology, Faculty of Medicine, Universitas Airlangga.
RESEARCH, TEACHING, or OTHER INTERESTS
Pathology and Forensic Medicine, Hematology, Oncology, Medicine
Scopus Publications
Scopus Publications
Yetti Hernaningsih, Yuli Syafitri, Yulia Nadar Indrasari, Prafa Alif Rahmawan, Mia Ratwita Andarsini, Indra Lesmana, Emmanuel Jairaj Moses, Nur Arzuar Abdul Rahim, and Narazah Mohd Yusoff
Frontiers Media SA
BackgroundThe frequency of the beta-thalassemia (β-thalassemia) gene in Indonesia ranges from 3 to 10%. However, in the East Java province, there is still limited information on the prevalence of β-thalassemia mutations in clinically diagnosed beta-thalassemia patients of East Java. Therefore, this study aimed to characterize β-thalassemia mutations in selected patients in the East Java province of Indonesia.MethodsThis is an analytical observational study. Diagnosis of β-thalassemia was based on clinical presentation, complete blood count (CBC), and hemoglobin (Hb) electrophoresis. Blood specimens taken from each patient in three ethylenediaminetetraacetic acid (EDTA) tubes were analyzed for CBC and Hb electrophoresis and processed for DNA extraction and subsequent polymerase chain reaction (PCR). Detection of mutations in Hemoglobin Subunit Beta (HBB) gene exons 1–3 of the β-thalassemia gene as the common mutation in Indonesia was done using PCR followed by Sanger sequencing.ResultsIn total, 33 (n = 33) participants were involved in this study with ages ranging from 5 to 17 years comprising 19 women and 14 men. Their ethnic origins were Javanese (n = 30) and Chinese (n = 3). CBC results showed that mean ± standard deviation (SD) for Hb, red blood cell (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW)-CV were 81.2 ± 7.0 g/L; 3.40 ± 0.39 × 109/L; 71.05 ± 5.72 fL; 24.12 ± 2.45 pg; 33.91 ± 1.47 g/dl; 24.38 ± 6.02%, respectively. Hb electrophoresis revealed that 5 out of 33 participants had beta-thalassemia and 28 out of 33 participants had hemoglobinopathy (Hb) E/beta-thalassemia. Results of Sanger sequencing showed the following genotype variations in the samples: 12 (36.4%) with βCD26/βIVS−I−5; 6 (18.2%) with βCD26/βCD35; 3 (9.1%) with βCD26/βIVS−I−2; 2 (6.1%) with βCD27/28/βCD40; 2 (6.1%) with βIVS−I−1/βCAP+1; and βCD26/βIVS−I−1; βIVS−I−5/βCAP+1; βIVS−I−5/βCD35; βCD26/βCD37; βCD26/βCD15; βCD26/βCD40; and βIVS−I−5/βCD19 in 1 (3%) sample, respectively, and 1 (3%) had no abnormality detected in sequencing even though electrophoresis showed abnormality in the migration pattern. The βCD26/βIVS−I−5 mutation was found in samples that were noted to have Hb E/beta-thalassemia on Hb electrophoresis.ConclusionThe underlying genetic variations are heterogeneous in thalassemia patients in East Java, where 12 variants were found. The most common variant was βCD26/βIVS−I−5, which all accounted for Hb E/beta-thalassemia on Hb electrophoresis. Furthermore, 28 out of 33 participants had hemoglobinopathy (Hb) E/beta-thalassemia.
Harida Zahraini, Yulia Nadar Indrasari, and Hartono Kahar
PDS Patklin
The use of anticoagulants is one of the important pre-analytic factors in hematological tests. Both dipotassium (K2) andtripotassium (K3) Ethylene Diamine Tetraacetic Acid (EDTA) are widely used anticoagulants. International CouncilStandardization of Hematology (ICSH) and several researchers recommend the use of K2 EDTA due to its less hyperosmolareffect on blood cells compared to K3 EDTA. This study aimed to compare the results of Complete Blood Count (CBC) andErythrocyte Sedimentation Rate (ESR) using anticoagulant K2 EDTA and K3 EDTA. This study was an analytic observationalstudy with a cross-sectional design conducted from April to December 2018. The subject of the study were 103 healthyadults selected by consecutive sampling. Blood samples were collected in both anticoagulant tubes with a volume of 3 mLeach. Samples were tested twice, in the first 0 hours and the next 6 hours using Sysmex XN 1000 and Alifax Roller 20 LC.Kolmogorov-Smirnov test, paired T-test and Wilcoxon rank test were used for statistical analysis. The agreement testbetween both anticoagulants was carried out using the Bland Altman plot for parameters with a significant difference. Therewas a significant difference between both anticoagulants for the parameters of hemoglobin, hematocrit MCV, MCHC, RDW,PDW, MPV, PLC-R, and erythrocyte sedimentation rate in both the first and second tests. The agreement test using the BlandAltman plot showed that the difference in these parameters was within the Limit of Agreement (LOA) range of 95%. Thisstudy showed that there were differences in some parameters of complete blood count and erythrocyte sedimentation ratebetween the two anticoagulants (K2 K3 EDTA), but these differences were within the LOA range.
Yulia Nadar Indrasari, Y. Hernaningsih, Munawaroh Fitriah, Arifoel Hajat, I. Ugrasena and N. Yusoff
Institute of Medico-legal Publications Private Limited
In this study, we evaluated the RBC indices in differentiating ?-thalassemia minor and iron deficiencyanemia in a healthcare center. This was an observational analytic study with a cross-sectional design usingblood specimens of children aged 3 years to 17 years with microcytic hypochromic anemia based onthe results of complete blood counts and evaluation of peripheral blood smears. Calculation of the RBCindices was performed as an initial screening to differentiate ?-thalassemia minor and iron deficiencyanemia. Iron profile examination and hemoglobin electrophoresis were performed to confirm the diagnosisof ?-thalassemia minor and iron deficiency anemia. The results of the independent samples t-test showedsignificant differences in Hb, MCV, MCH, and MCHC between ?-thalassemia minor and iron deficiencyanemia (p <0.05). The results of the Mann Whitney test showed a significant difference in the MentzerIndex to distinguish between ?-thalassemia minor and iron deficiency anemia (p <0.05). Also, the resultsof the independent samples t-test showed significant differences in the Green & King formula, Sirdah etal. formula, and the Maltos and Carvalho Index (p <0.05). The Green and King formula has a diagnosticsensitivity of 78.6% and a specificity of 76.6% and an accuracy of 78.03%. Various formulas based on theresults of complete blood count parameters have been developed to detect ?-thalassemia minor in areas witha high prevalence of ?-thalassemia with different sensitivity and specificity. In this study, it showed that theGreen and King formula has a diagnostic sensitivity of 78.6% and a specificity of 76.6%, and an accuracyof 78.03%. Green and King’s formula can be applied as an initial screening to differentiate ?-thalassemiaminor and iron deficiency anemia
Endah Indriastuti, Yetti Hernaningsih, Yulia Nadar Indrasari, and Andrianto Andrianto
PDS Patklin
Acute Coronary Syndrome (ACS) includes ST-Elevation Myocardial Infarction (STEMI), non-ST Elevation MyocardialInfarction (NSTEMI), and Unstable Angina (UA). Platelet plays an essential role in ACS pathogenesis. Immature PlateletFraction (IPF) and platelet indices can predict platelet activations. Platelet indices consist of platelet count, Mean PlateletVolume (MPV), Platelet Distribution Width (PDW), plateletcrit (Pct). This study aimed to analyze the differences of IPF andplatelet indices among ACS patients. This study was an observational analytical cross-sectional study conducted inDr. Soetomo Hospital during May-September 2019. The subjects consisted of 30-STEMI, 25-NSTEMI, and 24-UA patients.The EDTA-samples were measured for platelet indices and IPF using Sysmex XN-1000. The differences between IPF andplatelet indices among STEMI, NSTEMI, and UA patients were analyzed using Kruskal-Wallis and Mann-Whitney test. The IPFvalues were significantly higher in STEMI patients than NSTEMI and UA patients. The IPF values of NSTEMI patients werehigher than UA patients. The MPV, PDW, and P-LCR were significantly higher in STEMI and NSTEMI compared to UA. TheMPV, PDW, and P-LCR values of NSTEMI patients were significantly higher than UA patients. The significant differencesbetween STEMI and NSTEMI toward UA might be caused by the more severe thrombotic conditions in myocardial infarctionpatients than UA. The IPF values were significantly different among each type of ACS patients gave an opportunity using thisparameter to differentiate the ACS types. The MPV, PDW, and P-LCR were significantly higher in myocardial infarctionpatients than UA patients, which also allowed them to use those parameters to differentiate both conditions.
Arie Rahmanitarini, Yetti Hernaningsih, and Yulia Nadar Indrasari
DiscoverSys, Inc.
Background: Peripheral blood smear examination had a pivotal role in determining diagnosis and as confirmation of the automatic hematology analyzer results. The storage process was highly influential on the morphological stability of the cell. This study aimed to assess the morphological changes in blood cells stored at certain period and temperature. Method: Sample of 30 blood specimens of healthy people with dipotassium ethylenediaminetetraacetic acid (K2EDTA) anticoagulants. The specimens were stored at room temperature (18-25ºC) and refrigerator temperature (2-8ºC) and were analyzed at the preliminary examination i.e., 8 hours, 16 hours, 24 hours, 48 hours, 72 hours, and 96 hours. Kappa test was used in validating the reading of PBS (Peripheral Blood Smear). The discrimination testing used were paired t-test and Kolmogorov Smirnov test with p value <0.005, which stated to be significant. Result: The changes in erythrocytes morphology stored at room temperature (18-25ºC) was that the erythrocytes crenation started to happen at 8 hours storage with the grading scale of +2 that were found in 24 (80%) samples, whereas at refrigerator temperature (2-8ºC) the grading scale was +1 and found in 13 (43.3%) samples. Spherocytes on erythrocytes began to form at room temperature (18-25ºC) at 8 hours storage with grading scale of +1 and was found in 2 (6.7%) samples, whereas at refrigerator temperatures (2-8ºC) spherocytes on erythrocytes began to form at 24 hours storage with grading scale of + 2 and was found in 3 (10%) samples.Conclusion: Peripheral blood smear (PBS) examination shall be done immediately to obtain significant results.