Yulia Nadar Indrasari

Scopus Publications

Platelet Aggregation Test on Different Dual Antiplatelet Strategies in Acute Coronary Syndrome
Yustisia Amalia, Yetti Hernaningsih, Moch Yusuf, Yulia Indrasari
Indonesian Journal of Clinical Pathology and Medical Laboratory, 2025
Acute coronary syndrome (ACS) is frequently accompanied by platelet hyper-aggregation, which requires percutaneous coronary intervention (PCI) as definitive management, as it has the side effect of thrombosis, so platelet function must be monitored. This study aimed to evaluate platelet aggregation between the loading and maintenance doses of different DAPT combinations in patients with ACS undergoing PCI. This study employed a prospective cohort design with consecutive sampling, conducted at Dr. Soetomo General Academic Hospital in Surabaya and Universitas Airlangga Hospital in Indonesia. Patients with active bleeding, hemodynamic instability, or contraindications to antiplatelet agents were excluded. Patients were divided into a high-risk bleeding ACS group treated with aspirin–clopidogrel and a low-risk bleeding ACS group treated with aspirin–ticagrelor or aspirin–prasugrel according to the ARC-HBR score. Platelet aggregation tests (% maximum aggregation) were performed using the light transmission aggregometry method with adenosine diphosphate (ADP), collagen (COL), and epinephrine (EPI) agonists. Statistical analysis was performed to compare the differences between groups.The study included a total of 68 ACS patients with PCI: aspirin–clopidogrel (22.1%), aspirin–ticagrelor (44.1%), and aspirin–prasugrel (33.8%). There was no significant difference in platelet aggregation between groups with EPI and COL agonists. ADP agonists showed a significant difference between the loading and maintenance doses in the aspirin–ticagrelor and aspirin–prasugrel groups. The most important difference was observed in the aspirin–prasugrel group (95% CI: -22.68, -9.00; p = 0.000). Aspirin–prasugrel is the most potent inhibitor of platelet aggregation in patients with ACS undergoing PCI.
Correlation between IL-1β and IL-18 Levels with the Severity of Dengue Infection
Arabella Vonia Sari, Aryati Aryati, Theresia Indah Budhy, Anwar Ma`ruf, Dominicus Husada, Retno Palupi, I Gusti Agung Ayu Eka Putri Sunari, Yulia Nadar Indrasari
Indonesian Journal of Clinical Pathology and Medical Laboratory, 2025
Activated monocytes/macrophages and T lymphocytes that generate a cytokine storm are thought to play a critical role in the development of dengue. Cytokine storms, characterized by the excessive production of proinflammatory cytokines, can result in cellular dysfunction and organ failure, often contributing to the severity of dengue in affected patients. Interleukin-18 (IL-18), like IL-1beta, is a proinflammatory cytokine released during inflammation triggered by inflammasome activation. Increased IL-1beta and IL-18 during dengue virus infection (DVI) are known to worsen the host's vascular permeability, increasing hemostasis disorders and potentially, all of which are important elements in the pathophysiology of dengue fever. This study investigates the association between IL-1beta levels, IL-18 levels, age, dengue virus serotype, and the severity of dengue virus infection, aiming to understand how these factors interact and influence disease outcomes. This study is an observational cross-sectional design from 59 DVI patients in Dr. Soetomo General Hospital, Surabaya with positive dengue PCR results. Both IL-1beta and IL-18 levels reveal no significant relationship with the patient's age, infection status, and dengue virus serotype. A weak negative significant relationship between IL-1beta levels and the severity of DVI, indicating an inverse relationship between IL-1beta levels and the severity. Further studies are required to investigate the function of these cytokines in severe dengue.
Optimizing Leukocyte Analysis for Pediatric Leukemia: A Comparison of Two Advanced Hematology Analyzers
Alifferdi Rahman Wiyono, Aryati Aryati, Yulia Nadar Indrasari, Mia Ratwita Andarsini
Iranian Journal of Pediatric Hematology and Oncology, 2025
Background: Acute lymphocytic leukemia (ALL) is a hematologic malignancy affecting the lymphoid lineage, characterized by the uncontrolled proliferation of abnormal, immature lymphocytes and their precursors. The routine use of automated hematology analyzers has become a valuable aid for clinicians in diagnosing leukemia. This study aims to examine the correlation between two automated hematology analyzers in patients with leukemia, particularly in pediatric populations.Materials and Methods: This cross-sectional study involved 57 pediatric patients diagnosed with leukemia who were referred to the Paediatric Hematology Outpatient Clinic at Dr. Soetomo General Academic Hospital, Indonesia. After obtaining informed consent, peripheral blood samples were collected in ethylenediaminetetraacetic acid (EDTA) tubes and analyzed using the Sysmex XN-Series and Horiba Yumizen H2500 automated hematology analyzers. Parameters measured included White Blood Cell (WBC) count, Neutrophil Percentage (NEU%), Lymphocyte Percentage (LYM%), Eosinophil Percentage (EOS%), and Monocyte Percentage (MON%). Data were analyzed using SPSS version 21. Statistical tests applied included the Kolmogorov-Smirnov test, Shapiro-Wilk test, paired t-test, Wilcoxon signed-rank test, Spearman’s and Pearson’s correlation test, Passing-Bablok regression, and Bland-Altman analysis. A p-value of < 0.05 was considered statistically significant. Results: Statistically significant differences were observed between the two analyzers in the median values of WBC count (p = 0.001) and MON% (p = 0.006), as well as in the mean value of NEU% (p = 0.024). Despite these differences, strong correlations were found across all parameters, including WBC, NEU%, LYM%, MON%, and EOS% (p < 0.01). EOS% demonstrated higher variability (Sres) = 1.48.Conclusion: The Sysmex XN-Series and Yumizen H2500 demonstrated a good correlation in the measurement of WBC parameters in pediatric leukemia patients. However, minor variations, particularly in eosinophil percentages, may arise due to differences in measurement techniques, reagent formulations, and interlaboratory variability. Despite these variations, both analyzers are reliable for clinical use.
Correlation between dengue virus serotypes with shock and without shock in dengue virus infection
Journal of Medicinal and Pharmaceutical Chemistry Research, 2025
Brief report: Diversity of mosquito in East Surabaya
Siti Fatimatuz Zahra, Etik Ainun Rohmah, Kris Cahyo Mulyatno, Windi Nurfitri Rahmadani, Muhammad Zamharir Rojafi, Sri Subekti, Yulia Nadar Indrasari, Budi Utomo, Dia Bitari Mei Yuana, I Putu Dody Lesmana
E3s Web of Conferences, 2024
Mosquitoes are insects that are detrimental to human health because they act as disease vectors, such as dengue fever. Surabaya was known for its high risk of dengue fever. This study aims to describe the diversity of mosquitoes and breeding site distribution in Eastern Surabaya. The study was conducted in 2021 during the end of the wet season in different habitat types in the eastern Surabaya (residential, city park, bamboo forest, and mangrove forest). Eggs, larval, and adult-stage mosquitoes were collected and stored in the Entomology Laboratory for morphological identification. Adult mosquito was collected by using a sweep net and light trap method, while the larva and egg were collected incidentally from breeding sites. The diversity of mosquitoes in the Eastern Surabaya was determined by using the Shannon-Wiener diversity index (H’), dominance, species richness (R), and breeding site distribution. Eleven species were obtained in this study, namely Aedes aegypti, Aedes albopictus, Aedes annandalei, Anopheles subpictus, Anopheles vagus, Anopheles barbirostris, Culex bitaeniorhynchus, Culex pseudovishnui, Culex quinquefasciatus, Mansonia uniformis, and Malaya genurostris. The H’ index of 1.63 indicates the mosquito community was at a moderate level. The R-value of 1.56 indicates a low level of mosquito species richness. The most abundant species was Cx. quinquefasciatus (37.2%). Most of the breeding sites with mosquito larval infested were found in open areas (79.3%). These numbers mean the total of individuals of each species tends to be low and its dominance shows no effect on other species. The data on mosquito species and their distribution in Surabaya could be used as base information for vector control strategies.
Differences in Glutamate Dehydrogenase (GLDH) and Other Liver Biochemistry Levels before and after Remdesivir Treatment in COVID-19
Dwita Riadini, Puspa Wardhani, Yessy Puspitasari, M. Robiul Fuadi, Yulia Nadar Indrasari, Kustiah Kustiah, Bambang Pujo Semedi
Research Journal of Pharmacy and Technology, 2024
Background: Remdesivir (RDV) is a broad-spectrum antiviral approved by the Food and Drug Administration (FDA) for the treatment of Covid-19 patients, known to have the potential to cause toxic effects on the liver. Routine monitoring of liver biochemical parameters such as AST, ALT, bilirubin, ALP and GGT, can help detect liver injury. Drug-induced liver injury, according to Hy's law, is characterized by an increase in ALT > 5x ULN, or ALP > 2x ULN, or an increase in ALT > 3x and total bilirubin > 2x ULN, simultaneously. Glutamate dehydrogenase (GLDH) is a sensitive and specific hepatic marker, which can detect liver injury and loss of mitochondrial integrity earlier than other liver biochemical parameters. This study aimed to analyze GLDH levels and liver biochemical parameters before and after RDV therapy in patients with Covid-19. We also analyze several factors that affect liver function and suggest renal function. Methods: This study used an observational analytical with a prospective cohort design, in a population of Covid-19 patients receiving RDV therapy at the infectious emergency department and isolation ward Dr. Soetomo Surabaya for September-November. Consecutive sampling was taken. The subject had drawn blood twice; once before therapy and 5 days after receiving intravenous RDV. GLDH examination is using sandwich ELISA method, while ALT, AST, ALP, GGT, direct and total bilirubin were determined spectrophotometrically. Mann-whitney, the Wilcoxon rank test and Spearman correlation test were used to analyze the data. Results: The number of samples was 34 participants with an average age of 52.47+15.21 years. Concomitant medications were dominated by n-acetylcysteine (94.1%), antioxidants (91.2%) and immunomodulators (82.4%). None of the subjects suffered liver injury induced by RDV according to Hy’s Law. Median GLDH serum levels before RDV treatment 1,14 U/L and after 5 days RDV administration 0,85 U/L (p=0,945), AST (36,4 U/L; 34, 00U/L; p=0,140), ALT (30,43 U/L; 30,20 U/L; p=0,301), DBI (0,15mg/dL; 0,24mg/dL; p=0,090), TBI (0,49mg/dL; 0,50mg/dL; p=0,567), ALP (85,0U/L; 87, 5 U/L; p=0,313) dan GGT (64,5U/L; 71,0U/L; p=0,871). The use of concomitant medication was thought to have protective properties against hepatocytes. Conclusion: After 5 days of RDV treatment, there is no evidence of liver injury. There are no significant differences in GLDH levels and other liver biomarker parameters compared to baseline. There is no difference in delta GLDH levels between groups with and without renal impairment.
Comparison of the Diagnostic Performance of Platelet Aggregation Test using Light Transmission Aggregation (LTA) Method
Chiquita Hasri Mirandari, Yulia Nadar Indrasari, Muhamad Robiul Fuadi, Mohammad Saiful Ardhi
Journal of Medicinal and Chemical Sciences, 2024
Background: Antithrombotic therapy, such as acetylsalicylic acid (ASA) and clopidogrel, may interfere with platelet aggregation in thrombotic strokes. Therefore, a platelet aggregation test is essential for monitoring therapy. A previous study observed a decrease in platelet aggregation using antithrombotics with a manual LTA analyzer. Further research is required to compare this with an automatic tool to determine whether both instruments have similar detection capabilities.Methods: PPP and PRP samples were collected from 30 thrombotic stroke outpatients and 30 healthy controls. Platelet aggregation tests were performed using ADP 5µM and Collagen 2µg/mL on both instruments, Chronolog® Model 490, and Sysmex® CS-2500. The tests were then analyzed using the Wilcoxon test for differences, the Spearman test for correlation, and the Bland-Altman analysis for agreement.Results: No differences were observed in MA values and numerical alignment between the two instruments for ADP and Collagen. If the MA result for the platelet aggregation test on Chrono-log® Model 490 was high, it was likewise high on Sysmex CS-2500 and vice versa. Although the values of LP and Vel differed, the numbers for ADP and Collagen in both instruments were consistent.Conclusion: The comparison between both instruments indicates good agreement. Automated LTA demonstrates the same suitability as manual LTA and can be applied in clinical routines to assess platelet aggregation function. Due to many variations in the pre-analytics stage that might affect the results, it is vital to standardize both the pre-analytics, analytics, and post-analytics stages to compare platelet aggregation tests on the two instruments.
Diagnostic and predictive value of hematological parameters of COVID-19 patients: a retrospective study
Estie Ludi Kiriwenno, Yulia Nadar Indrasari
Bali Medical Journal, 2023
Link of Video Abstract: https://youtu.be/K2R3dfdvi20 Background: Simple, cost-effective, and practical laboratory indicators are required to diagnose and evaluate COVID-19 disease severity. This study assessed the diagnostic value and predictor of severity and outcome parameters of NLR, d-NLR, MLR, PLR, and ALC in COVID-19 patients. Methods: A retrospective study used medical record data from 100 COVID-19 patients from November 2020 to March 2021. SPSS version 22 was used to analyze the data. The severity of COVID-19 was predicted using a ROC curve. Kaplan-Meier analysis was employed to evaluate the ability of various inflammatory markers to predict COVID-19 prognosis. A multivariate analysis with logistic regression was conducted to assess the ability of an independent predictor of COVID-19 severity. A p-value of <0.05 was considered significant. Results: ALC values were lower in the severe-critical COVID-19 group, whereas NLR, d-NLR, MLR, and PLR values were higher. The NLR, d-NLR, and ALC parameters had sufficient accuracy, whereas the MLR and PLR parameters had low accuracy. NLR, d-NLR, MLR, PLR, and ALC had optimal cut-off values of 7.865, 4.82, 0.455, 235.000, and 0.895, respectively. The multivariate odds ratio for ALC was 7.348 (95% CI = 1.914-28.214; p = 0.004). Kaplan-Meier analysis revealed differences in survival time based on the optimal NLR, MLR, d-NLR, and ALC cut-offs obtained. Conclusion: NLR, d-NLR, MLR, PLR, and ALC are all potential predictors of COVID-19 severity and prognosis. ALC is a reliable predictor of COVID-19 severity.
Sorbitol Dehydrogenase and Other Liver Enzymes Before and After Five Days Remdesivir Therapy in Covid-19 Patients
Puspa Wardhani, Kustiah Kustiah, M. Robiul Fuadi, Yulia Nadar Indrasari, Dwita Riadini, et al.
Journal of Medicinal and Chemical Sciences, 2023
The antiviral remdesivir has the potential to cause drug-induced liver injury in Covid-19 patients as seen in increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Sorbitol dehydrogenase (SDH) is a cytoplasmic liver enzyme and can increase in acute liver injury, so it has been proposed as an alternative biomarker in liver injury. This study aimed to analyze the differences in serum SDH levels and other liver enzymes before and after 5 days of remdesivir therapy in Covid-19 patients. This was a prospective observational cohort conducted at RSUD Dr. Soetomo Surabaya, East Java between September and November 2022. The samples included in this study were selected consecutively. The venous blood sample were collected twice from each patient of 34 Covid-19 patients with positive real-time polymerase, namely on the first day of admission before receiving remdesivir therapy and after the fifth day of remdesivir therapy. Venous blood samples are then processed to obtain serum which will be used to measure SDH levels using the sandwich Enzyme-linked immunosorbent assay (ELISA) method and liver enzyme with Alinity-c analyzer. There were 34 subjects, 18 males and 16 females with median ages 56 years old. The median of serum SDH before and after 5 days therapy, respectively, was 0.75 U/L (SD=1.88) and 0.85 U/L (SD=1.32). The median difference of AST, ALT, direct bilirubin, total bilirubin, alkaline phosphatase (ALP), and gamma-glutamil transferase (GGT), respectively, were -3.75 mg/dL, -2 mg/dL, 0.045 mg/dL, 0.05 mg/dL, -3.5 mg/dL, and -1 mg/dL.
Analysis of Common Beta-Thalassemia (β-Thalassemia) Mutations in East Java, Indonesia
Yetti Hernaningsih, Yuli Syafitri, Yulia Nadar Indrasari, Prafa Alif Rahmawan, Mia Ratwita Andarsini, Indra Lesmana, Emmanuel Jairaj Moses, Nur Arzuar Abdul Rahim, Narazah Mohd Yusoff
Frontiers in Pediatrics, 2022
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.
Comparison of K2 and K3 EDTA Anticoagulant on Complete Blood Count and Erythrocyte Sedimentation Rate
Harida Zahraini, Yulia Nadar Indrasari, Hartono Kahar
Indonesian Journal of Clinical Pathology and Medical Laboratory, 2021
Reliability of different RBC indices and formulas in the discrimination of β-thalassemia minor and iron deficiency anemia in Surabaya, Indonesia
Yulia Nadar Indrasari, Y. Hernaningsih, Munawaroh Fitriah, Arifoel Hajat, I. Ugrasena, N. Yusoff
Indian Journal of Forensic Medicine and Toxicology, 2021
Immature Platelet Fraction as A Potential Marker To Differentiate Types of Acute Coronary Syndrome
Endah Indriastuti, Yetti Hernaningsih, Yulia Nadar Indrasari, Andrianto Andrianto
Indonesian Journal of Clinical Pathology and Medical Laboratory, 2020
The effect of storage and time of blood specimen examination of plasma prothrombin time and activated partial thromboplastin time stabilities
Indian Journal of Forensic Medicine and Toxicology, 2020
The stability of sample storage for complete blood count (CBC) toward the blood cell morphology
Arie Rahmanitarini, Yetti Hernaningsih, Yulia Nadar Indrasari
Bali Medical Journal, 2019

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