The Use of Ethanol Gelation Test to Screen the Activation of Coagulation and Disseminated Intravascular Coagulation / 임상검사와정도관리

BACKGROUND: Ethanol gelation test (EGT) is one of the paracoagulation test used to detect the activation of coagulation and formation of fibrin monomer complexes in the fibrinolytic process. Many patients with infectious diseases such as dengue haemorrhagic fever can develop disseminated intravacular coagulation (DIC), which should be diagnosed properly as soon as possible for the management of the patients. To diagnose the coagulation activation and DIC usually the laboratory has to perform the coagulation test, including fibrinopeptide A and D-dimer test. Many laboratories in rural areas in Indonesia do not have the facilities to do such test, and the cost will not be affordable by most of the patients. The aim for the study is to evaluate the EGT as a screening test to detect coagulation activation and DIC, the correlation of D-dimer and EGT. Method: Sixty citrated plasma were obtained from patients in Clinical Pathology Laboratory Cipto Mangunkusumo Hospital for D-dimer test. D-dimer were performed using Nycard Kit with cut off point of 300 ng/dl. The EGT were performed using the method described by Breen. Positive test could be observed by the clot formation. RESULTS: The result of the within-run test for normal and abnormal plasma for EGT showed good results. The plasma was stalell until day 22. The EGT was positive for all the plasma with D-dimer >700 ng/ml. The sensitivity for EGT was 81.6%, specificity 81.8%, positive predictive value 95.2% and negative predictive value 50%. Conclusion: EGT could be used as a screening test for thrombin activity in coagulation activation in rural laboratories with minimal facilities.

The Use of Immatane to Total Neutrophil (IT) Ratio to Detect Bacteriemia in Neonatal Sepsis / 임상검사와정도관리

BACKGROUND: Infection is still a major problem in developing countries, including Indonesia. The incidence of neonatal infection in some referral hospital in Indonesia is quite high, between 8.76-30.29%, with a mortality rate of 11.56-49.9%. The early detection of neonatal sepsis is very important for the management of the patients, but many rural health centers do not have the required laboratory facilities available to diagnose it. The ratio of immature neutrophyl to total neutrophyl (IT ratio) is a simple test, requiring no sophisticated equipment, and can be done in a minimal laboratory setting to be used as a screening test to detect infection. In infection or sepsis a shift to the left of the neutrophil in the peripheral blood smear could be observed. An IT ratio of >0.2 and leukopenia is a marker for detecting neonatal infection. The aim of this study is to obtain the reference value of IT ratio in healthy newborn children and to know the IT ratio in neonatal sepsis and the difference of IT ratio of between capillary and K3EDTA blood. Blood smears were also made hourly with K3EDTA blood kept for 6 hours to observe any changes. METHODS: Materials were obtained from 70 healthy and 41 septic newborns. Capillary blood smear and K3EDTA blood smear were prepared using May-Grunwald-Giemsa staining, and a differential counts were performed manually using a binocular microscope. RESULTS: Reference IT Ratio in healthy newborns was 0.01-0.13 (mean 0.06), in septic newborns 0.13-0.60 (mean 0.26) and the cut off value for sepsis detection was 0.13. There were no difference in the IT ratio between direct capillary blood or K3EDTA blood smear. Samples could be kept until 6 hour without any deterioration. CONCLUSION: The reference value of IT ratio in healthy newborns were 0.01-0.13 (mean 0.06), in sepsis neonatus 0.13-0.60 (median 0.26) and the cut off value for sepsis detection was 0.13. IT ratio could be used as a marker for early detection of newborn septicemia.