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FAQ Laboratory Study in Sepsis Nina Dwi Putri.

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Presentasi berjudul: "FAQ Laboratory Study in Sepsis Nina Dwi Putri."— Transcript presentasi:

1 FAQ Laboratory Study in Sepsis Nina Dwi Putri

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5 Hemoglobin-Anemia blood loss decreased production (hypoproliferative ane- mia) – a reticuloendothelial block in iron transport – decreased sensitivity of the erythron to erythropoietin – shortened red blood cell survival. increased destruction (hemolytic anemia) of red blood cells

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7 Neutrophils: phagocytosing infectious organisms, crystalline material (e.g., uric acid), and immune complexes Leucocytosis: – recruitment of mature neutrophils from the marginating pool into the circulating pool – mobilization of mature and developing neutrophils from the bone marrow – eventually increased leukopoiesis Neutropenia: exhaustion of BM progenitors, maturation arrest, imbalance extravasation and production

8 Leucocyte

9 Platelet

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12 ESR Non-specific marker of tissue injury More useful than leukocyte count in identifying inflammatory conditions Differentiating mild versus severe states of inflammation Detection of inflammatory diseases and malignancy Less useful in categorizing the etiology behind the highly inflamed patients

13 protein fase akut yang dibentuk oleh sel hepatosit akibat rangsangan sitokin anti-inflamasi CRP meningkat dalam 4-6 jam 8 jam: 2x lipat Puncaknya jam Penyembuhan: penurunan kadar CRP secara cepat CRP memiliki masa paruh 4 sampai 7 jam Sangat baik untuk menilai aktivitas penyakit dalam keadaan akut. C-REACTIVE PROTEIN (CRP)

14 Peningkatan CRP dapat dijumpai pada kondisi selain infeksi MAJOR ELEVATION a.Bacterial infection b.Hypersensitivity complications of infections c.Inflammatory disease d.Transplantation e.Cancer f.Necrosis g.trauma - pyelonephritis, pelvic infections, meningitis, endocarditis -Rheumatic fever, erythema nodosum - rheumatoid arthritis, juvenile chronic arthritis, ankylosing spondylitis, psoriatic arthritis, systemic vasculitis, polymialgia rheumatica, reiter’s disease, Crohn’s disease, familial mediterranian fever - renal transplantation - lymphoma, sarcoma - myocardial infarction, tumor embolisation, acute pancreatitis - burn, fractures MINOR OR NO ELEVATION a.Inflammatory disease b.Transplantations c.Cancer -SLE, systemic sclerosis, dermatomycosis, ulcerative colitis, Sjogren’s syndrome - graft vs host disease - leukemia Nobre V et al. Am J Respiir Crit Care Med, 2008;117:

15 …sepsis CRP LEVEL Normal concentration in healthy human serum < 10 mg/L (increasing with aging). CRP (mg/L) 10 – 40Mild inflammation, viral or bacterial infection, late pregnan woman Moderate inflammation, viral orbacterial infection 100 – 200Marked inflmmation, bacterial infection > 200Severe bacterial infection or extensive trauma Nobre V et al. Am J Respiir Crit Care Med, 2008;117: It takes 6-12 hours, even up to 24 hours for CRP to rise following onset infection. Sensitivity 40%, 60% of subsequently proven sepsis episodes will have an initial CRP (compared to 80% sensitivity of immature to total neutrophil ratio)

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20 PROCALCITONIN

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27 Asal Spesimen Seharusnya steril Darah Sumsum tulang Cairan sendi Jaringan Saluran napas bawah Kandung kemih Ada flora normal komensal Saluran napas atas Kulit Saluran gastrointestinal Saluran genital perempuan Uretra Pada bagian tubuh yang seharusnya steril, apabila ditemukan m.o: -Telah terjadi infeksi -Cara koleksi dan waktu pengiriman tidak tepat -Laboratorium terlambat memulai pemeriksaan Bila spesimen diambil dari tempat dengan flora normal: -Kuantitas/jumlah spesimen perlu diperhatikan -Kondisi pasien: imunokompromais/imunokompeten

28 Murray PR. Medical Microbiology BakteriskinnosefaringMouthLower GI Staphylococcus epidermidis++ + Staphylococcus aureus Enterococcus fecalis+++ Streptoccuc pneumonia++ Pseudomonas spp.+

29 Volume Darah untuk Pemeriksaan Kultur IDSA guidelines 2013 Increased volume Increased Yield 10 ml  20 ml30 %  40 % 20 ml  30 ml10 %  15 % NOTE: Pediatric volume guide: usually draw 1 mL/year of age.

30 Biakan Darah Remove the cap and disinfect the septum with an alcohol swab and allow to dry. Do not use iodine as it may damage the septum. Remember to hold the needle down onto the vial (WHO)  Diambil pd 2 sisi berbeda (Clin Microbiol. Rev19: , 2006)  Jumlah volume darah sangat menentukan hasil  Waktu bakteremia (penting)  2 kultur diambil dari vena dan kateter :  Keduanya vena (PPV 98 %)  Keduanya kateter ( 50 %)  Satu vena, satu kateter ( 96 % )

31 Number 1 blood culture is rarely, if ever, sufficient or advisable. – A positive result on a single culture is difficult to interpret, unless an unequivocal pathogen is isolated. 2 blood cultures are usually adequate when continuous bacteraemia is anticipated 3 blood cultures are reasonable when intermittent bacteraemia is suspected S Afr Med J 2010; 100:

32 Timing The ideal: ranging from one to several hours – 2 separate sites within minutes of each other from patients who are acutely ill or those in whom the likelihood of continuous bacteraemia is high Intermittent bacteraemia: – multiple blood cultures hours apart

33 Biakan Tinja dan Urin Biakan Tinja :  2 sampel berturut-turut  Tidak boleh >3 hari Biakan Urin:  Pengumpulan spesimen minimal kontaminasi  Pengambilan pagi hari  Pengambilan sebelum pemberian antibiotik  Segera dikirmkan untuk diproses, kemas dengan es  Jika tidak segera dikirim masukkan almari es ( 4 0 C )  Bakteriuria bermakna :  Suprapubik : berapapun  Kateter :  Mid stream :

34 1.Skrining sepsis : 1.C-Reaktive Protein >10 mg/L. Sensitivitas tes ini: Spesifik: Total Leucocyte Count (TLC) Sensitivitas tes ini: Spesifik: Absolute Neutrophil Count (ANC) Sensitivitas tes ini: Spesifik: Immature Total Ratio (ITR) >20 Sensitivitas tes ini: Spesifik: Micro-ESR (mESR) > umur dalam hari+ 3 mm Sensitivitas: Spesifik: Kultur darah 3. Urin, secara mikroskopik dan kultur 4. Kultur aspirat, ETT dan cairan tubuh/alat medis lainnya 5. Procalcitonin 6. PCR 7. Cytokines : interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64 SEPSIS

35 TERIMA KASIH


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