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"Latar belakang. Transfusi trombosit ditujukan untuk mencegah dan mengatasi perdarahan pada pasien trombositopenia. Trombosit dapat mengalami aktivasi walaupun tidak terjadi perdarahan sehingga dapat menimbulkan suatu keadaan yang disebut hiperagregasi seperti pada trombosit dari seseorang dengan hiperlipidemia. AABB menganjurkan untuk membuang semua produk darah yang berasal dari donor dengan plasma yang lipemia. Penelitian ini bertujuan untuk mengetahui pengaruh status lipid donor trombosit aferesis terhadap fungsi trombosit dan kadar malondialdehid selama penyimpanan. Metodologi. Penelitian ini menggunakan desain deskriptif analitik pada 31 sediaan trombosit aferesis yang berasal dari donor trombosit aferesis yang memenuhi kriteria inklusi dan eksklusi. Sediaan trombosit aferesis dibagi menjadi dua grup, yaitu grup hiperlipidemia dan normolipidemia. Dilakukan pengujian terhadap kandungan trombosit, fungsi agregasi dan kadar MDA pada hari pertama, kedua dan keempat penyimpanan. Hasil. Terjadi peningkatan kandungan trombosit selama penyimpanan pada kedua grup, yang berhubungan dengan proses apoptosis. Pada hari keempat terjadi kenaikan kandungan trombosit yang lebih banyak pada grup hiperlipidemia. Pada hari kedua didapatkan perbedaan yang bermakna pada agregasi trombosit dengan agonis ADP 2 μM. Pada hari keempat didapatkan perbedaan kadar MDA yang bermakna. Didapatkan korelasi yang positif dan bermakna antara kolesterol total, LDL dan trigliserida terhadap kadar MDA. Tidak didapatkan korelasi yang bermakna antara kolesterol total, trigliserida dan kadar MDA terhadap agregasi trombosit. Simpulan. Status lipid donor meningkatkan terjadinya apoptosis trombosit aferesis, lebih sensitif terhadap agonis ADP dan peningkatan kadar MDA. Perlunya mengingatkan donor trombosit aferesis untuk diet rendah lemak sebelum proses aferesis dilaksanakan. Perlunya penelitian lebih lanjut untuk menentukan kadar lipid yang masih dapat ditoleransi.

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Background. Platelet transfusions is intended to prevent and resolve bleeding in patients with thrombocytopenia. Platelet activation may have occured although there were no bleeding that can lead to a condition called hyperaggregation as in someone with hyperlipidemia. AABB recommends to dispose of all products from donors with plasma lipemia. This study aimed to determine the effect of lipid status of the donor platelet apheresis to platelet function and levels of malondialdehyde with in storage.

Methodology. This study used descriptive analytic design in 31 platelet apheresis concentrates. Samples were divided into two groups, hyperlipidemia and normolipidemia. The assay for the content of platelets, aggregation functions and levels of MDA was tested on the first day, second and fourth of platelet storage.

Results. An increase in the content of platelets during storage in both groups, which are associated with the process of apoptosis. On the fourth day there was higher of contents platelets in hyperlipidemic grup than normolipidemic grup. There were significant difference in platelet aggregation with ADP 2 μM at second day and levels of MDA at fourth day. There were positive and significant correlations between total cholesterol, LDL and triglyceride to the levels of MDA. There were no significant correlation between total cholesterol, triglycerides and MDA levels to platelet aggregation.

Conclusion. Improved of the lipid status of the donor platelet apheresis will increase platelet apoptosis, more sensitive to agonist ADP and increase MDA levels. The need to remind donors platelet apheresis to a low fat dietary before apheresis process implemented. Need for further research to determine the lipid levels that can still be tolerated."

"Background : The aim of the study is to provide an insight about mean platelet volume (MPV) value in systemic lupus erythematosus (SLE) with and without thrombocytopenia patient. MPV wa expected to be used to determine the cause thrombocytopenia in lupus, so the patient could be treated appropriately. Method: The study design was descriptive categoric, and the data were obtained by using cross-sectional method from patient’s medical record and lab examination result in the period from January 1st 2016 – January 31st 2018. The sampling method are done using total sampling. The inclusion criteria of this study were SLE patients which MPV and platelet count had been examined at the same time, the data used is data that was first discovered in the period of the study. The exclusion criteria were incomplete medical record data, patient with thrombocytosis, and SLE with comorbidity such as thrombotic disease (ischemic stroke and deep vein thrombosis), other high inflammatory overlap diseases (such as rheumatoid arthritis and inflammatory bowel disease), and infection. Result : From 75 patients that match with the inclusion criteria, all patients were female and based on the age of diagnosis, most patients were in age group of 25-34 years old (41,33%). Based on the lab results, group with normal platelet count have 53 data of normal MPV and 12 data of high MPV, while group with thrombocytopenia have 6 data of normal MPV and 4 data of high MPV. Conclusion : Group with normal MPV value and normal platelet count has the largest proportion, while the group with thrombocytopenia in lupus and high MPV value has the lowest proportion."

"Pasien sirosis hati perlu dievaluasi secara berkala untuk menentukan adanya varises esofagus (VE) dan ukurannya (besar atau kecil), karena VE besar membutuhkan penatalaksanaan yang lebih agresif. Evaluasi ini dilakukan dengan endoskopi yang tidak selalu ada, invasif, dan berbiaya tinggi. Penelitian ini bertujuan untuk mendapatkan pemeriksaan yang non invasif, lebih murah, dan lebih mudah diakses untuk menentukan besarnya VE. Parameter yang diteliti adalah hitung trombosit, prothrombin time (PT), kadar albumin, dan bilirubin. Desain penelitian adalah potong lintang dengan 64 subjek, terdiri atas 24 pasien sirosis hati dengan VE besar dan 40 tanpa VE besar. Pada penelitian ini didapatkan perbedaan bermakna pada hitung trombosit, PT, dan kadar albumin antara kedua kelompok, sedangkan kadar bilirubin tidak memberikan perbedaan yang bermakna. Untuk parameter hitung trombosit didapatkan besar area under the curve untuk memprediksi VE besar sebesar 80,9%, dengan cutoff 89,5 x 103/μL didapatkan sensitivitas 79,2% dan spesifisitas 75,0%; PT 68,4%, dengan cutoff 14,05 detik didapatkan sensitivitas 70,8% dan spesifisitas 67,5%; kadar albumin 76,6%, dengan cutoff 3,275 g/dL didapatkan sensitivitas 70,8% dan spesifisitas 75,0%. Model prediksi sirosis hati dengan VE besar adalah P = 1/(1 + Exp-Logit (y)) dengan Logit (y) = 11,989 – 0,026 x hitung trombosit – 2,243 x kadar albumin – 0,184 x PT.

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Patients with liver cirrhosis require periodic evaluation to determine the presence and size of esophageal varices (EV), because the large ones demand more aggressive management. Evaluation is done using endoscopy, which is not always available, invasive, and costly. This study aims to acquire tests that are noninvasive, cheaper, and more accessible to determine the size of EV. Studied parameters were platelet count, prothrombin time (PT), albumin, and bilirubin level. The study design was cross sectional with 64 subjects, consisted of 24 liver cirrhotic patients with large VE and 40 without.

This study found significant difference in platelet count, PT, and albumin level between both groups, while bilirubin level was not. The size of area under the curve for platelet count to predict large VE was 80.9%, cutoff 89.5 x 103/μL (sensitivity 79.2%, specificity 75.0%), PT 68.4%, cutoff 14.05 seconds (sensitivity 70.8%, specificity 67.5%), and albumin level 76.6%, cutoff 3.275 g/dL (sensitivity 70.8%, specificity 75.0%). Prediction model for liver cirrhosis with large VE was P = 1/(1 + Exp-Logit (y)) with Logit (y) = 11.989 – 0.026 x platelet count – 2.243 x albumin level – 0.184 x PT."

"Latar belakang: Immune thrombocytopenia (ITP) didiagnosis dengan mengekslusi penyebab lain trombositopenia. Mekanisme trombositopenia terjadi melalui 2 mekanisme, yaitu destruksi trombosit seperti pada pasien ITP dan penurunan produksi trombosit pada pasien leukemia. Aspirasi sumsum tulang merupakan metode yang dapat membedakan mekanisme trombositopenia yang terjadi, tetapi karena invasif tidak rutin dilakukan untuk diagnosis. Seiring dengan perkembangan zaman, dapat dilakukan pemeriksaan trombosit muda dengan teknik flouresensi untuk menilai kadar immature platelet fraction (IPF). Penelitian ini dilakukan untuk membandingkan kadar IPF pada pasien ITP dibandingkan dengan leukemia. Metode: Studi potong-lintang kadar IPF pasien anak dengan ITP dan leukemia, yang dilaksanakan dari 2017-2020 di RSUPN Cipto Mangunkusumo, Jakarta. Sampel penelitian adalah pasien anak umur kurang dari 18 tahun, yang menderita ITP dan leukemia, yang belum mendapatkan kemoterapi ataupun imunosupresan. Data penelitian diambil dari rekam medis atau pemeriksaan darah rutin. Hasil: Dari 42 pasien, didapatkan 21 pasien ITP dan 21 pasien leukemia. Terdapat perbedaan bermakna (16,6 poin) dari rerata kadar IPF pasien ITP dibandingkan pasien leukemia (P<0,001). Pasien ITP memiliki kadar rerata IPF sebesar 18,6%(SB 12,1%). Pasien leukemia memiliki kadar IPF 2%(SB 1,31%). Kesimpulan: Terdapat perbedaan bermakna kadar IPF pada pasien ITP dibandingkan pasien leukemia akut.

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.Background and aim: Immune thrombocytopenia (ITP) is diagnosed by excluding other causes of thrombocytopenia. The thrombocytopenia itself could occur through 2 mechanisms, which were platelet destruction as in ITP, and decrease platelet production as in leukemia. Bone marrow aspiration used to be done to distinguish the mechanism of thrombocytopenia, but it has not been routinely done due to its invasiveness. Examination of young platelets with fluorescence technique are currently done to assess the level of Immature Platelet Fraction (IPF). This study was conducted to evaluate the differences in IPF levels in ITP patients compared with leukemia patients.

Methods: A cross-sectional study was carried out on the IPF levels on patients with ITP and leukemia, from 2017-2020 at Cipto Mangunkusumo General Hospital, Jakarta. The study sample was pediatric patients, less than 18 years old, diagnosed with ITP and acute leukemia, whom had not received any chemotherapy or immunosuppressants. Research data were taken from medical records and/or routine blood tests.

Results: Total of 42 patients, 21 ITP patients and 21 leukemia patients were found. There was a significant difference (16,6 poin) in the mean of IPF levels of ITP patients compared with leukemia patients (P <0.001). ITP patients had an average IPF level of 18,6% (SB 12,1). Leukemia patients have 2% IPF levels (SB 1,31).

Conclusions: There is a subtantial different in IPF in ITP patient compared to acute leukemia patients. "

"Latar belakang: micro-RNA saat ini telah diketahui berperan dalam patofisiologi berbagai penyakit termasuk di bidang kardiovaskular. miR-26a platelet dikaitkan dengan aktifitas platelet tinggi.Resistensi klopidogrel telah diketahui memiliki prevalensi yang cukup tinggi di populasi Asia, yang mana dapat mempengaruhi mortalitas serta kejadian kardiovaskular mayor. Hubungan antara ekspresi miR-26a platelet dengan resistensi klopidogrel begitu pula dengan TIMI flow pasca IKPP pada IMA-EST di populasi Asia, belum pernah dilaporkan. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi miR-26a platelet terhadap reaktivitas platelet dan perfusi miokardium pasca IKPP. Metode: Pada pasien IMA-EST yang menjalani IKPP dan mendapatkan terapi dosis loadingklopidogrel 600 mg, dimasukkan kedalam populasi penelitian. Kami mengukur reaktivitas platelet dengan menggunakan VerifyNow P2Y12, aktifitas platelet tinggi didefiniskan jika memiliki nilai > 208 PRU. Metode RealtimePCR Taqman dilakukan untuk analisa ekspresi miR-26a platelet. Ekspresi miR-26a platelet dan reaktivitas platelet dikorelasikan dengan TIMI flowpasca IKPP pada pasien IMA-EST. Hasil: Terdapat 100 subyek yang direkrut pada studi ini. Diantaranya, 59% menunjukkan peningkatan ekspresi miR-26a. Reaktifitas platelet meningkat pada 27 % pasien studi ini dikategorikan non-responder terhadap klopidogrel. Terdapat hubungan antara ekspresi dengan penurunan fungsi penghambatan platelet (OR 4.2, p = 0.006). Indeks reaktivitas platelet >208 PRU meningkatkan risiko TIMI flow < 3 (OR 3.3, p= 0.015). Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIMI flow < 3. Kesimpulan: Pasien dengan peningkatan ekspresi miR-26a platelet memiliki risiko untuk mengalami menjadi non-responderklopidogrel. Tidak terdapat hubungan langsung antara ekspresi miR-26a platelet dan TIM flowpasca IKPP.

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Background: micro-RNA has now been known to play a role in the pathophysiology of various diseases including cardiovascular disease. Clopidogrel resistance has been known prevalent in Asian population, that may affect mortality and major cardiovascular events. The relationship between the expression of platelet miR-26a and clopidogrel resistance as well as TIMI flow post primary PCI in STEMI among Asian populations, has never been done.

Objective: the aim of this study is to define whether miR-26a platelet expression has a relation with platelet reactivity and myocardial perfusion after primary PCI.

Methods: STEMI patients who underwent primary PCI and has received 600 mg loading dose of clopidogrel were recruited for the study. We measured platelet reactivity by VerifyNow P2Y12, high platelet reactivity was defined as > 208 PRU. Realtime PCR by taqman method were performed to asses the expression of miR-26a platelet. miRNA-26a platelet expression and platelet reactivity were correlated with TIMI flow post primary PCI in STEMI.

Hasil: there were 100 patients recruited for this study. among them, 59% of patients with high expression of miR-26a platelet. Platelet reactivity showed 27% of the patients were clopidogrel non-responders. There was a relationship between high miR-26a expression and decreased function of platelet inhibition (OR 4.2, p = 0.006). Platelet reactivity index > 208 increased the risk of suboptimal reperfusion (OR 3.3, p = 0.015). There was no direct correlation between miR-26a expression and TIMI flow < 3.

Conclusion: Patients with high miR-26a platelet expression had increased risk of being clopidogrel non responders. There is no direct relationship between miR-26a platelet expression and TIMI flow after primary PCI."

"Background: Platelet-Rich Plasma is believed to repair cartilage degeneration by stimulating tissue regeneration, however the clinical evidence is still insufficient. The aim of this research is to compare the efficacy of intra-articular hyaluronic acid injection (HA) and combined hyaluronic acid and platelet-rich plasma (HA-PRP) on osteoarthritis of the knee, and the association on gender, age, body mass index and osteoarthritis degree towards the efficacy. Methods: This is a cross-setional study using 58 patients’ medical records. 27 patients received HA injections, and 31 patients received HA-PRP injections. Patients were evaluated weekly using IKDC and WOMAC score until 2 months after the injections. Results: On the 2nd month of follow up, AH-PRP shows greater increase in IKDC (p=0,146) and WOMAC (Pain p=0,004; Stiffness p=0,008; Knee function p=0,007) score compared to HA injection. There’s no association on gender, age, and body mass index towards the IKDC and WOMAC score increase on either HA or combined HA-PRP injection. There’s no significant difference on osteoarthritis degree towards IKDC and WOMAC score increase on HA injection. However, there’s a significant difference between osteoarthritis degree 2 and 4 towards IKDC (p=0,002) and WOMAC score (Pain p=0,042; Stiffness p=0,018; Knee function p=0,042) and between osteoarthritis degree 2 and 3 towards WOMAC Pain (p=0,008) and WOMAC Knee function (p=0,018). Conclusions: HA-PRP injection shows better results to reduce osteoarthritis symptoms compared to HA injections. Better results were observed in patients with less severe osteoarthritis degree."

"A series of alkaloids isolated from the roots of N. orientalis is investigated for the inhibitory activities on in vitro agonists induced human platelet aggregation. Human platelet samples were obtained to investigate the anti-platelet activity by high throughput 96-well microtiter plate format. Adenosine diphosphate (ADP), arachidonic acid (AA), thrombin and thrombin receptor activating peptide-6 (TRAP-6) were used as agonists for in vitro human platelet aggregation. All alkaloids were inactive in the AA induced platelet aggregation. Compound 2 was the only alkaloid to inhibit ADP induced platelet aggregation with the IC50 value of 27.01 ± 7.67 pM and was more potent than the standard drug, ibuprofen (p < 0.05). The compounds 1, 3, 4, 5 and 7 were more potent than the standard drug to inhibit thrombin induced platelet aggregation with the IC50 values of 3.05 ± 0.22,4.41 ± 0.47,7.50 ± 0.22,45.69 ± 1.74 and 4.89 ±0.13 pM (p < 0.05), respectively. None of the potent alkaloids in thrombin- mediated platelet aggregation exhibited the inhibitory effect in TRAP-6 induced platelet aggregation. Compound 2 could inhibit platelet aggregation through the interference of platelet purinergic receptors (P2Y1 and P2Y12 receptors). Moreover, compounds 1, 3,4, 5 and 7 could have inhibitory effects on thrombin-induced platelet aggregation through the proteolytic inhibition without the interferences of ligand-receptor interaction."

"Dual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice."