Early Screening of Hemoglobinopathy in Indonesia Using Erythrocyte Indices

BACKGROUND: The mutation spectrums of hemoglobinopathy are different among populations that yield a different result of erythrocyte indices. Calculation of erythrocyte indices with some formula has been reported to differentiate between hemoglobinopathy and non-hemoglobinopathy, but its cut-off should be recalculated specific for each population to gain a better sensitivity and specificity. We aimed to evaluate red blood cell count (RBC), Mentzer index, red cell distribution width (RDW), RDW index (RDWI), Shine and Lal index (S&L) and Green and King index (G&K) to screen hemoglobinopathy in Indonesia.METHODS: A retrospective cross-sectional study was performed on 202 subjects. The diagnosis of hemoglobinopathy was determined based on the results of complete blood count (CBC) data, high-performance liquid chromatography (HPLC) and Hemoglobin H (HbH) inclusion body. The ferritin concentration was checked to determine the status of iron. The erythrocytes indices were analyzed and calculated to predict hemoglobinopathy. RESULTS: A total 202 subjects who met the criteria were involved in this study. Fifty percent showed pure hemoglobinopathy and 4% showed a combination of thalassemia and hemoglobinopathy. The hemoglobin concentration and RBC were significantly higher, and the mean corpuscular volume (MCV) and RDW were significantly lower in hemoglobinopathy compared to iron deficiency. The difference was not significant if the hemoglobinopathy was combined with iron deficiency. By this study\u27s cut-off, the G&K and RDWI showed the highest accuracy, sensitivity, and specificity.CONCLUSION: The new cut-off of erythrocyte index and its calculation to screen hemoglobinopathy in Indonesia showed a higher sensitivity and specificity, especially for G&K and RDWI with cut-off 73 and 228, respectively. The presence of iron deficiency in hemoglobinopathy could decrease the sensitivity

C-Reactive Protein and Matrix Metalloproteinase-9 Are Associated with Outcome of Ischemic Stroke

BACKGROUND: C-Reactive protein (CRP) and matrix metalloproteinase (MMP)-9 are inflammatory mediators that are often associated with the evolution of stroke. In this study, we aimed to find out whether concentration of these biomarkers were associated with the severity of discharge National Institute of Health Stroke Scale (NIHSS) in ischemic stroke patient.METHODS: In prospective stody, we involved 143 ischemic stroke patient who were admitted to hospital not more than 72 hours after the onset and who met the criteria. The concentration of CRP was assessed by High Sensitivity CRP reagent from Siemens and the concentration of MMP-9 was measure with Quantikine Human MMP-9 (total) Immunoassay from R&D. The outcome of stroke was determined by NIHSS score at discharge.RESULTS: There was a significant correlation between the CRP level and the severity of NIHSS at discharge (r = 0.288, p = 0.000). Subjects with intermediate/high level of CRP had a higher probability to have a moderate or even severe NIHSS (OR = 1.7, p = 0.004). Subjects with high MMP level showed a higher probability to have a severe NIHSS. CONCLUSION: The measurement of CRP and MMP-9 at 48-72 hours after stroke onset were associated with the severity of ischemic stroke based on NIHSS score at discharge

GFAP and S100B Protein Are Associated with Discharged NIHSS of Anterior Circulation Ischemic Stroke

BACKGROUND: Patient with larger ischemic lesion will suffer more severe neurogical deficit. The utility of MRI for lesion size measurement is still limited, therefore additional approach was pursued through examination of markers released by damaged brain cell, GFAP and S100B protein. The aim of this study is to know whether both markers are associated with the neurological deficit of anterior circulation ischemic stroke. METHODS: This observational prospective study enrolled 74 patients with anterior circulation ischemic stroke diagnosis. GFAP and S100B protein were measured with ELISA using blood collected at 48 to 72 hours after onset. The neurological deficit was assessed with NIHSS ad discharged.RESULTS: There was a significant association between GFAP level and discharged NIHSS (p=0.008) with 100% sensitivity and 100% negative predictive value. S100B protein also showed a significant correlation with discharged NIHSS (r=0.488; p=0.000) and this correlation could be described with an equation (OR=1.009; 95% CI=1.0003-1.0188; p=0.044). S100B protein at 78.3215 ng/L would give true prediction as 73.9% (95% CI=62.7%-85.2%, p=0.001). CONCLUSIONS: GFAP and S100B protein that were measured at 48 to 72 hours after onset were significantly associated with NIHSS at discharge