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FAQ Laboratory Study in Sepsis

FAQ Laboratory Study in Sepsis. Nina Dwi Putri. 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.

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FAQ Laboratory Study in Sepsis

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  1. FAQ Laboratory Study in Sepsis Nina Dwi Putri

  2. Hemoglobin-Anemia • blood loss • decreased production (hypoproliferativeane- mia) • a reticuloendothelialblock in iron transport • decreased sensitivity of the erythron to erythropoietin • shortened red blood cell survival. • increased destruction (hemolytic anemia) of red blood cells

  3. Neutrophils: phagocytosinginfectious 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

  4. Leucocyte

  5. Platelet

  6. 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

  7. C-REACTIVE PROTEIN (CRP) protein faseakut yang dibentukolehselhepatositakibatrangsangansitokin anti-inflamasi CRP meningkatdalam4-6 jam 8 jam: 2x lipat Puncaknya36-50 jam Penyembuhan: penurunankadar CRP secaracepat CRP memilikimasaparuh 4 sampai 7 jam Sangatbaikuntukmenilaiaktivitaspenyakitdalamkeadaanakut.

  8. Peningkatan CRP dapatdijumpaipadakondisiselaininfeksi Nobre V et al. Am J RespiirCrit Care Med, 2008;117:498-505

  9. …sepsis CRP LEVELNormal concentration in healthy human serum < 10 mg/L (increasing with aging). 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) Nobre V et al. Am J RespiirCrit Care Med, 2008;117:498-505

  10. PROCALCITONIN

  11. AsalSpesimen Seharusnyasteril Ada flora normal komensal Salurannapasatas Kulit Saluran gastrointestinal Saluran genital perempuan Uretra • Darah • Sumsumtulang • Cairansendi • Jaringan • Salurannapasbawah • Kandungkemih • Padabagiantubuh yang seharusnyasteril, apabiladitemukanm.o: • Telahterjadiinfeksi • Cara koleksidanwaktupengirimantidaktepat • Laboratoriumterlambatmemulaipemeriksaan • Bilaspesimendiambildaritempatdengan flora normal: • Kuantitas/jumlahspesimenperludiperhatikan • Kondisipasien: imunokompromais/imunokompeten

  12. Murray PR. Medical Microbiology 2002.

  13. Volume DarahuntukPemeriksaanKultur IDSA guidelines 2013 Increased volume Increased Yield10 ml  20 ml 30 %  40 %20 ml  30 ml 10 %  15 % NOTE: Pediatric volume guide: usually draw 1 mL/year of age.

  14. BiakanDarah • Diambilpd2 sisiberbeda(ClinMicrobiol. Rev19:788-802, 2006) • Jumlahvolume darahsangatmenentukanhasil • Waktubakteremia(penting) • 2 kulturdiambildarivena dankateter : • Keduanyavena (PPV 98 %) • Keduanyakateter ( 50 %) • Satu vena, satukateter ( 96 % ) • 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)

  15. Number • 1blood 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 • 3blood cultures are reasonable when intermittent bacteraemia is suspected S Afr Med J 2010; 100: 839-843.

  16. 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 6 - 36 hours apart

  17. BiakanTinjadanUrin BiakanTinja: • 2 sampelberturut-turut • Tidakboleh >3 hari BiakanUrin: • Pengumpulan spesimen minimal kontaminasi • Pengambilan pagi hari • Pengambilansebelumpemberianantibiotik • Segera dikirmkan untukdiproses, kemas dengan es • Jika tidak segera dikirim masukkan almari es ( 40C ) • Bakteriuria bermakna : • Suprapubik : berapapun • Kateter : 10.000 • Mid stream : 100.000

  18. TERIMA KASIH

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