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FAQ Laboratory Study in Sepsis

This comprehensive study delves into sepsis and hemoglobin anemia, covering the mechanisms of blood loss and decreased red blood cell production. It discusses the role of neutrophils during infections, highlighting leucocytosis and neutropenia. Key laboratory markers, such as C-reactive protein (CRP) and procalcitonin, are evaluated for their significance in diagnosing inflammatory conditions. The study emphasizes the importance of blood culture procedures in detecting infections and the need for proper specimen collection practices to enhance diagnostic accuracy.

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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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