0100090000036701000000003a01000000003a01000026060f006a02574d464301000000000001 00fd710000000001000000480200000000000048020000010000006c0000000000000000000000 00000000000000000000000000000000220000002200000020454d46000001004802000009000 000010000000000000000000000000000000005000000030000c40100000f01000000000000000 0000000000000e3e3060055220400460000002c00000020000000454d462b014001001c0000001 00000000210c0db01000000600000006000000046000000fc000000f0000000454d462b2240040 00c000000000000001e4009000c00000000000000244001000c000000000000003040020010000 000040000000000803f214007000c000000000000000840000554000000480000000210c0db010 00000000000000000000000000000000000000100000047494638396101000100800000ffffff00 000021f90401000000002c00000000010001000002024401003b00084001082400000018000000 0210c0db01000000030000000000000000000000000000001b4000403400000028000000010000 0002000000000000bf000000bf0000803f0000803f0300000000000000010000000000010021000 00008000000620000000c000000010000004c00000064000000000000000000000000000000000 00000000000000000000001000000010000002900aa0000000000000000000000803f000000000 00000000000803f000000000000000000000000000000000000000000000000000000000000000 0220000000c000000ffffffff460000001c00000010000000454d462b024000000c00000000000000 0e000000140000000000000010000000140000000400000003010800050000000b020000000005 0000000c0201000100030000001e000c00000040092900aa000000000000000100010000000000 040000002701ffff030000000000 Anemia pada Lansia

Anemia sebenarnya bukanlah merupakan diagnosa akhir dari sesuatu penyakit akan tetapi merupakan hasil dari berbagai gangguan dan hampir selalu membutuhkan evaluasi lanjutan atau boleh juga dikatakan bahwa anemia merupakan salah satu gejala dari sesuatu penyakit dasar. Ada juga yang mengatakan bahwa anemia merupakan ekspresi kompleks gejala klinis suatu penyakit yang mempengaruhi mekanisme patogenesis gangguan eritropoesis (produksi eritrosit), perdarahan, atau penghancuran eritrosit. Anemia adalah gejala dari kondisi yang mendasari, seperti kehilangan komponen darah, elemen tak adekuat atau kurangnya nutrisi yang dibutuhkan untuk pembentukan sel darah merah, yang mengakibatkan penurunan kapasitas pengangkut oksigen darah (Doenges, 1999). Anemia adalah istilah yang menunjukan rendahnya hitungan sel darah merah dan kadar hemoglobin dan hematokrit di bawah normal (Smeltzer, 2002 : 935).

Insidensi anemia bervariasi tetapi diperkirakan sekitar 30% penduduk dunia menderita anemia, dimana prevalensi tertinggi berada di negaranegara sedang berkembang. 1. Definisi anemia Seseorang dikatakan menderita anemia apabila konsentrasi hemoglobin pada orang tersebut lebih rendah dari nilai normal hemoglobin yang sesuai dengan jenis kelamin dan umur dari orang tersebut. Oleh Badan Kesehatan Dunia (WHO: World Health Organization) telah ditetapkan batasan anemia yaitu untuk wanita apabilah konsentrasi hemoglobinnya di bawah 12 gr/dL (7,5 mmol/L) dan untuk pria apabila konsentrasi hemoglobinnya di bawah 13 gr / dL (8,1 mmol / L). 2. Klasifikasi anemia

a. Klasifikasi anemia berdasarkan morfologi eritrosit Anemia berdasarkan morfologi eritrosit dibagi atas: mikrositikhipokromik (MCV < 80 fl, MCHC < 30 g/l), normositiknormokromik (MCV 80100 fl, MCHC 30 35 g/l) dan makrositiknormokromik (MCV > 100 fl, MCHC > 35 g/l).

Keterangan: MCV : Volume korpuskuler ratarata MCHC : Konsentrasi hemoglobin korpuskuler ratarata b. Klasifikasi anemia berdasarkan beratringan Anemia berdasarkan berat ringannya dibagi atas 3 tingkatan yaitu ringan, sedang, dan berat.

c. Mekanisme terjadinya anemia Ada beberapa mekanisme untuk terjadinya anemia, yaitu: 1. Kehilangan darah, misalnya perdarahan, 2. Menurunnya umur hidup sel darah merah (eritrosit), misalnya anemia hemolitik, 3. Kelainan pada pembentukan sel darah merah (eritrosit), misalnya kelainan sintesis hemoglobin,

4. Berkumpul dan dihancurkannya eritrosit di dalam limpa yang membesar, 5. Meningkatnya volume plasma, misalnya kehamilan, splenomegali. d. Tanda dan gejala anemia berdasarkan beratringannya anemia Manifestasi gejala dan keluhan anemia tergantung dari beberapa faktor antara lain: 1. Penurunan kapasitas daya angkut oksigen dari darah serta kecepatan dari penurunannya, 2. Derajat serta kecepatan perubahan dari volume darah, 3. Penyakit dasar penyebab anemianya, 4. Kapasitas kompensasi sistem kardiopulmonal. Adapun tanda dan gejala anemia yang dijumpai berdasarkan beratringannya anemia adalah sebagai berikut:

e. Hubungan anemia dengan lansia Anemia merupakan salah satu gejala sekunder dari sesuatu penyakit pada lansia. Anemia sering dijumpai pada lansia dan meningkatnya insidensi anemia dihubungkan dengan bertambahnya usia telah menimbulkan spekulasi bahwa penurunan hemoglobin kemungkinan merupakan konsekuensi dari pertambahan usia. Tetapi ada 2 alasan untuk mempertimbangkan bahwa anemia pada lansia merupakan tanda dari adanya penyakit, yaitu:

Kebanyakan orangorang lansia mempunyai jumlah sel darah merah normal, demikian juga dengan hemoglobin dan hematokritnya, Kebanyakan pasien pasien lansia yang menderita anemia dengan hemoglobin < 12 gr / dL, penyakit dasarnya telah diketahui.

Prevalensi anemia pada lansia adalah sekitar 844%, dengan prevalensi tertinggi pada lakilaki usia 85 tahun atau lebih. Dari beberapa hasil studi lainnya dilaporkan bahwa prevalensi anemia pada lakilaki lansia adalah 2740% dan wanita lansia sekitar 1621%. Sebagai penyebab tersering anemia pada orangorang lansia adalah anemia penyakit kronik dengan prevalensinya sekitar 35%, diikuti oleh anemia defisiensi besi sekitar 15%. Penyebab lainnya yaitu defisiensi vitamin B12, defisiensi asam folat, perdarahan saluran cerna dan sindroma mielodisplastik. Meningkatnya perasaan lemah, lelah dan adanya anemia ringan janganlah dianggap hanya sebagai manifestasi dari pertambahan usia. Oleh karena keluhan-keluhan tersebut di atas merupakan gejala telah terjadinya anemia pada lansia. Selain gejalagejala tersebut di atas, palpitasi, angina dan klaudikasio intermiten juga akan muncul oleh karena biasanya pada lansia telah terjadi kelainan arterial degeneratif. Muka pucat dan konjungtiva pucat merupakan tanda yang dapat dipercayai bahwa seorang lansia itu sebenarnya telah menderita anemia. Pada lansia penderita anemia berbagai penyakit lebih mudah timbul dan penyembuhan penyakit akan semakin lama. Yang mana ini nantinya akan membawa dampak yang buruk kepada orang orang lansia. Dari suatu hasil studi dilaporkan bahwa lakilaki lansia yang menderita anemia, resiko kematiannya lebih besar dibandingkan wanita lansia yang menderita anemia. Juga dilaporkan bahwa lansia yang menderita anemia oleh karena penyakit infeksi mempunyai resiko kematian lebih tinggi. Penelusuran diagnosis anemia pada lansia memerlukan pertimbangan klinis tersendiri. Dari evaluasi epidemiologis menunjukkan walaupun telah dilakukan pemeriksaan yang mendalam, ternyata masih tetap ada sekitar 1525% pasien anemia pada lansia yang tidak terdeteksi penyebab anemianya.

Pemeriksaan Hb menurut Sahli digolongkan kepada metoda colorimetri. Prinsipnya, Hb darah diubah menjadi Hematin chlorida, yang warnanya menjadi coklat tua (tengguli). warna yang terjadi diencerkan dengan aquadest sampai dengan warna standart Hematin chlorida. Peralatan : Alatnya disebut "HAEMOMETER" yang terdiri dari : 1. Sepasang cylinder glass berisi larutan standart warna, kita sebut saja pembanding warna. 2. Tabung pengukur (tabung pengencer) yang mempunyai garis-garis, skala yang menunjukan kadar Hb. Skala yang terendah adalh angka 2. 3. Pipet darah kapiler (Pipet Hemoglobin) seukuran yang mempunyai volume 20 mm3 pada garis batasnya. 4. Pipet pasteur untuk aquadest 5. Batang glas pengaduk Reagen yang diperlukan : HCl 0,1 N dan Aquadestilata 010009000003ec2a04000000f34e020000001610000026060f002220574d4643010000000000010 01dcb000000001e000000002000006092030060b20300010000006c0000000000000000000000e 70100006e0100000000000000000000504300009532000020454d460000010060b203000c00000 0010000000000000000000000000000000005000000030000c40100000f0100000000000000000 00000000000e3e3060055220400460000002c00000020000000454d462b014001001c000000100 000000210c0db01000000600000006000000046000000309e0000249e0000454d462b224004000 c000000000000001e4009000c00000000000000244001000c00000000000000304002001000000 0040000000000803f214007000c00000000000000084000057c9d0000709d00000210c0db01000 0000000000000000000000000000000000001000000ffd8ffe000104a4649460001020100480048 0000ffed128250686f746f73686f7020332e30003842494d03ed0000000000100048000000010001 00480000000100013842494d03f300000000000800000000000000003842494d040a0000000000 0100003842494d271000000000000a000100000000000000023842494d03f5000000000048002f 66660001006c66660006000000000001002f6666000100a1999a00060000000000010032000000 01005a00000006000000000001003500000001002d000000060000000000013842494d03f80000 000000700000ffffffffffffffffffffffffffffffffffffffffffff03e800000000fffffffffffffffffffffffffffffffffffff fffffff03e800000000ffffffffffffffffffffffffffffffffffffffffffff03e800000000ffffffffffffffffffffffffffffff ffffffffffffff03e800003842494d0408000000000010000000010000024000000240000000003842 494d0414000000000004000000043842494d040c00000000110200000001000000700000005400 00015000006e40000010e600180001ffd8ffe000104a46494600010201004800480000ffee000e41 646f626500648000000001ffdb0084000c08080809080c09090c110b0a0b11150f0c0c0f15181313 15131318110c0c0c0c0c0c110c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0 10d0b0b0d0e0d100e0e10140e0e0e14140e0e0e0e14110c0c0c0c0c11110c0c0c0c0c0c110c0c0c0 c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0cffc00011080054007003012200021101 031101ffdd00040007ffc4013f00000105010101010101000000000000000300010204050607080 90a0b0100010501010101010100000000000000010002030405060708090a0b100001040103020 4020507060805030c33010002110304211231054151611322718132061491a1b14223241552c16 233347282d14307259253f0e1f163733516a2b283264493546445c2a3743617d255e265f2b384c3

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jangan sampai darah dalam kapiler turut keluar. 5. Masukkan pipet kapiler tsbt. kedalam tabung pengukur hingga tercelup didalam HCl 0,1 N dan hembuskan perlahan-lahan. Isap dan hembuskan lagi supaya isi tabung tercampur dengan baik. Letakkan tabung pengukur tsbt. diantara dua telapak tangan dan kocoklah beberapa saat, Tunggulah 1-2 menit. Terjadi warna coklat tua. 6. Ambilah Aquadest dengan pasteur pipet dan teteskan tetes demi tetes kedalam larutan Hematin chlorida yang berwrna coklat tua itu dan aduk dengan batang gelas pengaduk. Dengan melatakkan kedalam celah diantara cylinder warna standart kita samakan isi tabung perngukur itu. Bila masih terlalu tua warnanya tetesi lagi aquadest. Bila terlampau banyak aquadest dan warna menjadi lebih muda maka pemeriksaanharus diulang dari awal. 7. Setelah tercapai warna yang sama, kita perhatikan garis batas mana yang dicapai oleh permukaan larutan, menumjukan skala atau kadar Hb. dalam gr%. Misalnya : pada angka 13 >>> jadi kadar Hb = 13 gr% Kesalahan-kesalahan bisa disebabkan karena beberapa faktor : - Peralatan : pipet darah, tabung pengukur tidak kering sebelumnya. - Adanya sisa-sisa darah diluar pipet kapiler, yang tidak diisap lebih dulu. - Tidak sempurna mencampurkan darah dengan HCl 0,1 N. - Tidak dapat membedakan warna. - Pembanding warna sudah rusak. Read more : Pemeriksaan Hb Menurut Sahli | Blog Sodiyc & Acun http://www.sodiycxacun.web.id/2010/05/pemeriksaan-hb-menurut-sahli.html#ixzz1TVoOUbbw Under Creative Commons License: Attribution Share Alike