faq laboratory study in sepsis
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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.
• increased destruction (hemolytic anemia) of red blood cells
• Neutrophils: phagocytosing infectious 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
Leucocyte
Platelet
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
protein fase akut yang dibentuk oleh sel hepatosit akibat rangsangan sitokin anti-inflamasi
CRP meningkat dalam 4-6 jam8 jam: 2x lipat Puncaknya 36-50 jam
Penyembuhan: penurunan kadar CRP secara cepat CRP memiliki masa paruh 4 sampai 7 jam Sangat baik untuk menilai aktivitas penyakit dalam keadaan akut.
C-REACTIVE PROTEIN (CRP)
Peningkatan CRP dapat dijumpai pada kondisi selain infeksiMAJOR ELEVATIONa. Bacterial infection
b. Hypersensitivity complications of infections
c. Inflammatory disease
d. Transplantatione. Cancerf. Necrosis
g. trauma
- pyelonephritis, pelvic infections, meningitis, endocarditis-Rheumatic fever, erythema nodosum
- rheumatoid arthritis, juvenile chronic arthritis, ankylosing spondylitis, psoriatic arthritis, systemic vasculitis, polymialgia rheumatica, reiter’s disease, Crohn’s disease, familial mediterranian fever- renal transplantation- lymphoma , sarcoma- myocardial infarction, tumor embolisation, acute pancreatitis- burn, fractures
MINOR OR NO ELEVATIONa. Inflammatory disease
b. Transplantationsc. Cancer
-SLE, systemic sclerosis, dermatomycosis, ulcerative colitis, Sjogren’s syndrome- graft vs host disease- leukemia
Nobre V et al. Am J Respiir Crit Care Med, 2008;117:498-505
…sepsis
CRP LEVELNormal concentration in healthy human serum < 10 mg/L (increasing with aging).
CRP (mg/L)
10 – 40 Mild inflammation, viral or bacterial infection, late pregnan woman
40 - 100 Moderate inflammation, viral orbacterial infection
100 – 200 Marked inflmmation, bacterial infection
> 200 Severe bacterial infection or extensive trauma
Nobre V et al. Am J Respiir Crit Care Med, 2008;117:498-505
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)
PROCALCITONIN
Asal SpesimenSeharusnya steril• Darah• Sumsum tulang• Cairan sendi• Jaringan• Saluran napas bawah• Kandung kemih
Ada flora normal komensal• Saluran napas atas• Kulit• Saluran gastrointestinal• Saluran genital perempuan• Uretra
Pada bagian tubuh yang seharusnya steril, apabila ditemukan m.o:- Telah terjadi infeksi- Cara koleksi dan waktu pengiriman tidak tepat- Laboratorium terlambat memulai pemeriksaanBila spesimen diambil dari tempat dengan flora normal:- Kuantitas/jumlah spesimen perlu diperhatikan- Kondisi pasien: imunokompromais/imunokompeten
Murray PR. Medical Microbiology 2002.
Bakteri skin nose faring Mouth Lower GI
Staphylococcus epidermidis ++ ++ ++ ++ +
Staphylococcus aureus + + + + ++
Enterococcus fecalis + ++
Streptoccuc pneumonia + +
Pseudomonas spp. +
Volume Darah untuk Pemeriksaan Kultur
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.
Biakan Darah
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)
Diambil pd 2 sisi berbeda (Clin Microbiol. Rev19:788-802, 2006) Jumlah volume darah sangat menentukan hasil Waktu bakteremia (penting) 2 kultur diambil dari vena dan kateter :
Keduanya vena (PPV 98 %) Keduanya kateter ( 50 %) Satu vena, satu kateter ( 96 % )
Number
• 1 blood 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
• 3 blood cultures are reasonable when intermittent bacteraemia is suspected
S Afr Med J 2010; 100: 839-843.
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
Biakan Tinja dan UrinBiakan Tinja :
2 sampel berturut-turut Tidak boleh >3 hari
Biakan Urin: Pengumpulan spesimen minimal kontaminasi Pengambilan pagi hari Pengambilan sebelum pemberian antibiotik Segera dikirmkan untuk diproses, kemas dengan es Jika tidak segera dikirim masukkan almari es ( 40C ) Bakteriuria bermakna :
Suprapubik : berapapun Kateter : 10.000 Mid stream : 100.000
TERIMA KASIH