refrat llk

8/16/2019 Refrat LLK

1/29

UNIVERSITAS PEMBANGUNAN NASIONAL “VETERAN”

JAKARTA

LEUKIMIA LIMFOSITIK KRONIK

REFERAT

Yudistira

090!"!#

$EPARTEMEN ILMU PENYAKIT $ALAM RSPA$ GATOT

SOEBROTO JAKARTA

FAKULTAS KE$OKTERAN

UNIVERSITAS PEMBANGUNAN NASIONAL “VETERAN”

JAKARTA

"0%$AFTAR ISI

1


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HALAMAN JUDUL ......................................................................................

DAFTAR ISI ...................................................................................................

BAB I. PENDAHULUAN ..............................................................................

BAB II. LEUKIMIA LIMFOSITIK KRONIK

II. 1 Epidemiologi .............................................................................

II.2 Paoge!e"i" ................................................................................

II. # Diag!o"i" ...................................................................................

II.$ P%og!o"i" ...................................................................................

BAB III. DIA&NOSIS LEUKIMIA LIMFOSITIK KRONIK .......................

III.1 &e'ala Kli!i( .............................................................................

III.2 Peme%i("aa! Pe!)!'a!g .............................................................

BAB I*. PENATALAKSANAAN ..................................................................

BAB *. PENUTUP .........................................................................................

DAFTAR PUSTAKA ......................................................................................

2


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#


4/29

BAB I

PEN$A&ULUAN

Le)(imia lim+o"ii( (%o!i( ,LLK- adala pe!/a(i limpop%oli+e%ai+ (lo!al

"el B /a!g dia!dai de!ga! a()m)la"i da%i "el B mo!o(lo!al malig!a! dalam

da%a0 (ele!'a% gea e!i!g0 ai0 limpa da! ")m")m )la!g. A(ia a()m)la"i

da%i "el B mo!o(lo!al i!i0 a(a! me!/ea(a! e%'adi!/a lim+o"io"i"0

lim+ade!o+ai0 epao"ple!omegali0 a!emia da! %omo"iope!ia.102

Pe!/ea LLK ma"i el)m di(ea)i de!ga! 'ela". Fa(o% +a(o% /a!g

m)!g(i! e%pe%a! adala a!o%malia" (%omo"om , (%omo"om 30 140 110 12 da!

1#-0 +a(o% e%edie%0 a!o%malia" "ioge!i( da! +a(o% li!g()!ga!. Bee%apa

pe!eliia! me!/e)(a! e%dapa ))!ga! a!a%a i!+e("i 5i%)" epaii" 6 de!ga!

LLK.2

Pe!ega((a! diag!o"i" le)(imia lim+o"ii( (%o!i( ida( 7)()p a!/a

de!ga! a!am!e"i" da! peme%i("aa! +i"i( eapi ')ga di))(a! peme%i("aa!

pe!)!'a!g /a!g lai! "epe%i peme%i("aa! lao%ao%i)m0 a"pi%a"i da! iop"i

")m")m )la!g0 imm)!o+e!oip0 da! "ioge!ei(. Ba!/a( (a")" LLK a!pa ge'ala

/a!g "pe"i+i( da! e%diag!o"i" pada peme%i("aa! da%a %)i!. &e'ala (li!i" /a!g

ia"a!/a im)l a!a%a lai! adala le")0 7epa lela0 e%(e%i!ga pada malam a%i

e%a ada! me!)%)!0 !/e%i "e!di da! !/e%i oo. N/e%i "e!di da! !/e%i oo pada

LLK di ))!g(a! de!ga! rheumatoid factor.1020# Pada peme%i("aa! +i"i(

diem)(a! lim+ade!opai0 e%lo(ali"i% pada %egio lee%0 a("illa da! i!g)i!al.

Sple!omegali da! epaomegali ')ga dapa diem)(a! pada peme%i("aa! +i"i(.

Kee%liaa! "i"em "a%a+ p)"a pada LLK ia"a!/a 'a%a!g diem)(a!0 eapi dapa

me!/ea(a! "a(i (epala0 me!i!gii"0 pe%)aa! "a)" me!al da! (oma.

1

Pada peme%i("aa! lao%ao%i)m diem)(a! lim+o"io"i"0 ia"a!/a 189#8 : 18;


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dapa diem)(a! (elai!a! (%omo"om0 (elai!a! (%omo"om /a!g pali!g "e%i!g

diem)(a! adala %i"omi 12 da! (e%)"a(a! "%)()% le!ga! pa!'a!g (%omo"om 1#

da! 1$.>

Ka%e!a ")li!/a pe!ega((a! diag!o"i" da! pe!aala("a!aa! da%i le)(imia

lim+o"ii( (%o!i( i!i0 ma(a pada (e"empaa! i!i pe!)li" i!gi! memaa"

me!ge!ai diag!o"i" da! pe!aala("a!aa! le)(imia lim+o"ii( (%o!i(. Semoga

%e+e%a i!i dapa e%g)!a.

2


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BAB II

LEUKIMIA LIMFOSITIK KRONIK

II! EPI$EMIOLOGI

LLK me%)pa(a! le)(imia /a!g pali!g "e%i!g e%'adi di Ame%i(a Se%i(a

da! !ega%a E%opa Ba%a de!ga! ')mla lei da%i #8= da%i "em)a 'e!i"

le)(imia. LLK 'a%a!g diem)i di A"ia aa) elaa! d)!ia lai!. I!"ide! LLK di

Ame%i(a Se%i(a e%(i"a% #0>


7/29

Tael 1. I!"ide! LLK e%da"a%(a! Ra".3


8/29

Idiopatik Mutasi smati! sel in"ukPrli#erasi "an "i$erensiasi neplastik

Akumulasi sel mu"a "alam sumsum tulan%

hiperkata&lisme Ke%a%alan sumsum tulan%Sel leukemia

'suhu tu&uh

"emam

Kerin%at malam hari (nhi&isi hematpiesis nrmal

anemia trm&sitpenia

pete!hie

Per"arahan %usi

(n)ltrasi ke r%an

RES"arah

Splenme%ali* lumpha"enpath+

malaise

Per#usi ksi%en

,

takikar"i

Penin%katan lim#sit

&ama% #. Paoge!e"i" Le)(emia Lim+o"ii( K%o!i( ;

II!% $IAGNOSIS

Pada a?al diag!o"i"0 (ea!/a(a! pa"ie! LLK ida( me!)!')((a!

ge'ala


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lim+o"io"i"0 ia"a!/a 18 : 18;


10/29

Tael #. Sadi)m LLK Me!)%) RAI1

Sadi)m &e'ala (li!i" da! lao%ao%i)m Media!

survival ,)la!-

O Lim+o"io"i" da%a epi da! ")m")m )la!g 128

I Lim+o"io"i" Peme"a%a! Lim+o!odi ;8

II Lim+o"io"i" Sple!omegali < Hepaomegali 42

III Lim+o"io"i" a!emia ,H 11g%

&ama% #. A!g(a Ti!g(a Ha%apa! Hid)p Pa"ie! LLK Be%da"a%(a! Sadi)m

Kli!i( Bi!e di Ba%7elo!a 1

4


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12/29

BAB III

$IAGNOSIS LEUKIMIA LIMFOSITIK KRONIK

III! G*.a/a K/i+is

Kea!/a(a! pa"ie! le)(emia lim+o"ii( (%o!i( ida( me!)!')((a! ge'ala <

a"impomai( pada "aa diag!o"i" e%)ama pada "adi)m a?al pe!/a(i. &e'ala

(li!i" /a!g ia"a!/a diem)(a! a!a%a lai! (elelaa!0 e%(e%i!ga malam a%i0

e%a ada! me!)%)!0 demam /a!g ida( e%lal) i!ggi0 p)"i!g0 "e"a( !a+a" pada

"aa a(i5ia"0 !/e%i "e!di da! !/e%i oo. N/e%i "e!di da! !/e%i oo pada LLK di))!g(a! de!ga! rheumatoid factor. Kee%liaa! "i"em "a%a+ p)"a ia"a!/a

'a%a!g diem)(a!0 eapi dapa me!/ea(a! "a(i (epala0 pe%)aa! "a)" me!al

da! (oma. Peme"a%a! o%ga! "e7a%a ma"i+ pada LLK me!/ea(a! e(a!a!

me(a!i( pada lam)!g "ei!gga me!im)l(a! ge'ala 7epa (e!/a!g0 %a"a ida(

e!a( pada adome! da! )a!g ai% e"a% ida( e%a)%. Ra"a le") da! 7epa lela

pada pe!de%ia LLK di"ea(a! ole a!emia. &ama%a! (li!i" a(ia a!emia /a!g

"e%i!g diem)(a! pada pa"ie! LLK adala d/"p!e) da! p)"i!g. Pada peme%i("aa!

+i"i( /a!g pali!g "e%i!g diem)(a! adala lim+ade!opai0 e%lo(ali"i% pada %egio

lee%0 a("illa da! i!g)i!al. Sple!omegali da! epaomegali ')ga diem)(a! pada

2>= (a")". I!+il%a"i pada ()li0 (elopa( maa0 pa%) da! ple)%a )m)m!/a 'a%a!g

diem)(a! da! ia"a!/a im)l pada a(i% pe%'ala!a! pe!/a(i. I!+il%a"i pada

"al)%a! 7e%!a dapa me!/ea(a! e%'adi!/a pe%da%aa! "al)%a! 7e%!a da!

mala"o%p"i. Se'ala! de!ga! pe%'ala!a! pe!/a(i0 lim+ade!opai ma"i+ dapa

me!im)l(a! o")(i+ l)me! e%ma")( i(e%)" o"%)(i+0 edema e("%emia"

a?a da! o")("i )")" pa%"ial.1020>04

III!" P**ri(saa+ P*+u+.a+-

III!"!A P**ri(saa+ La1)rat)riu

LLK dapa didiag!o"i" 'i(a diem)(a! pe!i!g(aa! a"ol) lim+o"i

didalam da%a ,@>888 )L- da! mo%+ologi "el me!)!')((a! gama%a! /a!g (a".

;


13/29

Kla"i+i(a"i F%a!7e9Ame%i7a9B%ii" ,FAB- memagi iga ipe mo%+ologi

e%da"a%(a! pe%a!di!ga! lim+o"i aipi(al didalam da%a0 /ai)

• LLK ipi(al e%di%i da%i lei ;8= lim+o"i (e7il

• LLK ipe p%olim+o"ii( "el ,"el p%olim+o"ii( 119>$=-• LLK aipi(al /a!g dia!dai de!ga! mo%+ologi "el lim+o"i /a!g

ee%oge! eapi p%opo%"i p%olim+o"i ()%a!g da%i 18=

&ama%a! da%a epi ampa( lim+o"io"i" de!ga! gama%a! lim+o"i (e7il ma)%

da! smudge cell /a!g domi!a!0 i!i (%omai! ampa( memada da! di(elili!gi

poo!ga! poo!ga! (%omai! de!ga! 'a%a( e%?a%!a p)i dia!a%a!/a , G soccer

ball nucleus”).20$0>

&ama% $. Sel9B Le)(imia Lim+o"ii( K%o!i( 11

A!emia %i!ga! da! %omo"iope!ia "e%i!g diem)(a! pada "aa diag!o"i" eapi

pe!)%)!a! ')mla /a!g "ig!i+i(a! ,HB 11g


14/29

pa"ie!- eapi "e%i!g diem)(a! "ei%i!g pe%'ala!a! pe!/a(i , #>= pa"ie!-.

Pe!g)()%a! (o!"e!%a"i gammaglo)li! dalam da%a me%)pa(a! "ala "a) e"

/a!g pe!i!g )!)( me!diag!o"a LLK. Pe!)%)!a! gammaglo)li!

,ipogammaglo)li!emia- "e%i!g diem)(a! pada pa"ie! LLK /a!g dapa

me!/ea(a! pa"ie! LLK m)da e%(e!a i!+e("i e%)ama i!+e("i "al)%a! !a+a"

aa".$03

III!"!B As2irasi da+ Bi)2si Susu Tu/a+-

Peme%i("aa! i!i pe!i!g )!)( (o!+i%ma"i diag!o"i" LLK. Spe"ime! /a!g

didapa a%)" "ege%a dipe%i("a )!)( a!ali"i" i"ologi0 "ioge!ei( da!

imm)!o+e!oip. Keg)!aa! iop"i ")m")m )la!g pada pa"ie! LLK adala

• U!)( memeda(a! diag!o"i" de!ga! No!9Hodg(i! Lim+oma de%a'a

%e!da ,low grade)

• U!)( me!ilai %e"po! pe!goaa!

• Me!gea)i paoge!e"i" "iope!ia

• U!)( p%og!o"i"

A"pi%a"i ")m")m )la!g ia"a!/a me!)!')((a! i!+il%a"i lim+o"i #8=. I!+il%a"i

lim+o"i )la!g e%5a%ia"i dalam $ gama%a! /ai) i!e%"i"ial ,##=-0 !od)la%

,18=-0 7amp)%a! i!e%"i"ial da! !od)la% ,2>=- "e%a i!+il%a"i di+)" ,2>=-. $0>012

&ama% >. I!+il%a"i lim+o"ii( gama%a! i!e%"i"ial$

11


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&ama% 3. I!+il%a"i lim+o"ii( gama%a! !od)la% $

&ama% 4. I!+il%a"i lim+o"ii( gama%a! di+)"$

III!"!3 iu+)4*+)ti2

Le)(imia lim+o"ii( (%o!i( memili(i (a%a(e%i"i( imm)!o+e!oip /a!g

"a!ga (a" /ai) e("p%e"i "el pe!a!da B ,6D 1;0 6D 280 6D 2#- da! e("p%e"i

6D >. Pada LLK0 e("p%e"i 6D > diem)(a! pada "el B !o%mal dalam ')mla (e7il

didalam da%a !am)! e("p%e"i 6D > pada "el B !o%mal me!)!')((a! e%'adi!/a

(ega!a"a!. E(p%e"i 6D > (a" diem)(a! pada a!/a d)a 'e!i" "el B !eopla"ma

/ai) le)(imia lim+o"ii( (%o!i( da! lim+oma "el ma!el ,mantle cell lymphoma-.

LLK dapa dieda(a! de!ga! mantle cell lymphoma da%i ada!/a 6D 2#0 ida(

diem)(a!!/a FM694 da! e(p%e"i pe%m)(aa! imm)!oglo)li! 6D 28 /a!g

%ed)p.20>01#

Tael $. &ama%a! Imm)!o+e!oip pada Neopla"ma Sel B>

12


16/29

Pe!a!da 6LL Mantle

Cell

Lymphoma

Follicular

lymphoma

Hairy Cell

Leukemia

Marginal

one

Lymphoma

6D > 9 9 9

6D 18

, 7ALLA-

9 9 9 9

6D 28 Red)p

6D 2# 9


17/29

&ama% ;. Taap Ma)%a"i Sel Lim+o"i T da! Ma%(e% Pe%m)(aa!1$

III!"!$ Sit)-*+*ti(

Sa!da% a!ali"i" "ioge!ei( ")li )!)( dila()(a! pada LLK (a%e!a

%e!da!/a i!g(a mio"i" "el da! )(a! me%)pa(a! agia! da%i e5al)a"i %)i!

pada diag!o"i" LLK. Se7a%a (e"el)%)a!0 (elai!a! "ioge!ei( diem)(a! pada

>8= (a")" de!ga! me!gg)!a(a! "a!da% a!ali"i" (%omo"om. Kelai!a! /a!g

pali!g )m)m diem)(a! adala %i"omi 12 pada @ 28= (a")". Kelai!a! lai! /a!g

"e%i!g diem)(a! adala pe!gap)"a! "%)()% le!ga! pa!'a!g (%omo"om 1# da!

1$. Kelai!a! (%omo"om lei "e%i!g diem)(a! de!ga! +l)o%e"e!"i dalam

"i) i%idi"a"i ,FISH- da%ipada de!ga! "ioge!ei(a "a!da%0 de!ga!

diem)(a!!/a (elai!a! pada 8= (a")". Pe!gap)"a! da%i (%omo"om l#

me%)pa(a! (elai!a! /a!g pali!g "e%i!g diem)(a! de!ga! FISH.10$

&ama% 18. Pe!gap)"a! K%omo"om 1# pada A!ali"i" FISH$

BAB IV

PENATALAKSANAAN LEUKIMIA LIMFOSITIK KRONIK

1$


18/29

T)')a! e%api pada (ea!/a(a! pa"ie! LLK adala me%eda(a! ge'ala da!

mempe%pa!'a!g (ela!g")!ga! id)p. Teapi pada pa"ie! /a!g lei m)da de!ga!

+a(o% %e"i(o )%)(0 pe!de(aa! e("pe%ime!al de!ga! )')a! pe!/em)a! /a!g

dipili.

I!di(a"i e%api pada pa"ie! LLK melip)i >

• &e'ala "i"emi( /a!g p%og%e"i+ , demam @#o6 "elama 2 mi!gg)0 (e%i!ga

malam da! pe!)%)!a! e%a ada! lei da%i 18=-

• A!emia emolii( a)oim)! aa) %omo"iope!ia

• Sple!omegali ma"i+ ,@37m-

• Lim+o"io"i" p%og%e"i+ , @1>8.888 "ampai 288.888


19/29

Pe!gg)!aa! (lo%am)"il do"i" i!ggi pada pa"ie! LLK "adi)m la!')

ela dielii. Klo%am)"il die%i(a! "elama 3 )la! pada do"i" eap 1>

mg=- dia!di!g(a! de!ga! (omi!a"i "i(lo+o"+amid0 do("o%)i"i!0

5i!(%i"i! da! p%ed!i"o!.20>

Tael >. K%ie%ia Re"po! Pe!goaa!1>

K%ie%ia 6R PR PD

&e'ala Tida( ada

Lim+o!odi Tida( meme"a% Me!ge7il @ >8= Meme"a% @ >8=

Hepa%8= Meme"a% @ >8=

HB @ 11 g% : 18; : 18;8=

Lim+o"i $08 : 18;8= Me!i!g(a @ >8=

T%omo"i @188 : 18;8 9188 mg pe% o%al889

4>8 mg


20/29

diem)(a! e%)pa m)al0 m)!a0 %am) %o!o(0 da! ")p%e"i ")m")m

)la!g.20$01>

3! B*+dausti+

Be!dam)"i! me%)pa(a! age! al(il de!ga! e+e( /a!g !/aa pada

LLK. Be!dam)"i! dig)!a(a! pada LLK /a!g e%a aa) (am)

de!ga! do"i" 188 mg

a%i. Hampi% iga pe%empa pa"ie! LLK /a!g mela()(a! pe!goaa!

de!ga! e!dam)"i! "elama $93 mi!gg) me!7apai %emi"i "eagia!

aa) le!g(ap de!ga! %aa9%aa a!g(a a%apa! id)p me!7apai #2

)la!.201#

$! K*)t*ra2i K)1i+asi

Kemoe%api (omi!a"i /a!g die%i(a! adala (emoe%api /a!g

ia"a!/a pada pa"ie! lim+oma !o! Hodg(i! aa) mieloma m)lipel.

Kemoe%api (omi!a"i dii!di(a"i(a! pada pa"ie! LLK /a!g gagal

e%adap e%api )!ggal (lo%am)"il aa) "i(lo+o"+amid de!ga! aa)

a!pa p%ed!i"o!. Komi!a"i i!i memili(i i!g(a %e"po! /a!g lei

i!ggi dia!di!g(a! (lo%am)"il aa) "i(lo+o"+amid eapi memili(i

i!g(a o("i"ia" /a!g lei i!ggi da! )m)m!/a ida( me!)!')((a!

pe!i!g(aa! a!g(a a%apa! id)p.10>01>

Kemoe%api /a!g di%e(ome!da"i(a! adala

• Si(lo+o"+amid0 5i!(%i"i! da! p%ed!i"o! ,6OP-

Do"i"

Si(lo+o"+amid #88 mg aa) 4>8 mg


21/29

P%ed!i"o! $8 mg

• 6OP da! do("o%)i"i!

Do"i"

Do("o%)i"i! 2>9>8 mg8= pa"ie!. Ri):ima memili(i a(i5ia" /a!g ()a pada !o!

Hodg(i! lim+oma de%a'a %e!da da! LLK (ei(a di(omi!a"i(a!

de!ga! +l)da%ai!0 (lo%am)"il da! "i(lo+o"+amid. Me(a!i"me a("i

da%i %i):ima adala de!ga! me!ga(i+(a! 'al)% i!%i!"i( apopo"i"

da! mem%a! /a!g e%))!ga! de!ga! e!im (i!a"e. Pe!gg)!aa!

%i):ima ,#4> mg mg


22/29

B! A/*+tu6ua1

Ale!))ma adala a!iodi mo!o(lo!al humani"ed /a!g

di)')(a! la!g")!g )!)( a!ige! 6D>2. FDA me!/e)')i ale!))ma

)!)( pe!goaa! pa"ie! LLK /a!g "eel)m!/a dioai de!ga! age!

al(il da! me!galami pe!/a(i %e+%a(e% e%adap +l)da%ai!. A!ige!

6D >2 die("p%e"i(a! pada ampi% "em)a "el LLK "epe%i al!/a

lim+o"i T0 B !o%mal0 "el NK da! mo!o"i. A!iodi i!i e%i(aa! pada

pe%m)(aa! p%oei! gli7o"il +o"+aidili!o"iol /a!g e%dapa pada

(ea!/a(a! lim+o"i. Peme%ia! ale!))ma dim)lai da%i do"i"

e%(e7il /ai) 1 mg= da%i ')mla

"el9"el e%"e) "eel)m dila()(a! pe!goaa! "ei!gga me!/ea(a!

pa"ie! me!'adi lei %e!a! e%adap i!+e("i opo%)!i"i( e%)ama

"iomegalo5i%)".201>014

IV!" P*+-)1ata+ Su2)rti4

IV!"! A+a/)- Puri+

A! F/udara1i+

Fl)da%ai! me%)pa(a! de%i5a mo!o+o"+a +l)o%i! da%i a!alog p)%i!

/a!g memili(i a(i5ia" /a!g "ig!i+i(a! pada pe!goaa! LLK.

Me(a!i"me a("i da%i +l)da%ai! e%)pa de!ga! 7a%a me!gama

"i!e"i" DNA da! a(i5ia" 'al)% apopo"i". Me(a!i"me i!i

me!i!g(a(a! e+e( +l)da%ai! "e7a%a "ig!i+i(a! (ei(a di(omi!a"i(a!

de!ga! oa lai!!/a "epe%i "i(lo+o"+amid da! %i):ima. Pe!eliia!

/a!g dila()(a! ole MD A!de%""o! 6a!7e% 6e!e% me!)!')((a!

+l)da%ai! memili(i a!g(a %emi"i (ompli /a!g i!ggi ,##=- pada

pa"ie! /a!g el)m me!dapa(a! pe!goaa! da! eap memp)!/ai

a!g(a %emi"i /a!g 7)()p i!ggi ,1>928=- pada pa"ie! /a!g ela

me!dapa(a! pe!goaa!.

1;


23/29

Fl)da%ai! die%i(a! melal)i i!+)" i!%a5e!a "elama #8 me!i de!ga!

do"i" 2> mg a%i"eiap 2 a%i0 de!ga! do"i" /a!g di"e")ai(a! !ai( aa) )%)! "ee"a%

80> mg


24/29

IV!"!" S2/*+*(t)i

Sple!e(omi dii!di(a"i(a! pada pa"ie! de!ga! "ple!omegali /a!g

ma"i+ da! "iope!ia a)oim)! /a!g %e+%a(e% e%adap (o%i(o"e%oid.

Dalam "e)a pe!eliia! me!)!')((a! pa"ie! /a!g me!'ala!i "ple!e(omi

de!ga! a!emia aa) %omo"iope!ia memili(i pe!i!g(aa! a!g(a a%apa!

id)p "ampai # a)! dia!di!g(a! pa"ie! /a!g ida( me!'ala!i

"ple!e(omi. Sple!e(omi memili(i ma!+aa /a!g e"a% e%adap pa"ie!

de!ga! lim+a /a!g ma"i+ da! ida( dilapo%(a! ada!/a (emaia! pada

p%o"ed)% "ple!e(omi. Me"(ip)! pada pa"ie! de!ga! pe%(ema!ga! LLK

/a!g p%og%e"i+0 "ple!e(omi ')ga dapa mempe%ai(i ()alia" id)p

de!ga! me!i!g(a(a! (ada% HB "e(ia% >8=. Fa(o% /a!g mempe!ga%)i

i!g(a (ee%a"ila! da%i "ple!e(omi adala (eadaa! pa"ie! "eel)m

dila()(a! ope%a"i da! (ee%ampila! ali eda. Raa9%aa a!g(a a%apa!

id)p pa"ie! "eela me!'ala!i "ple!e(omi adala $04 a)!.20$012

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pali!g "e%i!g di')mpai pada LLK da! e%ama e%a "e")ai pe%'ala!a!

pe!/a(i.Te%api LLK dapa me!im)l(a! e("a"e%a"i a!emia /a!g ")da

ada0 ()")"!/a pada pa"ie! la!'). Ko!"e()e!"i!/a adala (elelaa! da!

di"p!e) /a!g "a!ga me!g)%a!gi ()alia" (eid)pa! pa"ie!. Pe!eliia!a7a( double blind me!)!')((a! a?a e%i%opoiei! %e(omi!a! dapa

me!gaa"i a!emia /a!g ida( e%e"po! e%adap (emo%api da! ge'ala /a!g

dia(ia(a!!/a. T%a!+)"i %omo"i (ada!g dipe%l)(a! pada (eadaa!

%omo"iope!ia de!ga! pe%da%aa! a(i+. Pla"ma+e%e"i" /a!g i!e!"i+ ')ga

dapa me!i!g(a(a! ')mla H da! %omo"i. Te%api i!i dii!di(a"i(a!

pada pa"ie! de!ga! (egagala! ")m")m )la!g da! me!galami %e+%a(e%

e%adap e%api "a!da%.201>

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IV!% Radi)t*ra2i

Radia"i "i"emi( me%)pa(a! modalia" e%api /a!g pe%ama (ali dig)!a(a!

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"i"emi( me!)!')((a! pe!i!g(aa! m)) id)p pa"ie! a(a! eapi ma!+aa da%i

%adia"i "i"emi( e%"e) ida( e%la!g")!g lama da! (ea!/a(a! a!/a e%a"il

pada pa"ie! de!ga! ")p%e"i ")m")m )la!g /a!g pa%a. Radioe%api di i!di(a"i(a!

)!)( pe!goaa! lo(al /a!g e%g)!a )!)( me!g)%a!gi ge'ala /a!g dia(ia(a!

ole le"i pada )la!g0 o%ga! 5ial0 "i"em "a%a+ "e%a le"i9le"i /a!g e"a%.2018

Radia"i lim+a e%g)!a pada pa"ie! de!ga! "ple!omegali /a!g di"e%ai

de!ga! %a"a !/e%i e%)ama pada pa"ie! /a!g memp)!/ai +a(o% %e"i(o pada eda

"ple!e(omi. >89;8= pa"ie! a(a! me!)!')((a! pe!)%)!a! )()%a! lim+a0

e%()%a!g!/a !/e%i pe%) "e%a %a"a ida( e!a( pada pe%). 6ao5"(/ pada a)!

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(ompli da! )!)( me!i!g(a(a! a!g(a %emi"i (ompli0 %adioe%api dapa

di(omi!a"i(a! de!ga! e%api lai!!/a. Do"i" %e!da 80>91 &/ die%i(a! 19#

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22


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BAB V

PENUTUP

Le)(imia lim+o"ii( (%o!i( ,LLK- adala pe!/a(i limpop%oli+e%ai+ (lo!al

"el B /a!g dia!dai de!ga! a()m)la"i da%i "el B mo!o(lo!al malig!a! dalam

da%a0 (ele!'a% gea e!i!g0 ai0 limpa da! ")m")m )la!g. A(ia a()m)la"i

da%i "el B mo!o(lo!al i!i0 a(a! me!/ea(a! e%'adi!/a lim+o"io"i"0

lim+ade!o+ai0 epao"ple!omegali0 a!emia da! %omo"iope!ia.102

LLK me%)pa(a! pe!/a(i pada o%a!g e%)"ia la!') ,@ 38 a)!- de!ga!

i!"ide! p)!7a( pada )m)% 42 a)! da! i!"ide!!/a a(a! "ema(i! me!i!g(a

"ei%i!g e%ama!/a )"ia. I!"ide! LLK di "el)%) d)!ia e%(i"a% $01 Pada peme%i("aa! +i"i(

/a!g pali!g "e%i!g diem)(a! adala lim+ade!opai0 e%lo(ali"i% pada %egio lee%0

a("illa da! i!g)i!al. Sple!omegali da! epaomegali ')ga diem)(a! pada 2>=

(a")".10204 Pada peme%i("aa! lao%ao%i)m /a!g pali!g "e%i!g diem)(a! adala

pe!i!g(aa! a"ol) lim+o"i didalam da%a ,@>888 )L- da! mo%+ologi "el

me!)!')((a! gama%a! /a!g (a" /ai) gama%a! lim+o"i (e7il ma)% de!ga!

smudge cell /a!g domi!a!0 a!emia %i!ga! da! %omo"iope!ia ')ga "e%i!g

diem)(a! pada "aa diag!o"i" "e%a (ada!g ')ga e%'adi pe!i!g(aa! e!im la(a

deid%oge!a"e ,LDH- da! "e%)m (ali)m.$03

Pada peme%i("aa! a"pi%a"i da! iop"i")m")m )la!g me!)!')((a! i!+il%a"i lim+o"i #8=. I!+il%a"i lim+o"i )la!g

e%5a%ia"i dalam $ gama%a! /ai) i!e%"i"ial ,##=-0 !od)la% ,18=-0 7amp)%a!

i!e%"i"ial da! !od)la% ,2>=- "e%a i!+il%a"i di+)" ,2>=-.$0>012 Be%da"a%(a!

peme%i("aa! imm)!o+e!oip LLK memili(i (a%a(e%i"i( imm)!o+e!oip /a!g

"a!ga (a" /ai) e("p%e"i "el pe!a!da B ,6D 1;0 6D 280 6D 2#- da! e("p%e"i

6D >.20>01# Pada peme%i("aa! "ioge!ei( dapa diem)(a! (elai!a! (%omo"om

/ai) pe!gap)"a! "%)()% le!ga! pa!'a!g (%omo"om 1# da! 1$.10$

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Pe!aala("a!aa! le)(imia lim+o"ii( (%o!i( melip)i pe!goaa! (a)"ai+0

")po%i+ da! %adioe%api. Pe!goaa! (a)"ai+ e%di%i aa" (emoe%api de!ga!

me!gg)!a(a! age! al(il /ai) (lo%am)"il0 "i(lo+o"+amid da! e!dam)"i!. 20$0>01>

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me!gg)!a(a! a!alog p)%i! e%)pa +l)da%ai! da! pe!o"ai!.20$01# Sple!e(omi

')ga e%ma")( pe!goaa! ")po%i+ pada LLK. Sple!e(omi dii!di(a"i(a! pada

pa"ie! de!ga! "ple!omegali /a!g ma"i+ da! "iope!ia a)oim)! /a!g %e+%a(e%

e%adap (o%i(o"e%oid.20$012 Radioe%api di i!di(a"i(a! )!)( pe!goaa! lo(al

/a!g e%g)!a )!)( me!g)%a!gi ge'ala /a!g dia(ia(a! ole le"i pada )la!g0

o%ga! 5ial0 "i"em "a%a+ "e%a le"i9le"i /a!g e"a%.2018

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$AFTAR PUSTAKA

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#. Mea A0 Ho++%a!d *. 6%o!i7 L/mpo7/i7 Le)(emia. Haemaolog/ a a

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11. Teml H0 Diem H0 Ha+e%la7 T. 6olo% Ala" o+ Hemaolog/. Edi"i (e9>.

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BMJ Boo(" P)li"i!g288# p $49>1

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Hemaolog/ 288$12>2;$9#14

14. Lo!do! 6a!7e% Ne? D%)g &%o)p. AP6

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