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PENENTUAN STATUS GIZI PENENTUAN STATUS GIZI
SECARA BIOKIMIASECARA BIOKIMIA
Edited by: Edited by: SuyatnoSuyatno, Ir. , Ir. MKesMKes
FakultasFakultas KesehatanKesehatan MasyarakatMasyarakatUniversitasUniversitas DiponegoroDiponegoro
SemarangSemarang
EE--mailmail : : suyatno@undip.ac.idsuyatno@undip.ac.idHp Hp : 08122815730: 08122815730BlogBlog : : suyatno.blog.undip.ac.idsuyatno.blog.undip.ac.id
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 22
Specific Lab TestsSpecific Lab Tests
Measurement of individual Measurement of individual nutrient in body fluids (e.g. nutrient in body fluids (e.g. serum retinol, serum iron, serum retinol, serum iron, urinary iodine, vitamin D) urinary iodine, vitamin D)
Detection of abnormal amount of Detection of abnormal amount of metabolites in the urine (e.g. metabolites in the urine (e.g. urinary urinary creatinine/hydroxyproline ratio)creatinine/hydroxyproline ratio)
Analysis of hair, nails & skin for Analysis of hair, nails & skin for micromicro--nutrients.nutrients.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 33
Advantages of Biochemical MethodAdvantages of Biochemical Method
It is useful in detecting early changes in It is useful in detecting early changes in
body metabolism & nutrition before the body metabolism & nutrition before the
appearance of overt clinical signs.appearance of overt clinical signs.
It is precise, accurate and reproducible.It is precise, accurate and reproducible.
Useful to validate data obtained from Useful to validate data obtained from
dietary methods e.g. comparing salt dietary methods e.g. comparing salt
intake with 24intake with 24--hour urinary excretion.hour urinary excretion.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 44
Limitations of Biochemical MethodLimitations of Biochemical Method
Time consumingTime consuming
ExpensiveExpensive
They cannot be applied on large They cannot be applied on large
scalescale
Needs trained personnel & Needs trained personnel &
facilitiesfacilities
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 55
PENGGUNAANPENGGUNAAN PSG BIOKMIAPSG BIOKMIA
•• DptDpt menentukanmenentukan status status gizigizi spesifikspesifik
•• DptDpt membuktikanmembuktikan pemeriksaanpemeriksaan tktk sub sub
klinisklinis
•• SebagaiSebagai pemeriksaanpemeriksaan pelengkappelengkap
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 66
PEMERIKSAAN DARAHPEMERIKSAAN DARAH
�� SampelSampel DarahDarah: : KapilerKapiler atauatau VenaVena
1.1. DARAH KAPILERDARAH KAPILER
-- Pd Pd ujungujung jarijari , , DaunDaun TelingaTelinga, , TumitTumit
((BayiBayi))
-- SejumlahSejumlah ±± 0,2 ml 0,2 ml –– 1 ml1 ml
-- DptDpt langsunglangsung dipipetdipipet
2.2. DARAH VENADARAH VENA
-- Pd Vena Pd Vena CubitiCubiti ((lenganlengan))
-- Plasma (+ Plasma (+ AntikoagulanAntikoagulan))
-- Serum (Serum (tanpatanpa AntikoagulanAntikoagulan))
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 77
PEMERIKSAAN URINEPEMERIKSAAN URINE
-- LangsungLangsung atauatau dg dg KateterKateter
-- Pd Pd penyimpananpenyimpanan dptdpt ++
pengawetpengawet ((ToluolToluol, , TimolTimol))
-- DptDpt Midstream/Midstream/tidaktidak
-- Media Media ygyg baikbaik utkutk tumbuhtumbuh kumankuman
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 88
PEMERIKSAAN FAESESPEMERIKSAAN FAESES
-- DptDpt mengetahuimengetahui gangguangangguan
metabolismemetabolisme zatzat gizigizi (KH, (KH,
LemakLemak))
-- DptDpt mengetahuimengetahui adanyaadanya infeksiinfeksi
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 99
Biochemical TestsBiochemical Tests
�� Serum albumin levelSerum albumin level
•• Measures main protein in bloodMeasures main protein in blood
•• Determines protein statusDetermines protein status
�� Serum Serum transferrintransferrin levellevel
•• Indicates ironIndicates iron--carrying protein in bloodcarrying protein in blood
•• ↑↑ indicates iron stores lowindicates iron stores low
•• ↓↓ indicates body lacks proteinindicates body lacks protein
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1010
Biochemical TestsBiochemical Tests�� Blood urea nitrogen (BUN)Blood urea nitrogen (BUN)
•• may indicate renal failure, insufficient renal blood supply, or may indicate renal failure, insufficient renal blood supply, or
blockage of the urinary tractblockage of the urinary tract
�� Serum Serum creatininecreatinine•• indicates amount of indicates amount of creatininecreatinine in bloodin blood
•• used to evaluate renal functionused to evaluate renal function
�� CreatinineCreatinine excretionexcretion
•• indicates amount of indicates amount of creatininecreatinine excreted in urine over a 24excreted in urine over a 24--
hour periodhour period
•• used in estimating body muscle massused in estimating body muscle mass
•• muscle mass depleted, as in malnutrition; level will be low muscle mass depleted, as in malnutrition; level will be low
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1111
Biochemical TestsBiochemical Tests��Other testsOther tests
•• CBCCBC
��Hemoglobin (Hemoglobin (HgbHgb))
��HematocritHematocrit ((HctHct))
��Red blood cells (Red blood cells (RBCsRBCs))
��White blood cells (White blood cells (WBCsWBCs))
•• Lipid profile Lipid profile
��high & lowhigh & low--density lipoprotein, serum density lipoprotein, serum
triglyceridestriglycerides
•• UrinalysisUrinalysis
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1212
BesiBesi dalamdalam TubuhTubuh::
�� Volume Volume darahdarah 4 4 ltrltr
��UmurUmur darahdarah merahmerah 3 3 blnbln
��DarahDarah merahmerah ��turn over: 35 mg turn over: 35 mg
Fe/Fe/harihari
��WanitaWanita HamilHamil butuhbutuh tambahantambahan: 0,5 : 0,5 ––
1 mg/1 mg/harihari
ANEMIA GIZI BESIANEMIA GIZI BESI
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1313
Fe dar makanan(1 mg)
Darah Merah(35 mg Fe Turn Over)
Sumsumtulang
haemoglobin
Sel-seljaringan
Sel dm mati
Keringat, urin, feces(1 mg Fe)
34 mg Fe
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1414
–– Blood loss:Blood loss:
��MenstruationMenstruation
��Worm infectionWorm infection
–– Increased iron need due to physical Increased iron need due to physical
growth:growth:
��Pregnant womenPregnant women
��ChildrenChildren
–– Low intake of absorbable ironLow intake of absorbable iron
��Plant dietPlant diet
Causes of iron deficiencyCauses of iron deficiency
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1515
TingkatanTingkatan AnemiAnemi besibesi(Gibson, 1990)(Gibson, 1990)
�� HilangnyaHilangnya zatzat besibesi (iron (iron deplesiondeplesion) :) :–– Pengurangan jumlah cadangan besi pada hatiPengurangan jumlah cadangan besi pada hati
–– Tingkat transport besi dan Hb normal, tetapi cadangan Tingkat transport besi dan Hb normal, tetapi cadangan besi hilang ditandai dengan rendahnya besi hilang ditandai dengan rendahnya serum ferritinserum ferritin
�� ErythropoiesisErythropoiesis defisiensidefisiensi besibesi (iron (iron deficentdeficenterythropoiesiserythropoiesis):):–– Suplai besi dalam plasma pada sel erythropoisis turun Suplai besi dalam plasma pada sel erythropoisis turun dan akan menyebabkan turunnya saturasi dan akan menyebabkan turunnya saturasi tranferrintranferrin
�� AnemiAnemi defisiensidefisiensi besibesi (iron deficiency anemia):(iron deficiency anemia):–– CadanganCadangan besibesi habishabis
–– TerjadiTerjadi penurunanpenurunan sirkulasisirkulasi besibesi, , ditandaiditandai penurunanpenurunankonsentrasikonsentrasi HbHb didi dalamdalam selsel darahdarah merahmerah..
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1616
IronIron
storesstores
Stage of iron deficiencyStage of iron deficiency
Erythron
Normal Iron store Depletes:•Marrow ironabsent
•Serum ferritinConsentration< 12 u g/L
Iron deficientErithropoiesis- Hb drop
Iron deficiencyAnemiaHb < standart
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1717
Changes in body iron compartments and laboratory parameters of iron status during development of iron deficiency due to a continuous negative iron balance
Source: International Nutritional Anemia Consultative Group, 1977
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1818
INDIKATORINDIKATORANEMIA GIZI BESI ANEMIA GIZI BESI
�� HemoglobiHemoglobi ((HbHb), ),
�� HematokritHematokrit,,
�� Serum Serum BesiBesi/Serum /Serum FerritinFerritin ((SfSf),),
�� TransferinTransferin Saturation (Ts), Saturation (Ts),
�� Free Free ErytrocytesErytrocytes ProtophophyrinProtophophyrin (FEP)(FEP)
�� Unsaturated IronUnsaturated Iron--binding Capacity binding Capacity
SerumSerum
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 1919
1. HAEMOGLOBIN (1. HAEMOGLOBIN (HbHb) :) :
DptDpt tentukantentukan prevalensiprevalensi AnemiaAnemia
MacamnyaMacamnya::
A.A. METODE SAHLIMETODE SAHLI
-- KesalahanKesalahan 2 2 –– 3 kali3 kali
-- HbHb + + HclHcl ➔➔➔➔➔➔➔➔ GlobinGlobin Fe Fe ++++ HemeHeme ➔➔➔➔➔➔➔➔ O2O2
➔➔➔➔➔➔➔➔ Fe Fe ++++++ HemeHeme + Ion + Ion clcl ➔➔➔➔➔➔➔➔ FerriFerri
HemecloridHemeclorid ((coklatcoklat))
-- SangatSangat subyektifsubyektif
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2020
B.B. METODE CYANMETHEMEGLOBINMETODE CYANMETHEMEGLOBIN
-- HbHb OksidasiOksidasi K. K. PeroksidaPeroksida ➔➔➔➔➔➔➔➔MethemoglobinMethemoglobin ➔➔➔➔➔➔➔➔ Ion Ion SianidaSianida ➔➔➔➔➔➔➔➔SianSian –– MethemoglobinMethemoglobin ((merahmerah))
-- HasilHasil lbhlbh obyektifobyektif
�� HARGA NORMALHARGA NORMAL
-- LakiLaki –– LakiLaki : 14 : 14 –– 18 g %18 g %
-- WanitaWanita : 12 : 12 –– 16 g %16 g %
-- WanitaWanita HamilHamil : 11 : 11 grgr %%
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2121
2. HEMATOKRIT (HCT)2. HEMATOKRIT (HCT)
-- Volume SDM Volume SDM ygyg terpisahterpisah drdr plasmaplasma
-- EstimasiEstimasi scrscr tdktdk langsunglangsung HbHb (HCT (HCT
3 X 3 X HbHb))
�� HARGA NORMALHARGA NORMAL
-- LakiLaki –– lakilaki : 40 : 40 –– 54 % 54 % KeplerKepler
-- WanitaWanita : 37 : 37 –– 47 % 47 %
-- lakilaki –– lakilaki : 42 : 42 –– 50 % Wells50 % Wells
-- WanitaWanita : 40 : 40 –– 48 % 48 %
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2222
Suggested criteria for diagnosis of anaemia using haemo globin (Hb)and haematocrit (PCV) determinations
32321212Child 6 to 14 yearsChild 6 to 14 years
32321111Child 6 months to 6 yearsChild 6 months to 6 years
30301111Pregnant femalePregnant female
36361212Adult female (nonAdult female (non--
pregnant)pregnant)
42421313Adult maleAdult male
(%)(%)(g/dl)(g/dl)
PCV PCV
belowbelowHbHb
belowbelowSubjectSubject
Source: WHO, 1975a.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2323
3. SERUM FERRITIN (SF)3. SERUM FERRITIN (SF)
-- MenilaiMenilai status status besibesi didi heparhepar
-- SF < 12 SF < 12 µµg /L (g /L (DefisiensiDefisiensi Fe)Fe)
-- MetodeMetode : IRMA, RIA, ELLISA: IRMA, RIA, ELLISA
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2424
4. TRANSFERIN SATURATION (TS)4. TRANSFERIN SATURATION (TS)
-- MenilaiMenilai kadarkadar Fe Fe dlmdlm serumserum
-- TS < 16 % (TS < 16 % (DefisiensiDefisiensi Fe)Fe)
-- TIBC TIBC tinggitinggi (Anemia (Anemia GiziGizi BesiBesi))
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2525
5. FREE ERYTHROCYTE 5. FREE ERYTHROCYTE
PROTOPHORPHYRIN (FEP)PROTOPHORPHYRIN (FEP)
�� MenilaiMenilai kecukupankecukupan Fe Fe utkutk pembtkpembtk SelSel
DarahDarah MerahMerah didi sumsumsumsum TulangTulang
�� Normal Normal : 35 : 35 –– 50 50 µµg/dl RBCg/dl RBC
�� FEP > 100 FEP > 100 µµg/dl ( g/dl ( DefisiensiDefisiensi Fe)Fe)
�� MetodeMetode : : FlurometicFlurometic
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2626
DEFISIENSI FeDEFISIENSI Fe
-- TahapTahap 11 : : CadanganCadangan Fe Fe heparhepar <<<<
-- TahapTahap 22 : Fe << : Fe << utkutk sintesissintesis SDM SDM didi
SSM SSM TulangTulang
-- TahapTahap 33 : : KadarKadar HbHb <<<<
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2727
PSG BIOKIMIA KEPPSG BIOKIMIA KEP
�� ANALISIS BIOKIMIA YG DIGUNAKAN ANALISIS BIOKIMIA YG DIGUNAKAN
NilaiNilai Protein & Protein & HasilHasil MetabolitMetabolit
Protein ( Protein ( DarahDarah, Urine), Urine)
�� INDIKATORINDIKATOR
-- HidroksiHidroksi ProlinProlin IndeksIndeks (Urine)(Urine)
-- RasioRasio As Amino As Amino BebasBebas (Plasma)(Plasma)
-- Plasma Protein, Albumin, Pre Plasma Protein, Albumin, Pre ––
AlbuminAlbumin
-- Plasma Plasma TransferinTransferin
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2828
�� HARGA NORMALHARGA NORMAL
-- AlbuminAlbumin : 3,5 : 3,5 –– 5 5 grgr/dl/dl
-- GlobulinGlobulin : 1,5 : 1,5 –– 3 3 grgr/dl/dl
-- FibrinogenFibrinogen : 0,2 : 0,2 –– 0,8 0,8 grgr/dl/dl
�� PRE PRE –– ALBUMINALBUMIN
-- GiziGizi BaikBaik : 23,8 : 23,8 ±± 0,9 mg/dl0,9 mg/dl
-- GiziGizi SedangSedang : 16,5 : 16,5 ±± 0,8 mg/dl0,8 mg/dl
-- GiziGizi KurangKurang : 12,4 : 12,4 ±± 1,0 mg/dl1,0 mg/dl
-- MarasmusMarasmus : 7,6 : 7,6 ±± 0,6 mg/dl0,6 mg/dl
-- Mars Mars –– KwasKwas : 3,3 : 3,3 ±± 0,2 mg/dl0,2 mg/dl
-- KwashiorkorKwashiorkor : 3,2 : 3,2 ±± 0,4 mg/dl 0,4 mg/dl
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 2929
�� SERUM ALBUMINSERUM ALBUMIN
-- < 1 < 1 ThTh : : CukupCukup > 2,5 > 2,5 grgr/dl/dl
-- 1 1 sdsd 5 5 ThTh : : CukupCukup > 3 > 3 grgr/dl/dl
-- 6 6 sdsd 16 16 ThTh : : CukupCukup > 3,5 > 3,5 grgr/dl/dl
-- 16 16 ThTh
CukupCukup : > 3,5 : > 3,5 grgr/dl/dl
KurangKurang : < 2,8 : < 2,8 grgr/dl/dl
MarginMargin : 2,8 : 2,8 –– 3,4 3,4 grgr/dl/dl
-- WanitaWanita HamilHamil
CukupCukup : > 3,5 : > 3,5 grgr/dl/dl
KurangKurang : < 3,5 : < 3,5 grgr/dl/dl
MarginMargin : 3 : 3 –– 3,4 3,4 grgr/dl/dl
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3030
�� SERUM PROTEIN SERUM PROTEIN
-- < 1 < 1 ThTh : : CukupCukup > 5 > 5 grgr/dl/dl
Margin < 5 Margin < 5 grgr/dl/dl
-- 1 1 sdsd 5 5 ThTh : : CukupCukup 5,5 5,5 grgr/dl/dl
Margin < 5,5 Margin < 5,5 grgr/dl/dl
-- 6 6 sdsd 16 16 ThTh : : CukupCukup 6 6 grgr/dl/dl
Margin < 6 Margin < 6 grgr/dl/dl
-- > 16 > 16 ThTh : : CukupCukup 6 6 grgr/dl/dl
KurangKurang 5,5 5,5 grgr/dl/dlMargin 6,5 Margin 6,5 –– 5,9 5,9 grgr/dl/dl
�� INDIKATOR KEPINDIKATOR KEP
AbuminAbumin/Globulin, /Globulin, KolestKolest & & HbHb turunturun
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3131
Levels of serum albumin concentrations in malnourished children
PathologicalPathological<< 2.52.5
LowLow2.52.5--2.92.9
SubnormalSubnormal33--3.43.4
NormalNormal> 3.5> 3.5
(g/dl)(g/dl)
InterpretationInterpretationConcentrationConcentration
Source: Alleyne et al., 1977.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3232
PSG BIOKIMIA KVAPSG BIOKIMIA KVA
�� PROSESPROSESCadanganCadangan VitVit A A HeparHepar << << ➔➔➔➔➔➔➔➔DeplesiDeplesi VitVit A A dlmdlm tbhtbh ➔➔➔➔➔➔➔➔ KadarKadar VitVit AA
plasma plasma turunturun ➔➔➔➔➔➔➔➔ DisfungsiDisfungsi RetinaRetina ➔➔➔➔➔➔➔➔perubahanperubahan epitelepitel
�� INDIKATORINDIKATOR1.1. VitVit A Plasma NormalA Plasma Normal : : ≥≥≥≥≥≥≥≥ 30 30 µµg/dlg/dl
KVAKVA : < 5 : < 5 µµg/dlg/dl2.2. VitVit A A HeparHepar NormalNormal : : ≥≥≥≥≥≥≥≥ 15 15 µµg/dlg/dl
KVAKVA : <15 : <15 µµg/dlg/dl3.3. RBPRBP NormalNormal : : ≥≥≥≥≥≥≥≥ 20 20 µµg/dlg/dl
KVAKVA : < 20 : < 20 µµg/dl g/dl
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3333
Prevalence criteria for determining public health Prevalence criteria for determining public health significance of vitamin A deficiencysignificance of vitamin A deficiency
55Plasma vitamin A <10 Plasma vitamin A <10 µµg/dlg/dl0.050.05Corneal scarCorneal scar
0.010.01Corneal Corneal xerosisxerosis/corneal /corneal ulceration/ulceration/keratomalaciakeratomalacia
0.50.5Bitot'sBitot's spotsspots11Night blindnessNight blindness
Prevalence above Prevalence above (%)(%)
SignSign
Source: WHO, 1982.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3434
PemeriksaanPemeriksaan GAKIGAKITest Test LaboratoriumLaboratorium ::
–– TSH : TSH : kadarkadar normal 0,4 normal 0,4 –– 4,8 4,8 µµg/mlg/ml
–– Urinary Urinary ExretionExretion Iodine (UEI) :Iodine (UEI) :
BeresikoBeresiko thdthd kesehatankesehatan lebihlebih luasluas
IIH, IIH, AutoimuneAutoimune, , penyakitpenyakit hiperhiper
thyroid thyroid dlldll..
SangatSangat kelebihankelebihan>300>300
ResikoResiko IIH IIH dlmdlm 55--10 10 thth program program
padapada kelkel umurumur tertentutertentu..LebihLebih200200--299299
OptimumOptimumCukupCukup100100--199199
KurangKurang iodiumiodium ringanringanKurangKurang5050--9999
KurangKurang iodiumiodium sedangsedangKurangKurang2020--4949
KurangKurang iodiumiodium beratberatKurangKurang<20<20
Status(giziStatus(gizi) ) iodiumiodiumAsupanAsupan iodiumiodiumMedian UIE Median UIE uug/lg/l
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3535
TSH neonatalTSH neonatal
�� SangatSangat pentingpenting untukuntuk kabupaten/kotakabupaten/kota endemikendemiksedangsedang &&beratberat atauatau pernahpernah dinyatakandinyatakanendemikberatendemikberat
�� SatuSatu--satunyasatunya caracara untukuntuk mengetahuimengetahui adanyaadanyakretinkretin barubaru
�� DilakukanDilakukan padapada semuasemua bayibayi barubaru lahirlahir..
�� DapatDapat mendeteksimendeteksi dinidini bayibayi hypothyroid transient hypothyroid transient maupunmaupun permanent.permanent.
�� PerluPerlu keterlibatanketerlibatan bidan/penolongbidan/penolong persalinanpersalinan..
�� MenggunakanMenggunakan bercakbercak darahdarah padapada kertaskertas saringsaring(Blood (Blood spot)atauspot)atau IndekIndek hipothyroidhipothyroid T.T.
�� PerluPerlu disiapkandisiapkan sistemsistem pelaporanpelaporan..
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3636
PemeriksaanPemeriksaan Urinary Urinary ExretionExretionIodine (UEI) Iodine (UEI)
�� Sampling random 300 Sampling random 300 orangorang kelompokkelompok
terawan(ibuterawan(ibu hamilhamil) ) untukuntuk diambildiambil urine urine
sesaatsesaat..
�� FrekuensiFrekuensi 1x/1 1x/1 –– 2th2th
�� KirimKirim keke LaboratoriumLaboratorium dgndgn ProsedureProsedure
bakubaku kirimkirim 10 % 10 % u/pemeriksaanu/pemeriksaan duploduplo didi
Lab Lab –– terakreditasi/rujukanterakreditasi/rujukan..
�� HasilHasil urutkanurutkan terendahterendah hinggahingga tertinggitertinggi
�� TentukanTentukan nilainilai median.median.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3737
Severity and public health significance of IDDSeverity and public health significance of IDD
CriticalCritical<20<20>30>30++++++++++++++++(Stage III)(Stage III)
SevereSevere
UrgentUrgent20 4920 492020--29.929.900++++++(Stage II)(Stage II)
ModerateModerate
ImportantImportant>50>50--99995.019.95.019.90000++(Stage l)(Stage l)
MildMild
CretinismCretinismHypothyrHypothyroidismoidism
GoitGoitrere
Need for Need for correctioncorrection
Median Median urinary urinary iodine iodine
((µµg/litreg/litre ))
Typical Typical goitregoitre
prevalence prevalence (%)(%)
Clinical Clinical featuresfeaturesaaSeveritySeverity
Source: Adapted from WHO, 1994.a 0 = absent; + = mild/least severe; ++ = moderate/more severe; +++ = most severe.
PSG PSG -- Suyatno FKM UNDIPSuyatno FKM UNDIP 3838
BatasanBatasan GOAL GOAL indikatorindikator dalamdalam surveilanssurveilans GAKIGAKI
< 3 %< 3 %
Neonatal TSH Neonatal TSH
ProporsiProporsi bayibayi dengandengan kadarkadar TSH TSH
darahdarah lebihlebih daridari 5 5 mUmU/L/L
< 5%< 5%
GondokGondok
AnakAnak usiausia sekolahsekolah (6(6--12 12 thth))
HasilHasil PalpasiPalpasi/ultrasound)/ultrasound)
< 50%< 50%
< 20%< 20%
IodiumIodium dalamdalam urineurine
ProporsiProporsi dibawahdibawah 100 100 uugg/ L/ L
ProporsiProporsi dibawahdibawah 50 50 uugg/L/L
> 90 %> 90 %
GaramGaram beriodiumberiodium
ProporsiProporsi rumahrumah tanggatangga yang yang mengkonsumsimengkonsumsi
garamgaram beriodiumberiodium ((efektifefektif))
GOALGOALINDIKATORINDIKATOR
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