Hemoglobin Structure %
A α2 β2 92%
A2 α2 δ2 2.5%
A1C α2 (β-N-glucose) 3%
F α2 γ2 <1%
Gower-1 ζ2 ε 2 0*
Gower-2 α2 ε2 0*
Portland ζ2 γ2 0*
* Indicates early embryonic form not seen in adults (Tahono, 2010)
Gen penyandi sintesis rantai globin dan β
2 2 1
Gen Kromosom 16
globin 141
asam amino
G
A
Gen β Kromosom 11
globin 146
asam amino Hb Gowers 1
(ζ 2 ε 2), Hb A (mayor)
2β2
Hemoglobin Hb Gowers 2 Hb F dan
( 2 ε 2) (22)
Hb A2 (minor)
Hb Portland 2 δ2.
(ζ 2 2).
5' 2 1 3'
2 1 1
G lo b in G e n e s :
C h a in s S y n t h e s iz e d
H b ty p e s : 2 2 2 2 2 2
(G o w e r- I) (P o rtla n d ) (G o w e r- II)
E m b ryo
C h ro m o s o m e # 11
5' G A 3'
G lo b in G e n e s :
C h a in s S y n th e s iz e d G A
G A
H b ty p e s : 2 2 2 2 2 2 2 2
(H b - F ) (H b - A 2 ) (H b - A )
F e tu s A d u lt
% o f to ta l
g lo b in 50
s y n th e s is
30
10
6 18 30 b ir th 6 18 30 42
p re n a ta l a g e (w k s ) p o s tn a ta l a g e (w k s )
(Tahono, 2010)
(Tahono, 2010)
Life cycle of red blood cells.
(Tahono, 2010)
MARKER DEFISIENSI BESI
ASSESSMENT OF IRON STATUS
A. Hematologi
1. Hemoglobine / Hgb -MCV = Ht / AE (fl)
2. Jumlah Eritrosit / RBC - MCH = Hb/AE
(pg)
3. Hematokrit / HCT - MCHC=Hb/Ht
4. Index Eritrosit atau MCH/MCV (%)
(Tahono, 2010)
B. Kimia Klinik
1. Kadar Fe
2. Saturasi transferin
3. TIBC
4. Ferritin
5. Soluble transferin receptor ( sTfR )
Ferritin
- Cadangan besi utama : SRE, hepatosit, makrofag ss.
tulang, lien.
- Cadangan yang efisien
- Representasi kadar ferritin plasma dalam keadaan
seimbang dengan cadangan besi tubuh
- Ferritin serum 1 ng/ml = + 8 mg Fe cadangan
(Tahono, 2010)
- Kadar ferritin pada proses berlangsungnya defisiensi Fe
terjadinya lebih awal dibandingkan Kadar Fe, Hb, AE,
Hct, morphologi eritrosit.
(Tahono, 2010)
- Analisa Ferritin kurang spesifik untuk diagnosis AGB
apabila ada penyakit lain yang menyebabkan kenaikan
ferritin.
22
DIAGNOSIS IN THE DEVELOPMENT OF IRON DEFICIENCY
ANAEMIA
Hemoglobin Serum iron TIBC Saturation Serum ferritin RBC
(g/dL) (ug/dL) (ug/dL) (%) (ng/mL) morphology
Stage 1
Iron depletion N N N or N Normochromic,
normocytic
Stage 2
Iron deficient N Normochromic,
erythropoiesis normocytic
Stage 3A
Iron deficient Normochromic,
anaemia normocytic
Stage 3B
Iron deficient Hypochromic,
anaemia microcytic