DECIPHERING IRON DEFICIENCY ANEMIA AND ANEMIA OF CHRONIC DISEASE : A LABORATORY APPROACH BEYOND FERRITIN
DOI:
https://doi.org/10.31004/jkt.v6i4.50433Keywords:
anemia of chronic disease, ferritin, inflammation, iron deficiency anemia, laboratory diagnosticsAbstract
Anemia defisiensi besi (ADB) dan anemia penyakit kronis (APK) merupakan jenis anemia yang paling sering ditemukan, namun perbedaan keduanya sering sulit ditegakkan karena pengaruh proses inflamasi. Ferritin tetap menjadi penanda standar cadangan besi, tetapi spesifisitasnya menurun karena perannya sebagai reaktan fase akut. Permasalahan penelitian ini adalah perlunya interpretasi pemeriksaan besi yang lebih akurat dalam kondisi inflamasi. Metode penulisan berbentuk tinjauan pustaka yang menganalisis literatur terkini mengenai peran indeks besi konvensional dan biomarker baru untuk membedakan ADB dari APK, dengan penekanan pada interpretasi dalam kondisi inflamasi. Data diperoleh dari publikasi tahun 2015-2025 yang membahas ferritin, C-reactive protein (CRP), soluble transferrin receptor (sTfR), laju endap darah (LED), hepcidin, dan reticulocyte hemoglobin content (CHr) dalam konteks inflamasi yang disintesis secara kualitatif untuk menilai nilai diagnostik, keunggulan, dan keterbatasannya. Ferritin tetap penting untuk menilai status besi, namun perlu penyesuaian terhadap inflamasi di mana dengan nilai ambang <100 ng/mL serta CRP >5 mg/L meningkatkan sensitivitas deteksi ADB. sTfR dan rasio sTfR/log ferritin memberikan spesifisitas lebih tinggi untuk defisiensi besi absolut, sedangkan hepcidin membedakan defisiensi fungsional pada APK dari defisiensi absolut pada ADB. CHr mencerminkan pasokan besi eritropoietik secara hampir real-time dan dipengaruhi inflamasi secara minimal. Kombinasi biomarker fungsional dan inflamasi meningkatkan akurasi diagnosis. Tidak ada uji tunggal yang bersifat definitif; pendekatan multi-marker dengan integrasi ferritin, biomarker baru, dan penanda inflamasi direkomendasikan untuk meningkatkan ketepatan diagnosis anemia pada kondisi inflamasi.References
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