Immunoassay interference: Studi kasus Nefritis Lupus kelas IV, Sindroma Mielodisplasia dan Neuropsikiatrilupus

  • Like Rahayu Nindhita KSM Patologi Klinik RSUP Dr. Kariadi
  • Dian Widyaningrum KSM Patologi Klinik RSUP Dr. Kariadi

Abstract

Latar belakang : Systemic Lupus Erythematosus adalah penyakit kronik inflamatif autoimun dengan manifestasi multiorgan. Pemeriksaan bone marrow punction  mengkonfirmasi gangguan hematologi. Imunoassai ANA, anti-dsDNA dan anti Sm mengkonfirmasi imunopatogenesis. Tujuan studi kasus ini adalah untuk menganalisis aspek laboratorium dalam diagnosis dan tatalaksana nefritis Lupus kelas IV dan neuropsikiatri lupus dengan Sindroma Mielodisplasia.

Kasus : Seorang wanita 35 tahun mengeluh lemas. Pemeriksaan fisik : hipertensi, konjungtiva palbebra pucat, ulkus dimulut, echimosis dikulit, pleural friction rub paru kanan, edema pitting ekstremitas. Pemeriksaan laboratorium : peningkatan LDH, hiperlipidemia, hipofibrinogenemia, peningkatan D-dimer, proteinuria, hematuria dan silinderuria. Pemeriksaan ANA dan Sel LE positif. Pansitopenia darah tepi dikonfirmasi pemeriksaan BMP didapatkan gambaran MDS. Pasien mengalami kejang, dikonfirmasi MSCT kepala terdapat infark serebri multipel. Anti ds-DNA positif moderate, C3/C4 rendah namun anti Sm negatif.

Kesimpulan : Berdasarkan data klinis dan laboratoris pasien ini didiagnosis  SLE derajat berat, nefritis lupus kelas IV, sindroma mielodisplasia dan neuropsikiatrilupus. Anti Sm negatif kemungkinan disebabkan  fenomena “cross reactivity” atau “Hook Effect” sehingga menyebabkan interferensi hasil negatif palsu. Anti Sm negatif tidak dapat menyingkirkan diagnosis SLE

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Published
2021-07-15