KEJADIAN INFEKSI PASIEN ANAK LEUKEMIA

LIMFOBLASTIK AKUT PADA FASE INDUKSI DAN

KONSOLIDASI DI RSUPN DR. CIPTO MANGUNKUSUMO

(PERIODE JANUARI 2014-DESEMBER 2015)

SKRIPSI

DIARY ARINA QONITA WIDOWATI

1210211147

UNIVERSITAS PEMBANGUNAN NASIONAL “VETERAN” JAKARTA

FAKULTAS KEDOKTERAN

PROGRAM STUDI KEDOKTERAN UMUM

2016

KEJADIAN INFEKSI PASIEN ANAK LEUKEMIA

LIMFOBLASTIK AKUT PADA FASE INDUKSI DAN

KONSOLIDASI DI RSUPN DR. CIPTO MANGUNKUSUMO

(PERIODE JANUARI 2014-DESEMBER 2015)

SKRIPSI

Diajukan Sebagai Salah Satu Syarat Untuk Memperoleh Gelar

Sarjana Kedokteran

DIARY ARINA QONITA WIDOWATI

1210211147

UNIVERSITAS PEMBANGUNAN NASIONAL “VETERAN” JAKARTA

FAKULTAS KEDOKTERAN

PROGRAM STUDI KEDOKTERAN UMUM

2016

v

KEJADIAN INFEKSI PASIEN ANAK LEUKEMIA

LIMFOBLASTIK AKUT PADA FASE INDUKSI DAN

KONSOLIDASI DI RSUPN DR. CIPTO MANGUNKUSUMO

(PERIODE JANUARI 2014-DESEMBER 2015)

Diary Arina Qonita Widowati

Abstrak

Kemoterapi masih menjadi pengobatan utama pada pasien leukemia limfoblastik

akut. Selain membunuh sel leukemik, obat sitostatika yang digunakan pada

kemoterapi juga dapat membunuh sel darah normal dan mengakibatkan

leukopenia. Akibatnya sistem imunitas tidak mampu mempertahankan tubuh dari

invasi benda asing dan pasien sering mengalami infeksi. Kejadian infeksi pada

pasien LLA merupakan masalah yang serius karena berdasarkan penelitian

sebelumnya 66% kematian pada pasien LLA disebabkan karena infeksi. Penelitian

ini bersifat deskriptif analitik, dengan pendekatan potong lintang dengan cara

mengumpulkan rekam medik pasien anak LLA di RSUPN Dr. Cipto

Mangunkusumo, kemudian mendeskripsikan tentang kejadian infeksi yang terjadi

pada pasien LLA berdasarkan fase induksi dan kemoterapi dan mencari hubungan

antara fase kemoterapi tersebut dengan kejadian infeksi. Didapatkan sampel

sebanyak 30 pasien LLA yang mengalami infeski saat kemoterapi fase induksi

dan konsolidasi. Hasil penelitian ini menunjukan bahwa infeksi yang terjadi pada

pasien LLA lebih banyak pada saat fase induksi dan infeksi yang paling sering

terjadi adalah infeksi saluran nafas. Hasil uji Chi-square menunjukan nilai p value

0,49 yang artinya tidak terdapat hubungan antara fase kemoterapi dengan kejadian

infeksi.

Kata Kunci : leukemia limfoblastik akut, kemoterapi, infeksi

vi

THE INCIDENCE OF INFECTIONS IN CHILDREN PATIENT

WITH ACUTE LYMPHOBLASTIC LEUKEMIA ON

INDUCTION AND CONSOLIDATION RSUPN DR. CIPTO

MANGUNKUSUMO

(PERIOD JANUARY 2014-DECEMBER 2015)

Diary Arina Qonita Widowati

Abstract

Chemotherapy is the common treatment used for acute lymphoblastic leukemia. It

works by killing the leukemic cells, but it also kills many normal cells and cause

leukopenia. One of the main consequences is inability of the immune system

defending the body from the invasion of foreign objects and cause an infection.

The incidence of infection in patients with ALL is a serious problem and from the

previous study caused 66% of deaths. This study is a descriptive retrospective,

with cross sectional approach by collecting the medical records of pediatric

patient with ALL in RSUPN Dr. Cipto Mangunkusumo, then described the

incidence of infections that occured in patients with ALL based on the phase of

chemotherapy and find the relationship between the phase of chemotherapy with

the incidence of infection. The samples were 30 patients ALL who suffered

infection during induction phase and consolidation phase. The result was most

patient has infection in induction phase and the most common infection in ALL

patient was respiratory tract infection. The result of Chi-Square test showed the p

value 0,49 which means there was no significant correlation between the phases

of chemotherapy and the incidence of infection.

Keywords : acute lymphoblastic leukemia, chemotherapy, infection

viii

DAFTAR ISI

HALAMAN JUDUL........................................................................................... i

PERNYATAAN ORISINALITAS...................................................................... ii

PERNYATAAN PERSETUJUAN PUBLIKASI................................................ iii

PENGESAHAN................................................................................................... iv

ABSTRAK........................................................................................................... v

ABSTRACT......................................................................................................... vi

PRAKATA........................................................................................................... vii

DAFTAR ISI........................................................................................................ viii

DAFTAR TABEL................................................................................................ x

DAFTAR BAGAN.............................................................................................. xi

DAFTAR GAMBAR........................................................................................... xii

DAFTAR LAMPIRAN........................................................................................ xiii

BAB I PENDAHULUAN

I.1 Latar Belakang......................................................................................... 1

I.2 Perumusan Masalah................................................................................. 3

I.3 Tujuan Penelitian..................................................................................... 3

I.4 Manfaat Penelitian................................................................................... 4

BAB II TINJAUAN PUSTAKA

II.1 Leukemia Limfoblastik Akut................................................................... 6

II.2 Kemoterapi............................................................................................... 18

II.3 Infeksi Pada LLA..................................................................................... 28

II.4 Kerangka Teori........................................................................................ 31

II.5 Kerangka Konsep..................................................................................... 32

II.6 Hipotesis.................................................................................................. 32

BAB III METODOLOGI PENELITIAN

III.1 Jenis Penelitian.........................................................................................33

III.2 Lokasi Penelitian...................................................................................... 33

III.3 Waktu Penelitian...................................................................................... 33

III.4 Subjek Penelitian..................................................................................... 34

III.5 Kriteria Inklusi dan Eksklusi................................................................... 34

III.6 Teknik Sampel......................................................................................... 35

III.7 Identifikasi Variabel.................................................................................35

III.8 Definisi Operasional................................................................................ 36

III.9 Instrumen Penelitian................................................................................ 37

III.10 Protokol Penelitian................................................................................... 37

III.11 Pengolahan Data...................................................................................... 38

III.12 Analisis Data............................................................................................ 39

ix

BAB IV HASIL & PEMBAHASAN

IV.1 Gambaran Umum Lokasi Penelitian........................................................ 40

IV.2 Hasil & Pembahasan................................................................................ 41

IV.3 Keterbatasan Penelitian............................................................................ 49

BAB V KESIMPULAN

V.1 Kesimpulan.............................................................................................. 50

V.2 Saran........................................................................................................ 50

DAFTAR PUSTAKA.......................................................................................... 52

RIWAYAT HIDUP

LAMPIRAN

x

DAFTAR TABEL

Tabel 1 Klasifikasi LLA Berdasarkan WHO .............................................. 7

Tabel 2 Klasifikasi LLA Berdasarkan morfologi nya .................................. 8

Tabel 3 Pembagian Prognosis LLA ............................................................ 17

Tabel 4 Protokol Kemoterapi Risiko Standar .............................................. 26

Tabel 5 Protokol Kemoterapi Risiko Tinggi ................................................ 27

Tabel 6 Penelitian Terkait ............................................................................ 30

Tabel 7 Definisi Operasional ....................................................................... 36

Tabel 8 Karakteristik Pasien LLA ............................................................... 42

Tabel 9 Fase Kemoterapi Saat Terjadi Infeksi ............................................. 45

Tabel 10 Kejadian Infeksi Selama Kemoterapi ............................................ 46

Tabel 11 Kejadian Infeksi Berdasarkan Fase Kemoterapi ............................ 48

xi

DAFTAR GAMBAR

Gambar 1 Klasifikasi LLA Berdasarkan Morfologi .................................. 8

xii

DAFTAR BAGAN

Bagan 1 Kerangka Teori .......................................................................... 31

Bagan 2 Kerangka Konsep ....................................................................... 32

Bagan 3 Protokol Penelitian .................................................................... 37

xiii

DAFTAR LAMPIRAN

Lampiran 1 Surat Persetujuan Pra Proposal

Lampiran 2 Surat Persetujuan Penelitian RSUPN Dr. Cipto Mangunkusumo

Lampiran 3 Surat Izin Etik UPN “Veteran” Jakarta

Lampiran 4 Surat Izin Etik Fakultas Kedokteran UI-RSCM

Lampiran 5 Surat Izin Pengambilan Data RSCM

Lampiran 6 Daftar Pasien

Lampiran 7 Hasil Analisis Data Univariat

Lampiran 8 Hasil Analisa Data Bivariat