Relationship between the length of treatment for PTB and Hb levels [TB0103]

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The notification rate for all tuberculosis cases in Central Java Province in 2022 was 179 per 100,000 population, an increase from 110 per 100,000 population in 2021. Semarang City continues to rank as the highest regency/city, with a Case Notification Rate (CNR) for all TB cases at 348 per 100,000 population. Kedungmundu District has the highest number of pulmonary TB cases, with a total of 186 cases, followed by Bangetayu District with 158 pulmonary TB cases.

TB treatment begins with an intensive phase lasting for the first two months, potentially followed by an advanced phase. Long-term TB treatment often leads to issues with patient compliance. Noncompliance in tuberculosis treatment can have a negative impact on clinical outcomes and public health. Hematological abnormalities are common in TB patients, including leukocytosis, monocytosis, lymphocytosis, thrombocytosis, lymphopenia, and anemia. Anti-TB drugs such as isoniazid and rifampicin can cause hemolytic anemia or metabolic disorders affecting hemoglobin (Hb) levels.

A quantitative descriptive study was conducted in April 2023 at Puskesmas Kedungmundu and Puskesmas Bangetayu in Semarang City. The study population consisted of TB patients from these health centers, specifically pulmonary tuberculosis patients in the intensive phase of treatment, selected using an accidental sampling method. A total of 31 respondents were included: 17 from Puskesmas Kedungmundu and 14 from Puskesmas Bangetayu. Blood samples were collected via venous puncture and analyzed using the KX21-N hematology analyzer.

The characteristics of intensive-phase pulmonary tuberculosis patients, based on age and gender, showed that most were in the 15-24 age group. Female patients accounted for 54.8% of the sample, while male patients represented 45.2%. In terms of treatment duration, 34.1% of patients had been treated for 5-8 weeks, while 65.9% had been treated for 1-4 weeks. Hemoglobin levels among the respondents indicated that 51.6% had normal levels, while 48.4% had low hemoglobin levels, with a minimum level of 9.9 g/dL, a maximum of 17.3 g/dL, and an average of 12.735 g/dL.

The Shapiro-Wilk test for normality on the length of treatment in intensive-phase pulmonary tuberculosis patients yielded a p-value <0.05, indicating the data was not normally distributed, while hemoglobin levels were normally distributed. A Pearson correlation test showed a significance level of 0.862, indicating no relationship between the duration of treatment and hemoglobin levels. This may be because more TB patients had normal hemoglobin levels than those with low levels.

The mechanism of anemia in pulmonary TB patients is explained as follows: bacterial invasion activates T lymphocytes and macrophages, which induce cytokine production, including interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), and interleukin-6 (IL-6). This response causes iron to be sequestered within the reticuloendothelial system, decreasing plasma iron concentration, reducing the availability of red blood cells for hemoglobin synthesis, and inhibiting erythroid progenitor cell proliferation and erythropoietin production and activity.

Source: Fadhilah, A.N. and Wikandari, R.J., 2024. The relationship between the length of treatment for pulmonary tuberculosis patients in the intensive phase and hemoglobin levels. Journal of Indonesian Medical Laboratory and Science, 5(2), pp.140-149.

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