Folat

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{\phpg\posx1405\pvpg\posy995\absw3200\absh178 \f21 \fs18 \cf0 \f21 \fs18 \cf0 Sari
Pediatri, Vol. 4, No. 1, Juni 2002 \par
}
{\phpg\posx7113\pvpg\posy995\absw3930\absh178 \f21 \fs18 \cf0 \f21 \fs18 \cf0 Sari
Pediatri, Vol. 4, No. 1, Juni 2002: 21 - 25 \par
}
{\phpg\posx1410\pvpg\posy1702\absw9017\absh4905 \f10 \fs33 \cf0 \f10 \fs33 \cf0
Defisiensi Asam Folat
\par}{\phpg\posx1410\pvpg\posy1702\absw9017\absh4905 \sl-301 \par\f10 \fs33 \cf0
{\i \f21 \fs21 Helena}{\i \f21 \fs21 Anneke}{\i \f21 \fs21 Tangkilisan,}{\i
\f21 \fs21 Debby}{\i \f21 \fs21 Rumbajan }
\par}{\phpg\posx1410\pvpg\posy1702\absw9017\absh4905 \sl-310 \par\par\f10 \fs33
\cf0 \fi846 {\f21 \fs19 Asam}{\f21 \fs19 folat}{\f21 \fs19 adalah}{\f21 \fs19
salah}{\f21 \fs19 satu}{\f21 \fs19 vitamin,}{\f21 \fs19 termasuk}{\f21 \fs19
dalam}{\f21 \fs19 kelompok}{\f21 \fs19 vitamin}{\f21 \fs19 B,}{\f21 \fs19
merupakan }
\par}{\phpg\posx1410\pvpg\posy1702\absw9017\absh4905 \sl-255 \f10 \fs33 \cf0 \fi846
{\f21 \fs19 salah}{\f21 \fs19 satu}{\f21 \fs19 unsur}{\f21 \fs19 penting}
{\f21 \fs19 dalam}{\f21 \fs19 sintesis}{\f21 \fs19 DNA}{\f21 \fs19 (}{\i
\f21 \fs19 deoxyribo}{\i \f21 \fs19 nucleic}{\i \f21 \fs19 acid)}{\f21 \fs19 .}
{\f21 \fs19 Unsur}{\f21 \fs19 ini }
{\f21 \fs19 diperlukan}{\f21 \fs19 sebagai}{\f21 \fs19 koenzim}{\f21 \fs19
dalam}{\f21 \fs19 sintesis}{\f21 \fs19 pirimidin.}{\f21 \fs19 Kebutuhan}{\f21
\fs19 meningkat}{\f21 \fs19 pada}{\f21 \fs19 saat }
{\f21 \fs19 terjadi}{\f21 \fs19 peningkatan}{\f21 \fs19 pembentukan}{\f21 \fs19
sel}{\f21 \fs19 seperti}{\f21 \fs19 pada}{\f21 \fs19 kehamilan,}{\f21 \fs19
keganasan}{\f21 \fs19 dan}{\f21 \fs19 bayi }
{\f21 \fs19 prematur.}{\f21 \fs19 Anemia}{\f21 \fs19 megaloblastik}{\f21 \fs19
merupakan}{\f21 \fs19 manifestasi}{\f21 \fs19 paling}{\f21 \fs19 khas}{\f21
\fs19 untuk}{\f21 \fs19 defisiensi }
{\f21 \fs19 asam}{\f21 \fs19 folat,}{\f21 \fs19 walaupun}{\f21 \fs19 ternyata}
{\f21 \fs19 defisiensi}{\f21 \fs19 asam}{\f21 \fs19 folat}{\f21 \fs19 dapat}
{\f21 \fs19 menyebabkan}{\f21 \fs19 kelainan-kelainan }
{\f21 \fs19 yang}{\f21 \fs19 berat}{\f21 \fs19 mengenai}{\f21 \fs19 jaringan}
{\f21 \fs19 non}{\f21 \fs19 hemopoetik.}{\f21 \fs19 Kelainan}{\f21 \fs19 ini}
{\f21 \fs19 bahkan}{\f21 \fs19 sudah}{\f21 \fs19 bermanifestasi }
{\f21 \fs19 sebagai}{\f21 \fs19 kelainan}{\f21 \fs19 kongenital}{\f21 \fs19
yaitu}{\i \f21 \fs19 neural}{\i \f21 \fs19 tube}{\i \f21 \fs19 defect}{\i
\f21 \fs19 (NTD).}{\f21 \fs19 Defisiensi}{\f21 \fs19 asam}{\f21 \fs19 folat}
{\f21 \fs19 juga }
{\f21 \fs19 mengakibatkan}{\f21 \fs19 peningkatan}{\f21 \fs19 homosistenin}
{\f21 \fs19 plasma}{\f21 \fs19 (hiperhomosisteinemia)}{\f21 \fs19 yang}{\f21
\fs19 dianggap }
{\f21 \fs19 sebagai}{\f21 \fs19 salah}{\f21 \fs19 satu}{\f21 \fs19 faktor}
{\f21 \fs19 risiko}{\f21 \fs19 penyakit}{\f21 \fs19 kardiovaskular}{\f21 \fs19
berupa}{\f21 \fs19 aterosklerosis.}{\f21 \fs19 Mengingat }
{\f21 \fs19 besarnya}{\f21 \fs19 risiko}{\f21 \fs19 akibat}{\f21 \fs19
defisiensi}{\f21 \fs19 folat,}{\f21 \fs19 FDA}{\f21 \fs19 (}{\i \f21 \fs19
Food}{\i \f21 \fs19 and}{\i \f21 \fs19 Drug}{\i \f21 \fs19 Administration}
{\f21 \fs19 ) }
{\f21 \fs19 menganjurkan}{\f21 \fs19 fortifikasi}{\f21 \fs19 folat}{\f21 \fs19
pada}{\f21 \fs19 makanan}{\f21 \fs19 yang}{\f21 \fs19 banyak}{\f21 \fs19
dikonsumsi}{\f21 \fs19 sehari-hari}{\f21 \fs19 oleh }
{\f21 \fs19 masyarakat}{\f21 \fs19 seperti}{\f21 \fs19 susu,}{\f21 \fs19 dengan}
{\f21 \fs19 upaya}{\f21 \fs19 menurunkan}{\f21 \fs19 angka}{\f21 \fs19
prevalensi}{\f21 \fs19 defisiensi}{\f21 \fs19 folat. }
\fi846 {\f21 \fs19 Kata}{\f21 \fs19 kunci:}{\f21 \fs19 asam}{\f21 \fs19 folat,}
{\f21 \fs19 anemia}{\f21 \fs19 megaloblastik,}{\i \f21 \fs19 neural}{\i \f21
\fs19 tube}{\i \f21 \fs19 defect}{\f21 \fs19 (NTD),hiperhomosisteinemia }\par
}
{\phpg\posx1283\pvpg\posy7927\absw865\absh859 \i \f10 \fs86 \cf0 \i \f10 \fs86 \cf0
A \par
}
{\phpg\posx2255\pvpg\posy7861\absw3911\absh886 \f21 \fs19 \cf0 \f21 \fs19 \cf0 sam
folat merupakan senyawa induk dari
\par}{\phpg\posx2255\pvpg\posy7861\absw3911\absh886 \sl-255 \f21 \fs19 \cf0
sekumpulan senyawa yang secara umum
\par}{\phpg\posx2255\pvpg\posy7861\absw3911\absh886 \sl-256 \f21 \fs19 \cf0 disebut
folat. Senyawa ini mempunyai berat
\par}{\phpg\posx2255\pvpg\posy7861\absw3911\absh886 \sl-255 \f21 \fs19 \cf0 molekul
(BM) 441. Molekul asam folat \par
}
terdiri dari tiga gugus yaitu pteridin, suatu cincin yang
mengandung atom nitrogen, cincin{\i psoriasis}{\i amino- }
\par}{\phpg\posx1416\pvpg\posy8885\absw4838\absh4816 \sl-255 \f21 \fs19 \cf0 {\i
benzoic}{\i acid} (PABA) dan asam glutamat.{\up006 \fs11 1} Tubuh
manusia tidak dapat mensintesis struktur folat,
sehingga membutuhkan asupan dari makanan.{\up006 \fs11 1,2 }
Walaupun banyak bahan makanan yang mengandung
\par}{\phpg\posx1416\pvpg\posy8885\absw4838\absh4816 \sl-255 \f21 \fs19 \cf0 folat,
tetapi karena sifatnya termolabil dan larut dalam
\par}{\phpg\posx1416\pvpg\posy8885\absw4838\absh4816 \sl-256 \f21 \fs19 \cf0 air,
sering kali folat dari bahan-bahan makanan
tersebut rusak karena proses memasak.{\up006 \fs11 1,3} Defisiensi
\par}{\phpg\posx1416\pvpg\posy8885\absw4838\absh4816 \sl-256 \f21 \fs19 \cf0 asam
folat biasanya terjadi pada minggu-minggu
pertama kehidupan bayi prematur, walaupun
defisiensi yang berat jarang tejadi. Kelompok yang
\par}{\phpg\posx1416\pvpg\posy8885\absw4838\absh4816 \sl-256 \f21 \fs19 \cf0 paling
sering memperlihatkan gejala-gejala defisiensi
{\fs14 Dr.}{\fs14 Debby}{\fs14 Rumbajan,}{\fs14 Peserta}{\fs14 Program}
{\fs14 Pendidikan}{\fs14 Dokter}{\fs14 Spesialis }
\par}{\phpg\posx1416\pvpg\posy8885\absw4838\absh4816 \sl-209 \f21 \fs19 \cf0 {\fs14
(PPDS)}{\fs14 Ilmu}{\fs14 Kesehatan}{\fs14 Anak}{\fs14 FK}{\fs14 Unsrat-RSUP}
{\fs14 Manado. }
{\b \fs15 Alamat}{\b \fs15 Korespondensi: }
Dr.}{\fs14 Helena}{\fs14 Anneke}{\fs14 Tangkilisan,}{\fs14 SpA. }
Kepala}{\fs14 Subbagian}{\fs14 Gizi.}{\fs14 Bagian}{\fs14 Ilmu}{\fs14
Kesehatan}{\fs14 Anak}{\fs14 FK}{\fs14 Unsrat-RSUP }
Manado}{\fs14 P.O.}{\fs14 BOX.}{\fs14 1066}{\fs14 Manado. }
Telepon:}{\fs14 0431-821652.}{\fs14 Fax:}{\fs14 0431-859091.}{\fs14 e-mail:}
{\fs14 ikarsup@}{\fs14 telkom.net }\par
}
asam folat adalah ibu hamil dan ibu menyusui.{\up006 \fs11 4 }
Defiensi asam folat biasanya dihubungkan dengan
\par}{\phpg\posx6460\pvpg\posy7830\absw4728\absh2062 \sl-255 \f21 \fs19 \cf0 anemia
megaloblastik, kemungkinan adanya{\i neural }
tube}{\i defect}{\i (NTD)} dan hiperhomosistemia.{\up006 \fs11 3} Anemia
megaloblastik dilaporkan 3%-75% terjadi pada
\par}{\phpg\posx6460\pvpg\posy7830\absw4728\absh2062 \sl-256 \f21 \fs19 \cf0 wanita
yang tidak menerima asupan asam folat.{\up006 \fs11 4} Di
\par}{\phpg\posx6460\pvpg\posy7830\absw4728\absh2062 \sl-255 \f21 \fs19 \cf0 Afrika
Selatan 90% wanita melahirkan dan wanita
menyusui menderita defisiensi asam folat.{\up006 \fs11 4} Di
Indonesia belum ada data yang pasti. \par
}
{\phpg\posx6460\pvpg\posy10655\absw4917\absh1132 \b \f10 \fs21 \cf0 \b \f10
\fs21 \cf0 Definisi
\par}{\phpg\posx6460\pvpg\posy10655\absw4917\absh1132 \sl-255 \par\b \f10 \fs21
\cf0 {\b0 \f21 \fs19 Defisiensi}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}
{\b0 \f21 \fs19 apabila}{\b0 \f21 \fs19 kadar}{\b0 \f21 \fs19 asam}{\b0 \f21
\fs19 folat}{\b0 \f21 \fs19 di}{\b0 \f21 \fs19 bawah }
\par}{\phpg\posx6460\pvpg\posy10655\absw4917\absh1132 \sl-256 \b \f10 \fs21 \cf0
{\b0 \f21 \fs19 normal}{\b0 \f21 \fs19 yaitu}{\b0 \f21 \fs19 folat}{\b0 \f21
\fs19 serum}{\b0 \f21 \fs19 {\ul <}}{\b0 \f21 \fs19 3}{\b0 \f21 \fs19 ng/ml}
{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 entrosit }
{\b0 \f21 \fs19 <}{\b0 \f21 \fs19 130}{\b0 \f21 \fs19 mg/ml.}{\b0\up006 \f21
\fs11 5,6 }\par
}
\fs21 \cf0 Sumber dan Kebutuhan Asam Folat
\cf0 {\b0 \f21 \fs19 Folat}{\b0 \f21 \fs19 tersebar}{\b0 \f21 \fs19 luas}{\b0
\f21 \fs19 pada}{\b0 \f21 \fs19 berbagai}{\b0 \f21 \fs19 tumbuh-tumbuhan }
{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 jaringan}{\b0 \f21 \fs19 hewan,}{\b0
\f21 \fs19 terutama}{\b0 \f21 \fs19 sebagai}{\b0 \f21 \fs19 poliglutamat }
\fi3744 {\b0 \f21 \fs11 6 }
{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19 bentuk}{\b0 \f21 \fs19 metil}{\b0 \f21
\fs19 atau}{\b0 \f21 \fs19 formil}{\b0 \f21 \fs19 tereduksi.}{\b0 \f21 \fs19
Sumber- }
{\b0 \f21 \fs19 sumber}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 paling}{\b0 \f21
\fs19 kaya}{\b0 \f21 \fs19 akan}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0
\f21 \fs19 adalah}{\b0 \f21 \fs19 ragi, }
{\b0 \f21 \fs19 hati,}{\b0 \f21 \fs19 ginjal,}{\b0 \f21 \fs19 sayur-sayuran}
{\b0 \f21 \fs19 berwarna}{\b0 \f21 \fs19 hijau,}{\b0 \f21 \fs19 kembang }\par
}
21 \par
}
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0028a28a0028a28a0028a28a0028a28a0028a28
28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}}\par}{\phpg\posx7571\pvpg\posy998\absw3200\absh178 \f21 \fs18 \cf0 \f21 \fs18
\cf0 Sari Pediatri, Vol. 4, No. 1, Juni 2002 \par
}
kol, brokoli; dalam jumlah yang cukup terdapat dalam
makanan yang terbuat dari susu, daging dan ikan, dan
sedikit dalam buah-buahan.{\up006 \fs11 1,3,4,6,-8} Pemanasan dapat
merusak 50-90% folat yang terdapat dalam makanan.
\par}{\phpg\posx1145\pvpg\posy1708\absw4872\absh2730 \sl-256 \f21 \fs19 \cf0 Asupan
sebanyak 3,1 mg/kgbb/hari dapat memenuhi
\par}{\phpg\posx1145\pvpg\posy1708\absw4872\absh2730 \sl-255 \f21 \fs19 \cf0 angka
kecukupan gizi yang dianjurkan di Indonesia.
\par}{\phpg\posx1145\pvpg\posy1708\absw4872\absh2730 \sl-256 \f21 \fs19 \cf0 Untuk
wanita hamil dan wanita menyusui dianjurkan
\par}{\phpg\posx1145\pvpg\posy1708\absw4872\absh2730 \sl-256 \f21 \fs19 \cf0 0,4
mg/hari atau 400 mg /hari.{\up006 \fs11 9,10} Apabila kebutuhan
folat tercukupi, tubuh menyimpan sekitar 5-10
\par}{\phpg\posx1145\pvpg\posy1708\absw4872\absh2730 \sl-256 \f21 \fs19 \cf0 mg
folat, dan hampir setengahnya disimpan di hati.
Cadangan ini cukup untuk 3-6 bulan tanpa asupan
\par}{\phpg\posx1145\pvpg\posy1708\absw4872\absh2730 \sl-256 \f21 \fs19 \cf0 folat
dari makanan.{\up006 \fs11 1 }\par
}
{\phpg\posx6179\pvpg\posy1975\absw88\absh196 \f21 \fs19 \cf0 \f21 \fs19 \cf0 - \par
}
{\phpg\posx6547\pvpg\posy1719\absw3349\absh426 \f21 \fs19 \cf0 \f21 \fs19 \cf0 5-
metil THF transferase.
\par}{\phpg\posx6547\pvpg\posy1719\absw3349\absh426 \sl-256 \f21 \fs19 \cf0 Lain-
lain: alkoholisme, penyakit hati. \par
}
{\phpg\posx1145\pvpg\posy5275\absw4678\absh4358 \b \f10 \fs21 \cf0 \b \f10 \fs21
\cf0 Metabolisme Asam Folat
\par}{\phpg\posx1145\pvpg\posy5275\absw4678\absh4358 \sl-256 \par\b \f10 \fs21 \cf0
{\b0 \f21 \fs19 Sebagian}{\b0 \f21 \fs19 besar}{\b0 \f21 \fs19 asam}{\b0
\f21 \fs19 folat}{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19 makanan}{\b0 \f21 \fs19
masuk }
{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19 bentuk}{\b0 \f21 \fs19 poliglutamat.}{\b0
\f21 \fs19 Absorpsi}{\b0 \f21 \fs19 terjadi }
{\b0 \f21 \fs19 sepanjang}{\b0 \f21 \fs19 usus}{\b0 \f21 \fs19 halus,}{\b0
\f21 \fs19 terutama}{\b0 \f21 \fs19 di}{\b0 \f21 \fs19 duodenum}{\b0 \f21 \fs19
dan }
{\b0 \f21 \fs19 jejunum}{\b0 \f21 \fs19 proksimal}{\b0 \f21 \fs19 dan}{\b0
\f21 \fs19 50-80%}{\b0 \f21 \fs19 di}{\b0 \f21 \fs19 antaranya}{\b0 \f21 \fs19
dibawa }
{\b0 \f21 \fs19 ke}{\b0 \f21 \fs19 hati}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19
sumsum}{\b0 \f21 \fs19 tulang.}{\b0 \f21 \fs19 Folat}{\b0 \f21 \fs19 diekskresi}
{\b0 \f21 \fs19 melalui }
{\b0 \f21 \fs19 empedu}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 urin.}{\b0\up006
\f21 \fs11 1,3,11}{\b0 \f21 \fs19 Di}{\b0 \f21 \fs19 mukosa}{\b0 \f21 \fs19
usus}{\b0 \f21 \fs19 halus, }
{\b0 \f21 \fs19 poliglutamat}{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19 makanan}
{\b0 \f21 \fs19 akan}{\b0 \f21 \fs19 dihidrolisis}{\b0 \f21 \fs19 oleh }
{\b0 \f21 \fs19 enzim}{\b0 \f21 \fs19 pteroil}{\b0 \f21 \fs19
poliglutamathidrolase}{\b0 \f21 \fs19 menjadi }
{\b0 \f21 \fs19 monoglutamat}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 kemudian}
{\b0 \f21 \fs19 mengalami}{\b0 \f21 \fs19 reduksi/ }
{\b0 \f21 \fs19 metilasi}{\b0 \f21 \fs19 sempurna}{\b0 \f21 \fs19 menjadi}{\b0
\f21 \fs19 5}{\b0 \f21 \fs19 metil}{\b0 \f21 \fs19 tetrahidrofolat }
{\b0 \f21 \fs19 (5-metil}{\b0 \f21 \fs19 THF).}{\b0\up006 \f21 \fs11 1,3,11,12}
{\b0 \f21 \fs19 Metil}{\b0 \f21 \fs19 THF}{\b0 \f21 \fs19 masuk}{\b0 \f21 \fs19
ke}{\b0 \f21 \fs19 dalam }
{\b0 \f21 \fs19 sel}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 mengalami}{\b0 \f21
\fs19 demetilasi}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 konjugasi. }
{\b0 \f21 \fs19 Dengan}{\b0 \f21 \fs19 bantuan}{\b0 \f21 \fs19 enzim}{\b0
\f21 \fs19 metil}{\b0 \f21 \fs19 transferase,}{\b0 \f21 \fs19 5-metil }
{\b0 \f21 \fs19 THF}{\b0 \f21 \fs19 akan}{\b0 \f21 \fs19 melepaskan}{\b0
\f21 \fs19 gugus}{\b0 \f21 \fs19 metilnya}{\b0 \f21 \fs19 menjadi }
{\b0 \f21 \fs19 tetrahidrofolat}{\b0 \f21 \fs19 (THF).}{\b0 \f21 \fs19
Metilkobalamin}{\b0 \f21 \fs19 akan }
{\b0 \f21 \fs19 memberikan}{\b0 \f21 \fs19 gugus}{\b0 \f21 \fs19 metil}{\b0
\f21 \fs19 tersebut}{\b0 \f21 \fs19 kepada}{\b0 \f21 \fs19 homo- }
{\b0 \f21 \fs19 sistein}{\b0 \f21 \fs19 untuk}{\b0 \f21 \fs19 membentuk}{\b0 \f21
\fs19 asam}{\b0 \f21 \fs19 amino}{\b0 \f21 \fs19 metionin. }\par
}
\cf0 Etiologi
{\b0 \f21 \fs19 Penyebab}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 asom}{\b0
\f21 \fs19 folat}{\b0 \f21 \fs19 ialah}{\b0 \f21 \fs19 sebagai}{\b0 \f21 \fs19
berikut}{\b0\up006 \f21 \fs11 1,3,5 }\par
}
{\phpg\posx1145\pvpg\posy11436\absw88\absh656 \f21 \fs19 \cf0 \f21 \fs19 \cf0 -
\par}{\phpg\posx1145\pvpg\posy11436\absw88\absh656 \sl-255 \par\f21 \fs19 \cf0 -
\par
}
\par
}
\par}{\phpg\posx1146\pvpg\posy13484\absw88\absh656 \sl-255 \par\f21 \fs19 \cf0 -
\par
}
Diet yang inadekuat: bayi dan anak-anak, orang
\par}{\phpg\posx1513\pvpg\posy11436\absw4457\absh2499 \sl-255 \f21 \fs19 \cf0 tua,
pemanasan, kemiskinan.
Malabsorpsi:{\i tropical}{\i sprue,}{\i blind}{\i loop}{\i syndrome, }
steatorrhea}, malabsorpsi folat kongenital, reseksi
jejunum,{\i Crohn's}{\i disease}.
Peningkatan kebutuhan: kehamilan, laktasi
prematuritas, anemia hemolitik, keganasan,
inflamasi kronik, hipertiroidisme.
\par}{\phpg\posx1513\pvpg\posy11436\absw4457\absh2499 \sl-255 \f21 \fs19 \cf0 Obat-
obatan: fenitoin, primidon, fenobarbital,
kontrasepsi oral,{\i methotrexate. }
Defisiensi enzim bawaan: dihidrofolat reduktase, \par
}
\fs21 \cf0 Manifestasi dan patogenesis defisiensi
asam folat
\cf0 {\fs19 A.}{\fs19 Anemia}{\fs19 megaloblastik }
\cf0 {\b0 \f21 \fs19 Anemia}{\b0 \f21 \fs19 megaloblastik}{\b0 \f21 \fs19
adalah}{\b0 \f21 \fs19 suatu}{\b0 \f21 \fs19 keadaan}{\b0 \f21 \fs19 yang }
{\b0 \f21 \fs19 ditandai}{\b0 \f21 \fs19 oleh}{\b0 \f21 \fs19 adanya}{\b0
\f21 \fs19 perubahan}{\b0 \f21 \fs19 abnormal}{\b0 \f21 \fs19 dalam }
{\b0 \f21 \fs19 pembentukan}{\b0 \f21 \fs19 sel}{\b0 \f21 \fs19 darah,}{\b0
\f21 \fs19 sebagai}{\b0 \f21 \fs19 akibat}{\b0 \f21 \fs19 adanya }
{\b0 \f21 \fs19 ketidaksesuaian}{\b0 \f21 \fs19 antara}{\b0 \f21 \fs19
pematangan}{\b0 \f21 \fs19 inti}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 sitoplasma }
{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 seluruh}{\b0 \f21 \fs19 sel}{\b0 \f21 \fs19
seri}{\b0 \f21 \fs19 myeloid}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 eritorid.}
{\b0\up006 \f21 \fs11 13}{\b0 \f21 \fs19 Anemia }
{\b0 \f21 \fs19 megaloblastik}{\b0 \f21 \fs19 merupakan}{\b0 \f21 \fs19
manifestasi}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 paling}{\b0 \f21 \fs19 khas }
{\b0 \f21 \fs19 untuk}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 folat. }
\fi340 {\b0 \f21 \fs19 Mekanisme}{\b0 \f21 \fs19 biokimiawi}{\b0 \f21 \fs19 yang}
{\b0 \f21 \fs19 mendasari}{\b0 \f21 \fs19 terjadinya }
{\b0 \f21 \fs19 perubahan}{\b0 \f21 \fs19 megaloblastik}{\b0 \f21 \fs19 adalah}
{\b0 \f21 \fs19 terganggunya}{\b0 \f21 \fs19 konversi }
{\b0\i \f21 \fs19 dump}{\b0 \f21 \fs19 menjadi}{\b0 \f21 \fs19 dTMP.}{\b0 \f21
\fs19 Dalam}{\b0 \f21 \fs19 keadaan}{\b0 \f21 \fs19 normal}{\b0\i \f21 \fs19
dump }
{\b0 \f21 \fs19 dikonversi}{\b0 \f21 \fs19 menjadi}{\b0 \f21 \fs19 dTMP}{\b0
\f21 \fs19 dengan}{\b0 \f21 \fs19 adanya}{\b0 \f21 \fs19 enzim }
{\b0 \f21 \fs19 timidilat}{\b0 \f21 \fs19 sintetase}{\b0 \f21 \fs19 yang}{\b0
\f21 \fs19 membutuhkan}{\b0 \f21 \fs19 koenzim}{\b0 \f21 \fs19 folat. }
{\b0 \f21 \fs19 Pada}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 folat}{\b0 \f21
\fs19 dump}{\b0 \f21 \fs19 diubah}{\b0 \f21 \fs19 menjadi}{\b0 \f21 \fs19
dUTP }
{\b0 \f21 \fs19 melebihi}{\b0 \f21 \fs19 kapasitas}{\b0 \f21 \fs19 kerja}{\b0
\f21 \fs19 enzim}{\b0 \f21 \fs19 dUTP}{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19
sel}{\b0 \f21 \fs19 melalui }
{\b0 \f21 \fs19 konversi}{\b0 \f21 \fs19 kembali}{\b0 \f21 \fs19 menjadi}{\b0\i
\f21 \fs19 dump}{\b0 \f21 \fs19 ,}{\b0 \f21 \fs19 akibatnya}{\b0 \f21 \fs19
terjadi }
{\b0 \f21 \fs19 penumpukan}{\b0 \f21 \fs19 dUTP}{\b0 \f21 \fs19 di}{\b0 \f21
\fs19 dalam}{\b0 \f21 \fs19 sel,}{\b0 \f21 \fs19 sehingga}{\b0 \f21 \fs19
terjadi }
{\b0 \f21 \fs19 kelambatan}{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19 sintesis}{\b0
\f21 \fs19 DNA.}{\b0\up006 \f21 \fs11 13,15 }
\fi340 {\b0 \f21 \fs19 Gambaran}{\b0 \f21 \fs19 darah}{\b0 \f21 \fs19 tepi}{\b0
\f21 \fs19 yang}{\b0 \f21 \fs19 paling}{\b0 \f21 \fs19 sering}{\b0 \f21 \fs19
dihu- }
{\b0 \f21 \fs19 bungkan}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 anemia}{\b0
\f21 \fs19 megaloblastik}{\b0 \f21 \fs19 adalah}{\b0 \f21 \fs19 makro- }
{\b0 \f21 \fs19 sitosis.}{\b0 \f21 \fs19 Makrositosis}{\b0 \f21 \fs19 yang}
{\b0 \f21 \fs19 khas}{\b0 \f21 \fs19 adalah}{\b0 \f21 \fs19 makroovalositosis. }
{\b0 \f21 \fs19 Hipersegmentasi}{\b0 \f21 \fs19 neutrofil}{\b0 \f21 \fs19
merupakan}{\b0 \f21 \fs19 tanda}{\b0 \f21 \fs19 pertama }
{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19 anemia}{\b0 \f21 \fs19 megaloblastik}{\b0
\f21 \fs19 di}{\b0 \f21 \fs19 daerah}{\b0 \f21 \fs19 tepi;}{\b0 \f21 \fs19
bila}{\b0 \f21 \fs19 ditemukan }
{\b0 \f21 \fs19 5%}{\b0 \f21 \fs19 neutrofil}{\b0 \f21 \fs19 dengan}{\b0 \f21
\fs19 lobus}{\b0 \f21 \fs19 lebih}{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19 lima}
{\b0 \f21 \fs19 kemungkinan }
{\b0 \f21 \fs19 adanya}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 asam}{\b0
\f21 \fs19 folat}{\b0 \f21 \fs19 meningkat}{\b0 \f21 \fs19 menjadi}{\b0 \f21
\fs19 98%.}{\b0\up006 \f21 \fs11 1,22 }
{\b0 \f21 \fs19 Pansitopenia}{\b0 \f21 \fs19 dapat}{\b0 \f21 \fs19 juga}{\b0
\f21 \fs19 ditemukan}{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 anemia }
{\b0 \f21 \fs19 megaloblastik}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 derajat}
{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 bervariasi}{\b0 \f21 \fs19 dan }
{\b0 \f21 \fs19 merupakan}{\b0 \f21 \fs19 atribut}{\b0 \f21 \fs19 langsung}{\b0
\f21 \fs19 dari}{\b0 \f21 \fs19 proses}{\b0 \f21 \fs19 hemopoesis }
{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 inefektif}{\b0 \f21 \fs19 dari}{\b0
\f21 \fs19 sumsum}{\b0 \f21 \fs19 tulang.}{\b0 \f21 \fs19 Sumsum}{\b0 \f21
\fs19 tulang }
{\b0 \f21 \fs19 menunjukkan}{\b0 \f21 \fs19 gambaran}{\b0 \f21 \fs19
hiperselular}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 hiperplasi }
{\b0 \f21 \fs19 seri}{\b0 \f21 \fs19 eritroid.}{\b0 \f21 \fs19 Prekursor}{\b0
\f21 \fs19 eritroid}{\b0 \f21 \fs19 tampak}{\b0 \f21 \fs19 sangat}{\b0 \f21
\fs19 besar}{\b0 \f21 \fs19 yang }
{\b0 \f21 \fs19 disebut}{\b0 \f21 \fs19 megaloblas.}{\b0 \f21 \fs19 Pada}{\b0
\f21 \fs19 seri}{\b0 \f21 \fs19 mieloid}{\b0 \f21 \fs19 dijumpai}{\b0 \f21 \fs19
adanya }
{\b0 \f21 \fs19 sel}{\b0 \f21 \fs19 batang}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19
metamielosit}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 sangat}{\b0 \f21 \fs19 besar}
{\b0\i \f21 \fs19 (giant }
{\b0\i \f21 \fs19 meta)}{\b0\i \f21 \fs19 myelocyte}{\b0 \f21 \fs19 . }
\cf0 {\fs19 B.}{\fs20 Neural}{\fs20 tube}{\fs20 defect }
\cf0 {\b0\i \f21 \fs19 Neural}{\b0\i \f21 \fs19 tube}{\b0\i \f21 \fs19 defect}
{\b0 \f21 \fs19 (}{\b0\i \f21 \fs19 NTD}{\b0 \f21 \fs19 )}{\b0 \f21 \fs19 atau}
{\b0 \f21 \fs19 defek}{\b0 \f21 \fs19 tuba}{\b0 \f21 \fs19 neuralis }
{\b0 \f21 \fs19 adalah}{\b0 \f21 \fs19 suatu}{\b0 \f21 \fs19 kelainan}{\b0
\f21 \fs19 kongenital}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 terjadi}{\b0 \f21
\fs19 akibat }
{\b0 \f21 \fs19 kegagalan}{\b0 \f21 \fs19 penutupan}{\b0 \f21 \fs19 lempeng}
{\b0 \f21 \fs19 saraf}{\b0 \f21 \fs19 (}{\b0\i \f21 \fs19 neural}{\b0\i \f21
\fs19 plate}{\b0 \f21 \fs19 )}{\b0 \f21 \fs19 yang }
{\b0 \f21 \fs19 terjadi}{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 minggu}{\b0
\f21 \fs19 ketiga}{\b0 \f21 \fs19 hingga}{\b0 \f21 \fs19 keempat}{\b0 \f21
\fs19 masa }\par
}
22 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101010
10101010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101ffdb0043010101010101010101010101010101010101010101010101010101010101010
1010101010101010101010101010101010101010101010101010101010101010101ffc0001108031a02
6103012200021101031101ffc4001f00000105010101010101000000000000000001020304050607080
90a0bffc400b5100002010303020403050504040000017d010203000411051221314106135161072271
14328191a1082342b1c11552d1f02433627282090a161718191a25262728292a3435363738393a43444
5464748494a535455565758595a636465666768696a737475767778797a838485868788898a92939495
0102030405060708090a0bffc400b511000201020404030407050404000102770001020311040521310
61241510761711322328108144291a1b1c109233352f0156272d10a162434e125f11718191a26272829
2a35363738393a434445464748494a535455565758595a636465666768696a737475767778797a82838
0028a28a0028a28a0028a28a0028a28a0028a28
28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}
gestasi.{\up006 \fs11 16} Defisiensi folat ternyata dapat menyebabkan
kelainan berat yang mengenai jaringan non hemo-
poietik, yaitu{\i neural}{\i tube}{\i defect} NTD yang terjadi dapat
merupakan{\i isolate}{\i NTD} (tanpa disertai kelainan
kongenital lain) yang kekambuhannya dapat dicegah
dengan pemberian folat.{\up006 \fs11 9 }
\fi340 Walaupun telah diketahui bahwa suplemen asam
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 folat
pada masa perikonsepsi dapat menurunkan risiko
terjadinya kehamilan dengan{\i NTD}, namun penyebab
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 pasti
terjadinya{\i NTD} masih belum diketahui.{\up006 \fs11 16}Diduga
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 bahwa
gangguan metabolisme homosistein berperan
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 dalam
terjadinya{\i NTD}. Hal ini ditunjang oleh
beberapa studi yang menunjukkan kadar homosistein
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 total
dalam plasma yang lebih tinggi pada pasien{\i NTD }
maupun wanita hamil dengan{\i NTD}, juga ditemukan
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 kadar
homosistein yang lebih tinggi pada cairan
amnion kehamilan dengan{\i NTD}{\up006 \fs11 17,18.} Brouwer dkk,
mengemukakan kemungkinan gangguan metabolisme
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 pada
ibu atau gangguan transport dari ibu ke janin
merupakan faktor penting dalam terjadinya{\i NTD}. Van
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 der
Put dan Whitehead dalam studinya masing-masing
menemukan bahwa mutasi C677T pada gen metilen
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 tetra
hidrofolat reduktase merupakan salah satu
penyebab peningkatan konsentrasi homosistein plasma
total.{\up006 \fs11 17} Coelho dkk mengemukakan bahwa metionin
diperlukan untuk penutupan tabung neural dan hal
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 ini
tidak dapat diatasi dengan suplementasi folat.{\up006 \fs11 18 }
{\b \f10 C.}{\b \f10 Hiperhomosisteinemia }
Metionin merupakan salah satu asam amino esensial
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 yang
dalam tubuh akan dikonversi menjadi S-
adenosilmetionin oleh enzim methionine adeno
sytrasferase. S-adenosilmetionin akan melepaskan
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 gugus
metilnya menjadi S-adensolhomosistein, yang
kemudian akan dihidrolisis menjadi homosistein.
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 Bila
terjadi defesiensi folat, proses remetilasi
homosistein terganggu, sehingga homosistein tidak
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-255 \f21 \fs19 \cf0 dapat
diubah menjadi metionin, yang pada akhirnya
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 akan
berakibat terjadinya peningkatan kadar
homosistein di dalam darah. Kelompok wanita yang
pernah mengalami kehamilan dengan{\i NTD} mem-
punyai kadar homosistein total plasma yang lebih
tinggi daripada kelompok kontrol.{\up006 \fs11 17 }
\fi340 Peningkatan kadar homosistein total plasma juga
dianggap sebagai salah satu faktor risiko penyakit
kardiovaskular.{\up006 \fs11 17,19} Hasil studi Brouwer, dkk.
Menunjukkan bahwa suplementasi 500ug asam folat
\par}{\phpg\posx1416\pvpg\posy1706\absw4929\absh11266 \sl-256 \f21 \fs19 \cf0 per
hari dapat menyebabkan terjadinya penurunan \par
}
kadar homosistein total plasma terutama pada dua
\par}{\phpg\posx6462\pvpg\posy1719\absw4751\absh1578 \sl-256 \f21 \fs19 \cf0 minggu
pertama. Hiperhomosisteinemi pada ibu
\par}{\phpg\posx6462\pvpg\posy1719\absw4751\absh1578 \sl-255 \f21 \fs19 \cf0 hamil
dapat menyebabkan terjadinya trombus pada
\par}{\phpg\posx6462\pvpg\posy1719\absw4751\absh1578 \sl-256 \f21 \fs19 \cf0 arteri
spiralis endometrium dan miometrium yang
berakibat infark dan insufisiesi plasenta.{\up006 \fs11 8} Mutasi gen
pengatur metabolisme homosistein menyebabkan
kelainan pembuluh darah koroner.{\up006 \fs11 10 }\par
}
\cf0 Gejala Klinis
{\b0 \f21 \fs19 Tanda}{\b0 \f21 \fs19 anemia}{\b0 \f21 \fs19 megaloblastik}{\b0
\f21 \fs19 berupa}{\b0 \f21 \fs19 glositis}{\b0 \f21 \fs19 (lidah }
{\b0 \f21 \fs19 pucat}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 licin),}{\b0 \f21 \fs19
stomatitis}{\b0 \f21 \fs19 angularis,}{\b0 \f21 \fs19 diare/konstipasi, }
{\b0 \f21 \fs19 anoreksia,}{\b0 \f21 \fs19 ikterus}{\b0 \f21 \fs19 ringan,}
{\b0 \f21 \fs19 sterilitas,}{\b0 \f21 \fs19 neuropati}{\b0 \f21 \fs19 perifer }
{\b0 \f21 \fs19 bilateral,}{\b0 \f21 \fs19 pigmentasi}{\b0 \f21 \fs19 melalui}
{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 kulit.}{\b0\up006 \f21 \fs11 4,5}{\b0
\f21 \fs19 Kegagalan }
{\b0 \f21 \fs19 penutupan}{\b0\i \f21 \fs19 neural}{\b0\i \f21 \fs19 tube}{\b0
\f21 \fs19 dapat}{\b0 \f21 \fs19 terjadi}{\b0 \f21 \fs19 di}{\b0 \f21 \fs19
daerah}{\b0 \f21 \fs19 kranial }
{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 spinal}{\b0 \f21 \fs19 mengakibatkan}{\b0
\f21 \fs19 anensefalus,}{\b0 \f21 \fs19 meningokel, }
{\b0 \f21 \fs19 ensefalokel,}{\b0 \f21 \fs19 spina}{\b0 \f21 \fs19 bifida}{\b0
\f21 \fs19 dan}{\b0 \f21 \fs19 hidrosefalus.}{\b0\up006 \f21 \fs11 9,10,16 }\par
}
\cf0 Pemeriksaan Laboratorium
{\b0 \f21 \fs19 Beberapa}{\b0 \f21 \fs19 pemeriksaan}{\b0 \f21 \fs19
laboratorium}{\b0 \f21 \fs19 diperlukan}{\b0 \f21 \fs19 untuk }
{\b0 \f21 \fs19 membantu}{\b0 \f21 \fs19 diagnosis}{\b0 \f21 \fs19 dan}{\b0
\f21 \fs19 membedakan}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 folat }
{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 vitamin}{\b0
\f21 \fs19 B}{\b0\dn006 \f21 \fs11 12}{\b0 \f21 \fs19 .}{\b0 \f21 \fs19 Kadar}
{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 serum }
{\b0 \f21 \fs19 mencerminkan}{\b0 \f21 \fs19 asupan}{\b0 \f21 \fs19 asam}{\b0
\f21 \fs19 folat}{\b0 \f21 \fs19 selama}{\b0 \f21 \fs19 beberapa}{\b0 \f21 \fs19
hari }
{\b0 \f21 \fs19 terakhir,}{\b0 \f21 \fs19 sedangkan}{\b0 \f21 \fs19 folat}{\b0
\f21 \fs19 eritrosit}{\b0 \f21 \fs19 merupakan}{\b0 \f21 \fs19 gambaran }
{\b0 \f21 \fs19 kandungan}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 selama}{\b0
\f21 \fs19 proses}{\b0 \f21 \fs19 pematangan}{\b0 \f21 \fs19 erirosit}{\b0
\f21 \fs19 di }
{\b0 \f21 \fs19 sumsum}{\b0 \f21 \fs19 tulang.}{\b0 \f21 \fs19 Folat}{\b0
\f21 \fs19 eritrosit}{\b0 \f21 \fs19 menggambarkan }
{\b0 \f21 \fs19 cadangan}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 tubuh}{\b0
\f21 \fs19 lebih}{\b0 \f21 \fs19 baik}{\b0 \f21 \fs19 daripada}{\b0 \f21
\fs19 folat }
{\b0 \f21 \fs19 serum.}{\b0 \f21 \fs11 1,11}{\b0 \f21 \fs19 Pemeriksaan}{\b0
\f21 \fs19 laboratorium}{\b0 \f21 \fs19 untuk}{\b0 \f21 \fs19 mengukur }
{\b0 \f21 \fs19 kadar}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19
antara}{\b0 \f21 \fs19 lain}{\b0 \f21 \fs19 pemeriksaan}{\b0 \f21 \fs19 folat}
{\b0 \f21 \fs19 serum }
{\b0 \f21 \fs19 secara}{\b0 \f21 \fs19 mikrobiologis,}{\b0 \f21 \fs19 c}
{\b0\i \f21 \fs19 ompetitive}{\b0\i \f21 \fs19 protein-binding }
{\b0\i \f21 \fs19 radioassay}{\b0 \f21 \fs19 ,}{\b0\i \f21 \fs19 ion}{\b0\i
\f21 \fs19 capture}{\b0\i \f21 \fs19 separation,}{\b0 \f21 \fs19 homosistein}
{\b0 \f21 \fs19 total,}{\b0 \f21 \fs19 tes }
{\b0 \f21 \fs19 supresi}{\b0 \f21 \fs19 deoksiuridin}{\b0 \f21 \fs19 (dU),}{\b0
\f21 \fs19 dan}{\b0 \f21 \fs19 pemeriksaan}{\b0 \f21 \fs19 kadar }
{\b0 \f21 \fs19 FIGlu}{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19 urin }\par
}
\fs21 \cf0 Diagnosis
\cf0 {\b0 \f21 \fs19 Selain}{\b0 \f21 \fs19 anamnesis}{\b0 \f21 \fs19 dan}
{\b0 \f21 \fs19 pemeriksaan}{\b0 \f21 \fs19 fisis,}{\b0 \f21 \fs19
diagnosis }
{\b0 \f21 \fs19 ditegakkan}{\b0 \f21 \fs19 berdasarkan}{\b0 \f21 \fs19
pemeriksaan}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 serum}{\b0 \f21 \fs19 dan }
{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 eritrosit.}{\b0 \f21 \fs19 Cara}{\b0
\f21 \fs19 pengukuran}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 plasma}{\b0 \f21
\fs19 dan}{\b0 \f21 \fs19 eritrosit }
{\b0 \f21 \fs19 terbaru}{\b0 \f21 \fs19 ialah}{\b0 \f21 \fs19 dengan}{\b0 \f21
\fs19 menggunakan}{\b0 \f21 \fs19 cara}{\b0\i \f21 \fs19 microbiological }
{\b0\i \f21 \fs19 assay}{\b0 \f21 \fs19 atau}{\b0\i \f21 \fs19 competitive}{\b0\i
\f21 \fs19 binding}{\b0\i \f21 \fs19 technique}{\b0\up006 \f21 \fs11 20.}
{\b0 \f21 \fs19 }{\b0 \f21 \fs19 Kadar}{\b0 \f21 \fs19 asam }
{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 serum}{\b0 \f21 \fs19 normal}{\b0 \f21
\fs19 sekitar}{\b0 \f21 \fs19 9-45}{\b0 \f21 \fs19 nm}{\b0 \f21 \fs19 (3-
16}{\b0 \f21 \fs19 mg/ml). }
{\b0 \f21 \fs19 Defisiensi}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0
\f21 \fs19 ditegakkan}{\b0 \f21 \fs19 bila}{\b0 \f21 \fs19 kadar}{\b0 \f21 \fs19
asam}{\b0 \f21 \fs19 folat }
{\b0 \f21 \fs19 serum}{\b0 \f21 \fs19 kurang}{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19
3}{\b0 \f21 \fs19 mg/ml}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19
folat}{\b0 \f21 \fs19 eritrosit }
{\b0 \f21 \fs19 kurang}{\b0 \f21 \fs19 dari}{\b0 \f21 \fs19 100}{\b0 \f21 \fs19
mg/ml.}{\b0\up006 \f21 \fs11 13,20 }\par
}
23 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101010
10101010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101ffdb0043010101010101010101010101010101010101010101010101010101010101010
1010101010101010101010101010101010101010101010101010101010101010101ffc0001108031a02
6103012200021101031101ffc4001f00000105010101010101000000000000000001020304050607080
90a0bffc400b5100002010303020403050504040000017d010203000411051221314106135161072271
14328191a1082342b1c11552d1f02433627282090a161718191a25262728292a3435363738393a43444
5464748494a535455565758595a636465666768696a737475767778797a838485868788898a92939495
0102030405060708090a0bffc400b511000201020404030407050404000102770001020311040521310
61241510761711322328108144291a1b1c109233352f0156272d10a162434e125f11718191a26272829
2a35363738393a434445464748494a535455565758595a636465666768696a737475767778797a82838
0028a28a0028a28a0028a28a0028a28a0028a28
28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}
\cf0 Diagnosis Banding
{\b0 \f21 \fs19 Di}{\b0 \f21 \fs19 samping}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19
folat,}{\b0 \f21 \fs19 untuk}{\b0 \f21 \fs19 pematangan}{\b0 \f21 \fs19 akhir}
{\b0 \f21 \fs19 sel }
{\b0 \f21 \fs19 darah}{\b0 \f21 \fs19 merah}{\b0 \f21 \fs19 diperlukan}{\b0
\f21 \fs19 vitamin}{\b0 \f21 \fs19 B}{\b0\dn006 \f21 \fs11 12;}{\b0\up006
\f21 \fs11 4,20}{\b0 \f21 \fs19 oleh}{\b0 \f21 \fs19 karena }
{\b0 \f21 \fs19 itu}{\b0 \f21 \fs19 anemia}{\b0 \f21 \fs19 megaloblastik}{\b0
\f21 \fs19 dapat}{\b0 \f21 \fs19 pula}{\b0 \f21 \fs19 disebabkan}{\b0 \f21 \fs19
oleh }
{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 vitamin}{\b0 \f21 \fs19 B}
{\b0\dn006 \f21 \fs11 12.}{\b0 \f21 \fs19 Seperti}{\b0 \f21 \fs19 halnya}{\b0
\f21 \fs19 defisiensi}{\b0 \f21 \fs19 asam }
{\b0 \f21 \fs19 folat,}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 vitamin}
{\b0 \f21 \fs19 B}{\b0\dn006 \f21 \fs11 12}{\b0 \f21 \fs19 dapat}{\b0 \f21
\fs19 mengakibatkan }
{\b0 \f21 \fs19 terjadinya}{\b0 \f21 \fs19 kerusakan}{\b0 \f21 \fs19 jaringan}
{\b0 \f21 \fs19 non}{\b0 \f21 \fs19 hemopoletik}{\b0 \f21 \fs19 yaitu }
{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 sistem}{\b0 \f21 \fs19 saraf}{\b0 \f21 \fs19
yang}{\b0 \f21 \fs19 memberikan}{\b0 \f21 \fs19 gejala}{\b0 \f21 \fs19 dan}
{\b0 \f21 \fs19 tanda }
{\b0 \f21 \fs19 neurologis}{\b0 \f21 \fs19 seperti}{\b0 \f21 \fs19 parestesia}
{\b0 \f21 \fs19 ekstremitas,}{\b0 \f21 \fs19 penurunan }
{\b0 \f21 \fs19 refleks}{\b0 \f21 \fs19 tendon}{\b0 \f21 \fs19 dalam}{\b0 \f21
\fs19 dan}{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 stadium}{\b0 \f21 \fs19 lanjut}
{\b0 \f21 \fs19 dapat }
{\b0 \f21 \fs19 terjadi}{\b0 \f21 \fs19 penurunan}{\b0 \f21 \fs19 ingatan}
{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 penurunan}{\b0 \f21 \fs19 fungsi }
{\b0 \f21 \fs19 penglihatan.}{\b0\up006 \f21 \fs11 4,6,21 }\par
}
hamil yang pernah melahirkan anak dengan NTD
dianjurkan untuk diberikan asam folat 4 -5mg/hari
\par}{\phpg\posx6179\pvpg\posy1716\absw4739\absh886 \sl-256 \f21 \fs19 \cf0 sejak
1 bulan sebelum konsepsi sampai kehamilan
trimester pertama.{\up006 \fs11 15,22 }\par
}
\cf0 Pengobatan dan Pencegahan
{\b0 \f21 \fs19 Penggunaan}{\b0 \f21 \fs19 terapi}{\b0 \f21 \fs19 asam}{\b0
\f21 \fs19 folat}{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19 klinik}{\b0 \f21 \fs19
terbatas }
{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 pencegahan}{\b0 \f21 \fs19 dan}{\b0 \f21
\fs19 pengobatan}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 vitamin. }
{\b0 \f21 \fs19 Penggunaan}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0
\f21 \fs19 secara}{\b0 \f21 \fs19 efektif}{\b0 \f21 \fs19 tergantung}{\b0
\f21 \fs19 pada }
{\b0 \f21 \fs19 keakuratan}{\b0 \f21 \fs19 diagnosis}{\b0 \f21 \fs19 dan}
{\b0 \f21 \fs19 pemahaman}{\b0 \f21 \fs19 mengenai }
{\b0 \f21 \fs19 mekanisme}{\b0 \f21 \fs19 terjadinya}{\b0 \f21 \fs19 penyakit. }
\fi340 {\b0 \f21 \fs19 Prinsip-prinsip}{\b0 \f21 \fs19 umum}{\b0 \f21 \fs19 yang}
{\b0 \f21 \fs19 perlu}{\b0 \f21 \fs19 diperhatikan:}{\b0\up006 \f21 \fs11 24 }
{\b0 \f21 \fs19 pemberian}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0 \f21
\fs19 profilaksis}{\b0 \f21 \fs19 harus}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19
indikasi }
{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 jelas,}{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19
setiap}{\b0 \f21 \fs19 pasien}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 defisiensi}
{\b0 \f21 \fs19 asam }
{\b0 \f21 \fs19 folat,}{\b0 \f21 \fs19 harus}{\b0 \f21 \fs19 dicari}{\b0 \f21
\fs19 penyebabnya}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 teliti,}{\b0 \f21 \fs19
sebaiknya }
{\b0 \f21 \fs19 merupakan}{\b0 \f21 \fs19 terapi}{\b0 \f21 \fs19 yang}{\b0
\f21 \fs19 spesifik,}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19
tidak}{\b0 \f21 \fs19 dapat }
{\b0 \f21 \fs19 memperbaiki}{\b0 \f21 \fs19 kelainan}{\b0 \f21 \fs19
neurologis,}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 disebabkan }
{\b0 \f21 \fs19 oleh}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 vitamin}{\b0 \f21
\fs19 B}{\b0\dn006 \f21 \fs11 12 }
\fi340 {\b0 \f21 \fs19 Folat}{\b0 \f21 \fs19 tersedia}{\b0 \f21 \fs19 sebagai}
{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 dalam}{\b0 \f21
\fs19 bentuk }
{\b0 \f21 \fs19 tablet}{\b0 \f21 \fs19 0,1,}{\b0 \f21 \fs19 0,4,}{\b0 \f21 \fs19
10,}{\b0 \f21 \fs19 20}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 dalam}{\b0 \f21 \fs19
bentuk}{\b0 \f21 \fs19 injeksi}{\b0 \f21 \fs19 asam }
{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 5}{\b0 \f21 \fs19 mg/cc.}{\b0 \f21 \fs19
Selain}{\b0 \f21 \fs19 itu}{\b0 \f21 \fs19 terdapat}{\b0 \f21 \fs19 pula}{\b0
\f21 \fs19 dalam}{\b0 \f21 \fs19 berbagai }
{\b0 \f21 \fs19 sediaan}{\b0 \f21 \fs19 multivitamin}{\b0 \f21 \fs19 dan}
{\b0 \f21 \fs19 mineral.}{\b0\up006 \f21 \fs11 9,22}{\b0 \f21 \fs19 Pengobatan }
{\b0 \f21 \fs19 pasien}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 anemia}{\b0
\f21 \fs19 megaloblastik}{\b0 \f21 \fs19 akut}{\b0 \f21 \fs19 berupa }
{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 1-5}{\b0 \f21 \fs19
mg}{\b0 \f21 \fs19 intra}{\b0 \f21 \fs19 muskular}{\b0 \f21 \fs19 dan}{\b0
\f21 \fs19 dilanjutkan }
{\b0 \f21 \fs19 dengan}{\b0\i \f21 \fs19 maintenance}{\b0 \f21 \fs19 1-2}
{\b0 \f21 \fs19 mg/hari}{\b0 \f21 \fs19 oral}{\b0 \f21 \fs19 selama}{\b0 \f21
\fs19 1-2 }
{\b0 \f21 \fs19 minggu.}{\b0 \f21 \fs19 Pemberian}{\b0 \f21 \fs19 asam}{\b0
\f21 \fs19 folat}{\b0 \f21 \fs19 secara}{\b0 \f21 \fs19 oral}{\b0 \f21 \fs19
dengan }
{\b0 \f21 \fs19 dosis}{\b0 \f21 \fs19 0,5-1}{\b0 \f21 \fs19 mg}{\b0 \f21 \fs19
sehari}{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 pasien}{\b0 \f21 \fs19 anemia}
{\b0 \f21 \fs19 mega- }
{\b0 \f21 \fs19 loblastik}{\b0 \f21 \fs19 umumnya}{\b0 \f21 \fs19 memuaskan.}
{\b0\up006 \f21 \fs11 9}{\b0 \f21 \fs19 Terapi}{\b0 \f21 \fs19 profilaktiks }
{\b0 \f21 \fs19 pada}{\b0 \f21 \fs19 bayi}{\b0 \f21 \fs19 prematur}{\b0 \f21
\fs19 50}{\b0 \f21 \fs19 mg/hari.}{\b0\up006 \f21 \fs11 33}{\b0 \f21 \fs19
Terapi}{\b0 \f21 \fs19 selama}{\b0 \f21 \fs19 4 }
{\b0 \f21 \fs19 bulan}{\b0 \f21 \fs19 biasanya}{\b0 \f21 \fs19 cukup}{\b0
\f21 \fs19 untuk}{\b0 \f21 \fs19 memperbaiki}{\b0 \f21 \fs19 gejala }
{\b0 \f21 \fs19 klinis}{\b0 \f21 \fs19 dan}{\b0 \f21 \fs19 untuk}{\b0 \f21 \fs19
mengganti}{\b0 \f21 \fs19 sel}{\b0 \f21 \fs19 darah;}{\b0\up006 \f21 \fs11 16,33}
{\b0 \f21 \fs19 Namun}{\b0 \f21 \fs19 bila }
{\b0 \f21 \fs19 penyebab}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 belum}{\b0
\f21 \fs19 dapat}{\b0 \f21 \fs19 diatasi,}{\b0 \f21 \fs19 perlu}{\b0 \f21 \fs19
terapi }
{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 lebih}{\b0 \f21 \fs19 lama.}{\b0\up006
\f21 \fs11 17,23}{\b0 \f21 \fs19 Rekomendasi}{\b0 \f21 \fs19 dari}{\b0\i \f21
\fs19 US}{\b0\i \f21 \fs19 Public }
{\b0\i \f21 \fs19 Health}{\b0\i \f21 \fs19 Service}{\b0 \f21 \fs19 (USPHS),}
{\b0 \f21 \fs19 semua}{\b0 \f21 \fs19 wanita}{\b0 \f21 \fs19 usia}{\b0
\f21 \fs19 subur }
{\b0 \f21 \fs19 harus}{\b0 \f21 \fs19 mengkonsumsi}{\b0 \f21 \fs19 400mg}
{\b0 \f21 \fs19 (0,4}{\b0 \f21 \fs19 mg)}{\b0 \f21 \fs19 asam}{\b0 \f21 \fs19
folat/ }
{\b0 \f21 \fs19 hari}{\b0 \f21 \fs19 untuk}{\b0 \f21 \fs19 mencegah}{\b0 \f21
\fs19 NTD.}{\b0 \f21 \fs19 Pemberian}{\b0 \f21 \fs19 sejak}{\b0 \f21 \fs19 1}
{\b0 \f21 \fs19 bulan }
{\b0 \f21 \fs19 konsepsi}{\b0 \f21 \fs19 sampai}{\b0 \f21 \fs19 kehamilan}{\b0
\f21 \fs19 trimester}{\b0 \f21 \fs19 pertama}{\b0 \f21 \fs19 dapat }
{\b0 \f21 \fs19 mencegah}{\b0 \f21 \fs19 NTD}{\b0 \f21 \fs19 50%}{\b0 \f21 \fs19
atau}{\b0 \f21 \fs19 lebih.}{\b0\up006 \f21 \fs11 15,24-26}{\b0 \f21 \fs19 Pada}
{\b0 \f21 \fs19 wanita }\par
}
\cf0 Prognosis
{\b0 \f21 \fs19 Prognosis}{\b0 \f21 \fs19 defisiensi}{\b0 \f21 \fs19 asam}
{\b0 \f21 \fs19 folat}{\b0 \f21 \fs19 umumnya}{\b0 \f21 \fs19 baik. }
{\b0 \f21 \fs19 Diagnosis}{\b0 \f21 \fs19 dini}{\b0 \f21 \fs19 dan}{\b0 \f21
\fs19 pengobatan}{\b0 \f21 \fs19 yang}{\b0 \f21 \fs19 cepat}{\b0 \f21 \fs19
diberikan, }
{\b0 \f21 \fs19 maka}{\b0 \f21 \fs19 respon}{\b0 \f21 \fs19 terapi}{\b0 \f21
\fs19 akan}{\b0 \f21 \fs19 terjadi}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19
cepat.}{\b0\up006 \f21 \fs11 14,25,26 }
{\b0 \f21 \fs19 Tapi}{\b0 \f21 \fs19 bila}{\b0 \f21 \fs19 sudah}{\b0 \f21 \fs19
terjadi}{\b0 \f21 \fs19 NTD}{\b0 \f21 \fs19 berupa}{\b0 \f21 \fs19
anensefalus }
{\b0 \f21 \fs19 umumnya}{\b0 \f21 \fs19 meninggal}{\b0 \f21 \fs19 sebelum}{\b0
\f21 \fs19 atau}{\b0 \f21 \fs19 segera}{\b0 \f21 \fs19 setelah}{\b0 \f21 \fs19
lahir. }
{\b0 \f21 \fs19 Sedangkan}{\b0 \f21 \fs19 bayi}{\b0 \f21 \fs19 dengan}{\b0
\f21 \fs19 spina}{\b0 \f21 \fs19 bifida}{\b0 \f21 \fs19 mungkin}{\b0 \f21 \fs19
dapat }
{\b0 \f21 \fs19 bertahan}{\b0 \f21 \fs19 hidup}{\b0 \f21 \fs19 hingga}{\b0 \f21
\fs19 dewasa}{\b0 \f21 \fs19 dengan}{\b0 \f21 \fs19 berbagai }
{\b0 \f21 \fs19 kesulitan.}{\b0 \f21 \fs11 9,16,24 }\par
}
\cf0 Kesimpulan \par
}
{\phpg\posx6179\pvpg\posy6836\absw117\absh1117 \f21 \fs19 \cf0 {\f0\fs25
\bullet }\f21 \fs19 \cf0
{\f0\fs25 \bullet }
{\f0\fs25 \bullet } \par
}
{\phpg\posx6179\pvpg\posy9140\absw117\absh196 \f21 \fs19 \cf0 {\f0\fs25
\bullet }\f21 \fs19 \cf0 \par
}
{\phpg\posx6547\pvpg\posy6836\absw4545\absh3191 \f21 \fs19 \cf0 \f21 \fs19 \cf0 Ada
korelasi terbalik antara kadar homosistein dan
folat.
Defisiensi asam folat dapat menyebabkan kelainan
\par}{\phpg\posx6547\pvpg\posy6836\absw4545\absh3191 \sl-256 \f21 \fs19 \cf0 yang
mengenai jaringan non- hemopoietik.
\par}{\phpg\posx6547\pvpg\posy6836\absw4545\absh3191 \sl-255 \f21 \fs19 \cf0 Asam
folat memberikan harapan baik sebagai
pencegahan terjadinya kelainan cacat bawaan yang
disebabkan kelainan pertumbuhan susunan saraf
\par}{\phpg\posx6547\pvpg\posy6836\absw4545\absh3191 \sl-256 \f21 \fs19 \cf0 pusat.
Namun di Indonesia diperlukan penelitian
\par}{\phpg\posx6547\pvpg\posy6836\absw4545\absh3191 \sl-255 \f21 \fs19 \cf0 lebih
lanjut.
Mengkonsumsi ekstrak asam folat yang ada di
\par}{\phpg\posx6547\pvpg\posy6836\absw4545\absh3191 \sl-255 \f21 \fs19 \cf0 dalam
makanan relatif tidak efektif dalam
meningkatkan status fotal eritrosit; sedangkan
ekstrak asam folat dalam suplemen mempunyai
pengaruh yang jelas. \par
}
\cf0 Daftar Pustaka \par
}
1. \par
}
2. \par
}
3. \par
}
4. \par
}
5. \par
}
McKenzie SB. Megaloblastic and nonmegaloblastic mac-
rocytic anemias. Dalam: Textbook of hematology, edisi
\par}{\phpg\posx6575\pvpg\posy11442\absw4198\absh2428 \sl-210 \f21 \fs16 \cf0 ke-2.
Baltimore, Williams & Wilkins, 1996. h . 179-99.
Hoffbrand AV, Pettit JE. Megaloblastic anaemias and
\par}{\phpg\posx6575\pvpg\posy11442\absw4198\absh2428 \sl-210 \f21 \fs16 \cf0 other
macrocytic anemias. Dalam: Essential haematology,
\par}{\phpg\posx6575\pvpg\posy11442\absw4198\absh2428 \sl-209 \f21 \fs16 \cf0 edisi
ke-3. London, Blackwell science, 1999. h. 53-73.
\par}{\phpg\posx6575\pvpg\posy11442\absw4198\absh2428 \sl-210 \f21 \fs16 \cf0 Mc.
Laren DS, Burman D, Belton NR, William AD.
Textbook of pediatric nutrition. Edisi ke-3. London: WB
Saunders, 1991. h. 416-8.
Lanzkowsky P. Manual of pediatrics hematology and
oncology. Edisi ke-2. New York: Churchill Livingstone
\par}{\phpg\posx6575\pvpg\posy11442\absw4198\absh2428 \sl-210 \f21 \fs16 \cf0 Inc,
1995. h. 51-62.
\par}{\phpg\posx6575\pvpg\posy11442\absw4198\absh2428 \sl-209 \f21 \fs16 \cf0 Mayes
PA. Vitamin yang larut dalam air. Dalam: Harper \par
}
24 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101010
10101010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101ffdb0043010101010101010101010101010101010101010101010101010101010101010
1010101010101010101010101010101010101010101010101010101010101010101ffc0001108031a02
6103012200021101031101ffc4001f00000105010101010101000000000000000001020304050607080
90a0bffc400b5100002010303020403050504040000017d010203000411051221314106135161072271
14328191a1082342b1c11552d1f02433627282090a161718191a25262728292a3435363738393a43444
5464748494a535455565758595a636465666768696a737475767778797a838485868788898a92939495
0102030405060708090a0bffc400b511000201020404030407050404000102770001020311040521310
61241510761711322328108144291a1b1c109233352f0156272d10a162434e125f11718191a26272829
2a35363738393a434445464748494a535455565758595a636465666768696a737475767778797a82838
0028a28a0028a28a0028a28a0028a28a0028a28
28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}
{\phpg\posx1416\pvpg\posy2165\absw148\absh160 \f21 \fs17 \cf0 \f21 \fs17 \cf0 6.
\par
}
8. \par
}
\par
}
{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \f21 \fs17 \cf0 \f21 \fs17 \cf0 HA,
Rodwell VW, Mayes PA. penyunting. Biokimia;
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-209 \f21 \fs17 \cf0 edisi
17. Jakarta: EGC, 1974. h. 180-7.
Rosalind SG. Assessment of the status of folate and vita-
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-209 \f21 \fs17 \cf0 min B-
12. Dalam: Principles of nutritional assessment,
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-209 \f21 \fs17 \cf0 New
York, Oxford university press, 1990. h. 46-56.
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-210 \f21 \fs17 \cf0 Fomon
SJ. Infant nutrition. Edisi ke-2. Philadelphia:WB
Saunders, 1990. h. 233-4.
Lostpeich-Steinger CA. Anemias of abnormal nuclear
development. Dalam: Clinical hematology principle,
procedure, correlations, edisi ke-2, Philadephia,
Lippincott, 1998. h. 155-73.
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-209 \f21 \fs17 \cf0 Berry
JR, Li Z, Erickson JD, LiS, Moore CA, Wang H,
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-210 \f21 \fs17 \cf0 dkk.
Preventation of neural tube defects with folic acid
\par}{\phpg\posx1813\pvpg\posy1745\absw4199\absh2617 \sl-209 \f21 \fs17 \cf0 in
China. N Engl. J Med. 1999; 341:1485-90. \par
}
Besa EC, Catalono PM, Kant JA, Jerreries LC,
penyunting. Anermia associated with DNA synthesis.
Dalam: Hematology. Edisi ke-1. Baltimore: William &
Wilkins; 1992. h. 79-93.
\par}{\phpg\posx1416\pvpg\posy4685\absw4594\absh1860 \sl-209 \f21 \fs17 \cf0 11.
Pittiglio DH, Sacher RA, penyunting. Megaloblastic ane-
mias. Dalam: Clinical hematology and fundamentals of
hemostasis. Philadelphia, F.A Davis Co. 1987. h. 58-72.
Daly LE, Kirke PN, Molloy A, dkk,. Folate level and
neural tube defect. JAMA 1995; 274:1698-762.
RayburnWF, Stanley JR, Garret E. Periconceptional folete \par
}
{\phpg\posx6462\pvpg\posy1716\absw4593\absh4507 \f21 \fs17 \cf0 \fi396 \f21
\fs17 \cf0 intake and neutral defets. AJCN 1996; 15:121-5.
Brouwer IA. Folic acid, folate and homocysteine: Human
intervention studies, Thesis:1999. Dikutip dari Steeger.
Mills JL, Scott JM. Homocysteine and neural tube de-
fects, J Nutr 126; 1996:60s-75s.
Brattsrorn L. Vitamin as homocystein-lowering agets, J
Nutr 126; 1996:1276S-80S.
Hillman RS. Hematopietie agents. Dalam: Hardman JE,
Limbird LE, Milinoff PB, dkk,. Goodman & Gilman's
the pharmacological basis of therapeuties. Edisi ke-9,
New York. Mc Graw-Hill, 1996. h. 1326-36.
Mattews CK, Van Holde KE. Biochemistry. California:
Cummings Publishing Co, Inc, 1990: 693-9.
Kadir RA, Sabinc, Whitlow B, dkk. Neutral tube defect
and periconceptional folic acid in England and Wales:
retrospective study. Br Med J 1999; 319:92-3.
American Academy of Pediatrics. Folic acid for the preven-
tion of neutral tube defect. Pediatrics 1999; 104:325-7.
Committee on Genetics. Folic acid for preventation of
neural tube defets. Pediatrics 1993; 92:493-4.
The Centers for disease control and prevention. Knowl-
edge and use of folic acid by woman of childbearing.
Age united states, 1995 and 1998, JAMA 1999;
281:1883-4. \par
}
25 \par
}
}

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