• Download Anz Komik Apk

    Anz Komik adalah aplikasi baca komik gratis dengan lebih dari 1000 judul komik mulai dari Manga, Manhwa dan Manhua yang sudah dirilis dalam versi bahasa Indonesia.

  • Tujuan Pembentukan LBB

    Liga Bangsa-Bangsa beranggotakan 28 negara sekutu dan 14 negara netral. Tujuan pembentukan LBB pada waktu itu adalah untuk:

  • Daftar lagu soundtrack piala dunia (1990-2018)dan piala eropa (2000-2020)

    1.Gianna Nannini dan Edoardo Bennato-Un'estate (World Cup 1990) 1.1 We Are the Champions - Queen (World Cup 1994) 2.Ricky Martin - La Copa De La Vida (World Cup 1998)...

Rabu, 15 Mei 2019

Almost a Hero 3.1.5 Apk + Mod Money for Android

Almost a Hero 3.1.5 Apk + Mod Money for Android

Almost a Hero Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 3.1.5
  • File size: 67 MB
  • Memorize:

Offline

Almost a Hero

Almost A Hero is a incremental RPG clicker game where 10 of the most useless idiots embark on a quest to be slightly less useless idiots.

They say never give a loser an even chance. We say different.

Nine deeply unique and deeply flawed individuals have been chosen for greatness. Heroic, noble, enlightened… Just 3 of the many words they can’t spell. They will set off on an epic journey that will turn them from zeroes to almost heroes. Or dead people. More likely the latter.

Join these 9 zeroes on a quest to become heroes in an ancient land. Train them to learn battle skills, magical powers and which end of a sword is the business end.

In AaH you’ll find quests, secrets to unlock and there’s lots of clicking to do. Yup, it’s a clicker game. Have nearly got what it takes to become almost a hero?

Download Almost a Hero – RPG Clicker Heroes today!

WHAT’S NEW

• New ring at stage 1440: Darkness Ring!
• Two new mythical artifacts and a new max stage!
• You can now earn mythstones while offline
• Reach the endgame and obtain fame points!
• QoL and bug fixes
• Read the patch notes here: http://bit.ly/aah31notes

Setup:

  1. “APK” install it on your device.
  2. com.beesquare.almostahero” folder “android / obb” copy into.
  3. Enter the game.
Almost a Hero Apk

Download Now


Soccer Royale 2019 1.2.8 Apk for Android

Soccer Royale 2019 1.2.8 Apk for Android

Soccer Royale 2018 Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 1.2.8
  • File size: 168 MB
  • Memorize:

Online

Soccer Royale 2018

Ready to be a soccer star? Welcome to Soccer royale 2018, the ultimate football clash! In this amazing soccer card strategy game you will find the perfect mix between strategy and soccer games. Imagine be the coach and the player at the same time. Epic matches where you feel yourself like if you are in a battle.

The soccer stars are waiting for you. Choose your favourite clan and be the best player in the world.
Beat your opponents and reach the glory!

Soccer royale 2018, the ultimate football clash! It’s the perfect soccer and cards game. Imagine play soccer games with the Clash games style? This is a new concept of soccer games! Start to play now and prepare yourself for the FIFA Soccer World Cup 2018.

Plan every soccer match before go to the stadium. Prepare your soccer strategies and tactics to win every match. Choose your best soccer players and win every epic duel. All the top stars want to go to Russia 2018 and win the FIFA Soccer World Cup 2018. So play with all of them and decide who are the best soccer stars to defend the t-shirt of your team. Only the best clan of soccer stars could play in Russia 2018.

Every card give you a special power-ups that will allow you to defeat your opponent and win every football match and get the cup.

Play free and online (you’ll need internet connection to play) Soccer royale 2018, the ultimate football clash! Challenge your friends and opponents from around the world.

Do you want to be the manager of your favorite football team? Soccer royale 2018, the ultimate football clash! offers you that chance! This free-to-play game is completely renewed and contains all football competitions and clubs from all over the world.

Choose your club and manage everything: line-up, tactics, training, transfers and more!

Lead your clan to victory! Build a strong soccer team and crush your opponents! Earn trophies and climb the global ranking! Beat the enemy clans and defend your t-shirt! Use your cards to discover and unlock new powerful power-ups and tactics! Will you get one of the all the cards?

Play Soccer royale 2018, the ultimate football clash and collect and upgrade dozens of cards, tactics and skill. Knock the opponent soccer stars and win cups and Trophies, reaching the glory. Form a the best soccer clan to share cards and build your very own soccer community.

The tops stars of European and world football like Lionel Messi, Cristiano Ronaldo or Neymar are waiting for you in the best football card strategy game. The soccer stars of FC Barcelona, ​​Real Madrid or Manchester United will be your teammates outside and on the field. Jump on the field and show that you are the best!

SOCCER ROYALE 2018 FEATURES:

REAL-TIME MULTIPLAYER
Enjoy the multiplayer mode and face off against your friends anytime, anywhere. Enjoy heated matches against your friends and clinch the top spot! Keep up with real-world events.

SOCCER CARD STRATEGY GAME
Soccer royale 2018, the ultimate football clash! is the best football card strategy. In this free game you can enjoy the best features of the football games combined with the best game modes of card games such as Clash games.

BUILD & CUSTOMIZE YOUR TEAM
Acquire players through Scouts, Agents, or the Scout Auction. Choose the best players to fit your unique tactics. Every player is unique and every match is a new experience!Create your very own team and play right away!

POWER-UPS, TACTICS & STRATEGIES
Attack to win! Controller actions and gameplay have been optimized to make playing on your mobile device! Use power-ups and domine the controls for precise passing and controlled shooting. Master your technique and feel the excitement of scoring the winning goal!

JOIN A LEAGUE, CONQUER THE WORLD
Play, compete and win in the best leagues in the world. Go to the FIFA World Cup 2018 of Russia and come back with the world cup.

WHAT’S NEW

🥇Our players come off the bench after warming up and bring us a new update to offer you a great gaming experience! In this update you will find:🥇

⚽️ We’ve shortened the tutorial
⚽️ We have reduced the world ranking to 50 people. The player position no longer appears.
⚽️ Modifications in the offers system
⚽️ Fixed the bug to play with your facebook friends
⚽️ Other problems have been solved

Soccer Royale 2018 Apk

Download Now


Incredibox 0.3.8 So Far So Good Apk for Android

Incredibox 0.3.8 So Far So Good Apk for Android

Incredibox Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 0.3.8
  • File size: 45 MB
  • Memorize:

Offline

Incredibox

Incredibox is a musical game that helps you create a mix very easily by managing a band of beatboxers. Just drag and drop icons on the different characters and start creating music! Find the right combos during the game and unlock animated bonuses that will help you improve your mix.

Record your creation, then share it with your friends all over the world. If you get enough votes, you may join the Top 50 chart. Too lazy to create your own mix? No problem, just let the automatic mode play for you 😉

Express you musicality with Incredibox!
Pump it up and chill 😉

—————-
The first version of Incredibox was created in 2009 and got super positive feedbacks, including recognitions from Adobe newsletter, BBC Click, Yahoo news, The FWA and more. The online game has attracted more than 50M visitors since its creation. Enjoyed by music teachers, Incredibox is also used in schools to introduce rhythm to children.

WHAT’S NEW

• The app has been translated into 23 languages!
• Minor bug fixes
Incredibox Apk

Download Now


RollerCoaster Tycoon Touch 2.10.0 Apk + Mod Money + Data for Android

RollerCoaster Tycoon Touch 2.10.0 Apk + Mod Money + Data for Android

RollerCoaster Tycoon Touch Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 2.10.0
  • File size: 69 MB | 209 MB
  • Memorize:

Online & Offline

RollerCoaster Tycoon Touch

Create, customize and rule your theme park kingdom in RollerCoaster Tycoon® Touch™.

Building, managing and sharing your coolest park creations in beautiful 3D graphics has never been this fun or easy. Open card packs full of coasters, rides, decorations and more to build out your dream park. Complete missions and acquire more cards to upgrade your buildings, keeping your peeps happy and making more money for your park! An innovative, touch-control coaster builder allows you to effortlessly draw coasters, and combined with intuitive pathing and building placement, you can quickly start expressing your Tycoon creativity. Your dream park awaits!

Key Features:

• Card Packs: Create fun, wild and imaginative parks by collecting cards packs full of exciting rides and coasters. Level-up, complete Missions, or visit the Card Shop to collect new cards to get different coasters, rides, scenery and missions for your park.

• Coaster Builder & Track Editor: Easily draw wooden, hyper, iron and steel coasters, tracks, supports and stations with the user-friendly spline-based coaster and track editor.

• Park Attractions: Customize your dream park and delight guests by choosing from over 100 different flat rides, park decorations, paths, restaurants, shops, and more. All rides are beautifully rendered and animated in 3D!

• Park Management: Create a successful park by maintaining peep satisfaction levels on activities, park value, revenue, and park decorations, and track everything with the intuitive Park Management panel.

• Social Features: Share your park with friends and play socially with others during live events and coaster contests.

WHAT’S NEW

Company Value: Your Main Park Value, Water Park Value, and Medal Value will be combined to form your overall Company Value.
Info for Game Modes: Help buttons give more info about each game mode.
Collapsible HUD: Menus are collapsed by default, giving a better view of the park
New Scenario: The Small Marvel! Get a park with 100 Satisfaction using as few buildings as possible

Setup:

  1. “APK” install it on your device.
  2. com.atari.mobile.rctempire” folder “android / obb” copy into.
  3. Enter the game.
RollerCoaster Tycoon Touch Apk

Download Now


BAD 2 BAD: EXTINCTION 1.6.0 Apk + Mod Money for Android

BAD 2 BAD: EXTINCTION 1.6.0 Apk + Mod Money for Android

BAD 2 BAD: EXTINCTION Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 1.6.0
  • File size: 97 MB | 98 MB
  • Memorize:

Offline

BAD 2 BAD: EXTINCTION Mod

◆ Caution
Your data will be reset if you change your device or delete the game. Please login on the game and Save the game data before doing so.

◆ Features
– Interesting characters and stories
– Survival, open-world style
– A variety of character decorations and gun modifications
– 20+ playable characters
– 60+ weapons and armors based on real-life references
– Randomly generated maps and sub missions
– Form and grow your troops
– Futuristic combats using AI and drones.

Bad 2 Bad: Extinction Details
Bad 2 Bad: Extinction is a sequel of Bad 2 Bad: Delta, back with more stories and a variety of contents. Extinction covers the story after you defeat Gorat al-Llama’s terrorist organization, Al-Qatala, and discover humans behind them. Here, you will engage in a war against the Tailless Legion – humans – as the B2B Delta Team.

■ Introducing the 5 forces
In Bad 2 Bad: Extinction, a total of 5 different forces are introduced as your new enemy – zombies called Wilders(WD), Purebloods(PS), Underdogs(UD), Amazoness(AZ), and the Tailless Legion(TL). Each forces have their own characteristics and stories.

■ Struggle for Survival
While searching for your main target in the mission field full of Wilders to proceed with campaigns by force, you can also play the game with more freedom in randomly generated maps and clearing sub missions to collect items and/or get rewards.

■ Character and Firearm Customization
You can modify your gun and decorate your character as much as you want. More weapons, equipment, costumes, and more characters are coming soon.

■ Form Your Own Special Force
In Extinction, you can organize and grow your own unit. Each enemies have different attack patterns and characteristics. If you get stuck, try upgrading your equipment and changing the tactics.

■ Weapon Skills and Proficiency
In order to use weapons other than your main weapon effectively, you must learn the respective weapon skills. Learn the skill and increase the proficiency levels to get buffs such as increased attack power, less durability↓, reload speed up, and headshot accuracy.

■ Intensive Converging Fire & Drone Attacks
Use the Converging Fire and Drone(DR-6L) attacks effectively to overcome the crisis. Air Drone(DR-2A) doesn’t have an attacking feature, but it will difinitely come in handy.

WHAT’S NEW

+ Japanese added.
+ Chinese has been added.
+ Some UIs have been adjusted.
+ Added the ability to lock the control pad when turning off the semi-auto Control option.
+ Some Russian words(related to graphics options) have been changed.
BAD 2 BAD: EXTINCTION Apk

Download Now


Kritika The White Knights 3.5.4 Apk Data Game for Android

Kritika The White Knights 3.5.4 Apk Data Game for Android

Kritika The White Knights Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 3.5.4
  • File size: 82 MB + 456 MB
  • Memorize:

Online Game

Kritika The White Knights

FEEL THE RUSH! KRITIKA: The White Knights

Feel the adrenaline at your fingertips!

  • Play the most exhilarating action RPG that will keep you electrified!
  • Intense EX skills that jump off the screen! Call upon a friend’s Striker to help you dominate!

Meet the champions!

  • The Demon Blade: His sword slices through the battleground!
  • The Crimson Assassin: Cool as ice! The battlefield is her playground!
  • The Dark Valkyrie. She seduces with her chains and judges with her scythe!
  • The Berserker. Behold his rage as he destroys everything in sight!
  • The Cat Acrobat. Quick and agile, fall in love with her spunky fighting moves!
  • The Shadow Mage. His eerie shadow will ensnare and annihilate enemies!

Experience a game system like no other!

  • It’s more fun if you work together! Enjoy the new Guild system!
  • Pets that keep your side and make you stronger!
  • Grow stronger through 94 different stages in Stage Mode!
  • Encounter the Monster Wave! Attack an endless wave of monsters!
  • Climb and conquer the 70 floors of the Tower of Tribulation!
  • Test your skills in Arena, Versus, and Melee! Become the ultimate champion!
  • Work together to defeat powerful bosses in “World Boss”!
  • Use the Auto-Battle feature to clear stages more conveniently!

Minimum Device Requirement: Galaxy S3

WHAT’S NEW:

[v3.5 Update details]
– New Super Awakened Steam Walker
– Character Achievement System Raised to Level 15
– Raised Master Level
– Avatar Slot Enhance System Added

Setup:

  1. “APK” install it on your device.
  2. com.gamevil.kritikamobile.android.google.global.normal” folder “android / data” copy into.
  3. Enter the game.
  4. Additional data download into the game

Kritika The White Knights android

Kritika The White Knights apk

Download Now


Tags: download Kritika The White KnightsKritika The White Knights androidKritika The White Knights apkKritika The White Knights data

Basketball Stars 1.23.0 Apk + Mod for Android

Basketball Stars 1.23.0 Apk + Mod for Android

Basketball Stars Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 1.23.0
  • File size: 47 MB | 45 MB
  • Memorize:

Fast Level Up

Online

Basketball Stars

The world’s best multiplayer Basketball game on mobile, from the creators of multiple smash-hit online sports games!

Dribble, shoot, score, WIN! Grab the ball and take on the world with BASKETBALL STARS.

Play fast-paced, authentic 1v1 multiplayer basketball! Show your skills, moves and fakes to juke out your opponent and shoot for the basket! On defense, stay in the face of the attacker, steal the ball, and time your leaps to block their shots! All in REAL-TIME!

REALISTIC 3D GRAPHICS
Basketball on mobile has never looked this good: fully customisable 3D players and a variety of environments to play in!

COMPETE 1-ON-1 IN TWO AWESOME MULTIPLAYER GAME MODES
Test your duelling instincts in 1v1 Matches, or race to shoot hoops in time-based 1v1 Shootouts.

INCREDIBLE REWARDS AND HUNDREDS OF UNIQUE ITEMS
Playing like an all-star? Enter higher-ranked matches with bigger stakes, and unlock special basketballs and unique wearables to grow your power and style.

LEVEL UP
Start out on the Underdog court and play your way up to the top. Gain access to more exclusive courts and compete with the best Basketball Stars players out there!

KEY FEATURES

  • True 1-on-1 basketball gameplay
  • Realistic 3D graphics
  • 2 different online multiplayer game modes
  • Easy to pick-up, challenging to master
  • 400+ customisation items = thousands of unique looks!
  • 40+ unlockable basketballs
  • Dribble, feint, shoot, steal, block and get powerful bonuses off the backboard
  • Free to play!

— Download Basketball Stars by Miniclip NOW! —

This game requires an internet connection.

Don’t miss out on the latest news:
————————————
Find out more about Miniclip: http://www.miniclip.com
TERMS AND CONDITIONS: http://www.miniclip.com/terms-and-conditions
PRIVACY POLICY: http://www.miniclip.com/privacy

WHAT’S NEW

• Get Ready for Tournaments: King of the Court Cup begins on 10 May!
• Cool new items – show off your gear!
• Bug Fixes and Performance Improvements

 Note: Fast Level Up Mod

Basketball Stars Apk

Download Now


Hearthstone 14.2.30795 Apk + Mod Android

Hearthstone 14.2.30795 Apk + Mod Android

hearthstone heroes of warcraft android thumb

    by Rexdl · May 15, 2019

  • Current Version: 14.2.30795
  • File size: 37 MB
  • Memorize:

Online

Hearthstone Heroes of Warcraft APK + DATA for Android

Hearthstone: Heroes of Warcraft is an online collectible card game developed by Blizzard Entertainment. It is free-to-play withoptional purchases to acquire additional cards and access content quicker. The game was announced at the Penny Arcade Expo in March 2013 and released on March 11, 2014. Hearthstone is available on Microsoft Windows and OS X systems and on Windows 8,iOS and Android touchscreen devices. New content for the game involves the addition of new card sets and gameplay, taking the form of either expansion packs or single-player adventures that reward the player with collectible cards upon completion.

In early May 2015, there were more than 30 million registered Hearthstone accounts.

DECEPTIVELY SIMPLE. INSANELY FUN.

Pick up your cards and throw down the gauntlet! In Hearthstone, you play the hero in a fast-paced, whimsical card game of cunning strategy. In minutes, you’ll be unleashing powerful cards to sling spells, summon minions, and seize control of an ever-shifting battlefield. Whether it’s your first card game or you’re an experienced pro, the depth and charm of Hearthstone will draw you in.

JUMP RIGHT IN: Fun introductory missions bring you into the world of Hearthstone’s intuitive gameplay.

BUILD YOUR DECK: With hundreds of additional cards to win and craft – your collection grows with you.

HONE YOUR SKILLS: Play in practice matches against computer-controlled heroes of the Warcraft universe. Thrall, Uther, Gul’dan – they’re all here!

COLLECTION TRAVELS WITH YOU: Your card collection is linked to your Battle.net account – enabling you to switch your play between tablet and desktop with ease.

AND FIGHT FOR GLORY: When you’re ready, step into the Arena and duel other players for the chance to win awesome prizes!
Post feedback about the game in our forums:
http://us.battle.net/hearthstone/en/forum/13619661/

Languages Supported:

  • English
  • Français
  • Deutsch
  • Español (Latinoamérica)
  • Español (Europa)
  • Italiano
  • Português
  • Polski
  • Русский
  • 한국어 (Korean)
  • 简体中文 (Simplified Chinese)
  • 繁體中文 (Traditional Chinese)

©2015 Blizzard Entertainment, Inc. All rights reserved. Hearthstone and Heroes of Warcraft are trademarks, and Battle.net and Blizzard Entertainment are trademarks or registered trademarks of Blizzard Entertainment, Inc., in the U.S., and/or other countries.

WHAT’S NEW

THE DALARAN HEIST – AVAILABLE MAY 16 – Experience the largest Solo Adventure yet. More cards, more customization, and more ways to experience hijinks in Dalaran!

GET STARTED FOR FREE – The first chapter of The Dalaran Heist will be available to everyone – for free!

UNLOCK A GOLDEN LEGENDARY – Add the Legendary Zayle, Shadow Cloak card to your collection when you own all five chapters of The Dalaran Heist.

For full patch notes visit www.playhearthstone.com

Setup:

  1. “APK” install it on your device.
  2. Enter the game.

Download Now


Garena Contra: Return 1.13.58.0113 Apk + Mod + Data for Android

Garena Contra: Return 1.13.58.0113 Apk + Mod + Data for Android

Garena Contra: Return Android thumb

    by Rexdl · May 15, 2019

  • Current Version: 1.13.58.0113
  • File size: 34 MB + 1.07 GB
  • Memorize:

Online

Garena Contra: Return

Remember the secret code, Up Up Down Down Left Right Left Right BA?

Contra is back! Together with KONAMI and Tencent Timi Studio Group, Garena has released the classic sequel, “Contra: Return!”

“Contra: Return” retains the side-scrolling shooter action gameplay, along with duo mode and additional new features. Defeat ultimate bosses and relive arcade glories.

With new action packed gameplay and HD high-definition graphics, 3D character, vivid sound and animation effects, you are in for an extraordinary experience! Unleash the warrior in you! Choose from an arsenal of heroes and weapons and challenge yourself in PVP instant battles, team modes and face our ultimate challenge, Underwater 8!

Join our legendary heroes Bill and Lance in their fight against menacing aliens and together, we shall save the world!

– Challenge a New Classic
Licensed by KONAMI, the classic sequel Contra: Return is back!

– Team up with friends in DUO mode
Gather your friends and conquer the world of Contra!

– Battle for Victory
Whether it’s, 1v1, 3v3 or ultimate championship, experience the most thrilling, balanced gameplay with our quick 3s matchmaking system

– Multiple Game Modes
Underwater 8, BOSS Challenge, One Life Mode, to give you a never before seen gaming experience!

– Hundreds of Weapons , Customise your playstyle
Customise your weapon and conquer the battlefield, unlock special skills with different hero combinations!

Setup:

  1. “APK” install it on your device.
  2. com.garena.game.hdltw” folder “android / obb” copy into.
  3. Enter the game.

Garena Contra: Return Apk

Download Now


Hemoglobin: Fungsi, Nilai Normal, Nilai Tidak Normal

Jangan lupa membaca artikel tentang bisnis di > Informasi bisnis terbaik 2020.

hemoglobin-doktersehat

DokterSehat.Com – Hemoglobin (Hb) adalah salah satu komponen paling penting dalam darah. Terlalu tinggi atau terlalu rendahnya kadar hemoglobin seseorang dapat mengindikasikan suatu kondisi kelainan dalam darah.  Dalam artikel ini pula Anda juga akan diajak mengenal lebih jauh apa yang dimaksud dengan hemoglobin, nilai normal, serta bagaimana cara mengukur nilai normal hemoglobin?

Apa Itu Hemoglobin?

Hemoglobin adalah protein dengan kandungan zat besi yang ditemukan di dalam sel darah merah. Keberadaan hemoglobin ini lah yang memberikan ciri khas warna merah pada sel darah (eritrosit). Beberapa penyakit atau kondisi tertentu yang memengaruhi sel darah merah dapat berakibat pada hemoglobin.

Umumnya tingkat hemoglobin juga akan meningkat ketika jumlah sel darah merah meningkat. Begitu juga sebaliknya, jika jumlah sel darah merah menurun, maka kadar hemoglobin umumnya juga akan menurun dan hal ini bisa diakibatkan oleh beberapa kondisi tertentu.

Fungsi Hemoglobin

Fungsi hemoglobin yang paling utama adalah sebagai transportasi oksigen dari paru-paru ke seluruh jaringan dan organ di seluruh tubuh, yang dimana  fungsi oksigen sendiri sangat besar peranannya untuk proses metabolisme. Hemoglobin juga membantu sebagian kecil transportasi dari karbon dioksida dan hasil metabolisme tubuh yang nantinya akan dibuang saat kita mengeluarkan nafas.

Berikut adalah penjelasan tentang fungsi hemoglobin:

1. Memberikan warna merah pada darah

Telah disingging sebelumnya fungsi hemoglobin adalah memberikan warna merah pada sel darah (eritrosit).

Hemoglobin terdiri dari empat rantai asam amino. Masing-masing rantai terbuat dari 141-146 asam amino. Setiap rantai asam amino memiliki kandungan heme. Heme ini lah yang merupakan molekul yang tanggung jawab memberikan warna merah pada darah.

2. Mengikat dan mengangkut oksigen

Fungsi hemoglobin yang paling utama dan paling penting di dalam darah adalah mengikat dan mengangkut oksigen ke seluruh tubuh. Hemoglobin akan mengikat oksigen dari kapiler di paru-paru, kemudian mengangkut dan menyebarkannya ke semua jaringan dan organ dalam tubuh.

3. Mengangkut karbon dioksida dan molekul lainnya

Selain berfungsi untuk mengangkut oksigen, hemoglobin juga berperan dalam pengangkutan karbon dioksida dari jaringan dan organ tubuh menuju ke paru-paru, lalu dikeluarkan saat kita menghembuskan nafas.

Nilai Normal Hemoglobin

Tes hemoglobin dilakukan untuk mengetahui kadar hemoglobin. Tingkat hemoglobin dapat dihitung sendiri atau dengan mengetahui hematokrit atau persentase volume sel darah merah dalam darah. Selain itu dapat juga diketahui saat melakukan tes darah lengkap atau complete blood count (CBC).

Sampel darah untuk tes hemoglobin biasanya diambil dari pembuluh darah vena di lengan atau pembuluh kapiler di ujung jari. Hal ini berlaku untuk anak-anak maupun orang dewasa. Sedangkan untuk bayi yang baru lahir, sampel darah bisa diambil dari bagian tumit.

Nilai hemoglobin normal dapat berbeda pada setiap orang dipengaruhi dengan usia, jenis kelamin, dan kondisi kesehatannya. Berikut adalah nilai normal hemoglobin:

  • Anak usia 0,5 hingga 4 tahun: 11 g/dL atau lebih
  • Anak usia 5-12 tahun: 11,5 g/dL
  • Pria dewasa: 13,5-17,5 g/dL
  • Wanita dewasa: 12,0-15,5 g/dL
  • Wanita hamil: 11,0 g/dl atau lebih

Setiap laboratorium dapat memiliki rentang nilai normal hemoglobin yang berbeda-beda, namun umumnya angkanya tidak akan berjauhan.

Nilai Tidak Normal Hemoglobin

Jika kadar hemoglobin seseorang terlalu tinggi atau terlalu rendah, hal tersebut menandakan adanya masalah pada sel darah merah (eritrosit). Ketika nilai hemoglobin tinggi, kondisi ini disebut dengan polisitemia, namun polisitemia ini biasanya juga disertai peningkatan nilai trombosit dan leukosit. Sebaliknya, jika nilai hemoglobin rendah, maka disebut sebagai anemia.

A. Nilai hemoglobin terlalu tinggi

Nilai hemoglobin terlalu tinggi disebabkan oleh peningkatan jumlah eritrosit atau sel darah merah. Kondisi ini termasuk ke dalam kondisi yang jarang terjadi. Penyebab hemoglobin tinggi yang paling umum disebabkan oleh kondisi seperti sebagai berikut ini:

1. Penyakit paru-paru

Penyebab polisitemia yang pertama adalah penyakit paru-paru.

Penyakit paru-paru dapat menyebabkan seseorang kesulitan menghirup dan menyerap oksigen dalam jumlah normal yang dibutuhkan tubuh. Akibat kondisi ini, tubuh mencoba menggantikannya dengan memproduksi sel darah merah lebih banyak.

2. Penyakit jantung bawaan

Terdapat beberapa bentuk penyakit jantung yang disebabkan oleh hubungan abnormal antara kedua sisi jantung.

Kondisi ini menyebabkan berkurangnya kadar oksigen dalam darah. Sama halnya seperti kasus pertama, tubuh juga berusaha memperbaiki kondisi penurunan kadar oksigen ini dengan memperbanyak produksi sel darah merah.

3. Polisitemia vera

Polisitemia vera adalah kelainan pada sumsum tulang tempat produksi sel darah sehingga menyebabkan produksi sel darah merah tidak terkontrol.

Kondisi ini tidak umum dan biasanya berkembang perlahan. Kondisi ini tidak hanya didiagnosis melalui tes hemoglobin, tapi juga tes hematokrit. Selain pemeriksaan darah, dibutuhkan juga aspirasi atau biopsi sumsum tulang untuk memastikan kondisi ini.

Selain kondisi di atas, kondisi lain yang menyebabkan nilai hemoglobin tinggi adalah seperti dehidrasi, merokok, tumor ginjal, hidup di tempat tinggi, dan penyebab genetik.

B. Nilai hemoglobin terlalu rendah

Nilai hemoglobin rendah umumnya juga ditunjukkan dengan nilai sel darah merah dan hematokrit rendah. Kondisi ini disebut dengan anemia. Kondisi yang bisa menyebabkan nilai hemoglobin rendah adalah seperti berikut ini:

1. Kehilangan banyak darah

Kadar hemoglobin rendah bisa disebabkan oleh tubuh kehilangan banyak darah.

Kondisi ini bisa disebabkan oleh trauma parah atau pendarahan kronis pada bagian tubuh tertentu seperti:

  • Saluran pencernaan (akibat polip, radang perut kanker usus besar).
  • Kandung kemih
  • Rahim (pendarahan menstruasi berat)

2. Kekurangan nutrisi tertentu

Terdapat beberapa jenis jenis anemia yang disebabkan oleh kekurangan nutrisi tertentu. Anemia tersebut antara lain seperti anemia defisiensi zat besi, anemia defisiensi asam folat, dan anemia defisiensi vitamin B12.

3. Hancurnya sel darah merah secara berlebihan

Hancurnya sel darah merah secara berlebihan dapat menyebabkan kadar hemoglobin rendah.

Penyebab hancurnya sel darah merah secara berlebihan termasuk anemia hemolitik, anemia sel sabit, defisiensi G6PD, dan penyebab lainnya.

4. Talasemia

Talasemia adalah kelainan darah  di mana produksi hemoglobin kurang dari jumlah normal. Kondisi ini disebabkan oleh faktor genetik.

5. Gangguan sumsum tulang belakang

Penyebab nilai hemoglobin tinggi lainnya adalah akibat adanya masalah pada sumsum tulang belakang.

Gangguan sumsum tulang belakang dapat berupa anemia aplastik, myelodysplastic syndrome, kanker yang menyerang sumsum (leukimia, limfoma, multiple myeloma, dll). Kerusakan sumsum juga bisa diakibatkan oleh racun, radiasi seperti kemoterapi, infeksi, hingga efek obat-obatan.

6. Penyakit atau radang kronis

Penyakit atau radang kronis seperti gagal ginjal juga bisa menyebabkan nilai hemoglobin menurun.

Gagal ginjal dapat menyebabkan penurunan produksi erythropoietin, hormone yang merangsang produksi sel darah merah oleh sumsum tulang. Hormon ini diproduksi oleh ginjal.

Sama halnya untuk mendeteksi kondisi yang menyebabkan nilai hemoglobin tinggi, beberapa kondisi penyebab hemoglobin rendah juga membutuhkan pemeriksaan lain selain tes hemoglobin untuk memastikannya.

 

Informasi kesehatan ini telah ditinjau oleh dr. Antonius Hapindra Kasim

 

Sumber:

  1. Hemoglobin Levels – https://ada.com/hemoglobin-levels/ diakses 20 Maret 2019
  2. Hemoglobin – https://labtestsonline.org/tests/hemoglobin diakses 20 Maret 2019


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