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Daftar Ketrampilan Klinis (SKDI 2012)Kedokteran Forensik & MedikolegalNo Keterampilan Tingkat Keterampilan
1 Prosedur medikolegal 4A
2 Pembuatan Visum et Repertum 4A
3 Pembuatan surat keterangan medis 4A
4 Penerbitan sertifikat kematian 4A
5 Pemeriksaan selaput dara 3
6 Pemeriksaan anus 4A
7 Deskripsi luka 4A
8 Pemeriksaan derajat luka 4A
9 Pemeriksaan luar korban mati 4A
10 Pengambilan sampel vaginal swab, buccal swab,
4A
darah, urine, dan isi lambung
11 Pemeriksaan bercak darah, cairan mani, dan sperma
3
12 Fotografi forensik 3
Forensic Analysis of Blood
1. Visual examination of evidence
2. Presumptive screening test (Is it blood?)
3. Confirmation test (Seriously, is it blood?)
4. Determine species origin (human blood?)
5. Identify the blood (whose blood is it?)
Serology Test
Species Origin (1)
Most methods test for serum proteins Serum proteins are found in all animals,
but are slightly different Species ID methods based on antigen-
antibody interactions
Species Origin (2)
Antigen = Serum Protein Antibody = Produced when
foreign serum protein is detected
Certain antibody will only attach to one species’s serum protein
Methods
1. Ring Precipitin Test (Uhlenhut)
2. Ouchterlony Double Diffusion
3. Crossed-Over Electrophoresis
4. BM Test Colon Albumin (Sudiono S)
Antiserum in heavy bottom layer
Blood sample (dilute) in top layer
Ring Precipitin Test (2)
Antiserum in heavy bottom layer
Blood sample (dilute) in top layer Precipitate means blood &
antiserum species match
Ring Precipitin Test (2)
Antiserum placed in center Several bloodstains tested at one time
White line means antiserum and blood match
Humanantiserum
Human blood
Not human blood
Ouchterlony Double Diffusion
Antiserum and Blood move toward each other
Antiserum Blood Stain
Gel
Holes
Crossed-Over Electrophoresis
Antiserum and Blood move toward each other
Antiserum Blood Stain
If line forms, antiserum and blood match
Crossed-Over Electrophoresis
Identify The Blood
If a stain is blood, and it is human blood, then whose is it?
1. Blood Group Markers
2. Protein / Enzyme Markers
3. DNA
Blood Group Markers
• Erythrocyte surface antigen– ABO, MNS, Rhesus, Duffy, Kell, Kidd, etc
• Protein serum system– Gm, Gc, Haptoprotein, etc
• Erythrocyte enzyme system – PGM, AK, ADA, PCE, EAP, GPT, 6-GPD, etc
• Leucocytes antigen – HLA
• Others– Secretor/non secretor, platelets antigen
ABO Markers (1)
Antigens on RBC are glycoproteins and are attached to the outside of the cell
Testing is similar to species test An anti-A, anti-B, or anti-AB antiserum
(containing antibodies) is reacted with the blood stain to detect blood cells
A, B, or AB blood cells are reacted with a blood stain to detect antibodies
Tests can get complicated with absorbing and releasing cells
Final step is usually testing for agglutination
ABO Markers (3)
Tahap 1
Pemberian antiserum.
Antibodi berikatan dengan
antigen spesifik.
Tahap 2
Kelebihan antibodi dihilangkan
dengan pencucian.
Tahap 3
Antibodi dan antigen mengalami
elusi atau dibebaskan satu dengan
yang lainnya dengan pemanasan.
Tahap 4
Terjadi aglutinasi jika antigen
yang terdapat pada eritrosit tambahan
sama dengan sebelumnya.
Gambar 5. Metode absorpsi-elusi
Tambahkan eritrosit yang telah dikenali
Indirect Test(Absorption Elution)
Some protein or enzymes can be in different forms (different shapes)
These differences can be detected by separating the protein in a gel by electrophoresis
Protein or Enzyme Markers (1)
• Charge makes proteins move through gel
• Different shapes move at different rates
• After several minutes, their location will tell what type they are.
+
-
Ladder Type 1 Type 2 Type 3
Protein or Enzyme Markers (2)
Another Uses of Forensic Serology
Paternity Cases:• The babies get accidently exchanged • Kidnapped baby• Man suspected as biologic father• Husband confuse about the baby• Disputed paternity
– Mendel Law– Paternity exclusion
Blood TypeAntigen
(Blood Group)Antibody % Population
A A Anti-B 40
B B Anti-A 10
AB A & B None 5
O H Anti-A & Anti-B
45
Percentage of Blood Types
Blood Group Markers Probability (%)
RBC Antigen
MNS 32.1
Rhesus 28.0
Kidd 19.0
Duffy 18.0
ABO 17.6
Kell 3.3
Lutheran 3.3
Protein Serum
Gc 24.7
Hp 17.5
Glm 6.5
Km 6.0
RBC Enzyme
PGM 25.3
EAP 21.0
GPT 19.0
Glyoxalase 18.4
Esterase D 9.0
AK 4.5
ADA 4.5
HLA 94.0
Combination of all 99.7
Rape• Serological evidence is crucial • Forceful physical contact Transfer
of evidence:– Blood– Semen– Perspiration– Urine– Hair– Nail
Semen
Consist of:
1. Sperm cells
2. Seminal Fluid Protein Rich Bodily Fluid
Serology Tests for Semen are:
a. Acid Phosphatase Test
b. Prostate Specific Antigen (p30)
Acid Phosphatase Test
“Adam & Wraxall” Gel Electrophoresis:
1. Polyacrylamide Gel
2. Buffer pH 8,5
3. Substrate: 4-methylumbelliferyl phosphate
4. Result: Seminal Acid Phosphatase ANODA Vaginal Acid Phosphatase KATODA
Results
Invalid Results
Research
Year Researcher Rapid Test Sen Spe PPV NPV Time
2004 Khaldi, et al PSA Check-1 99.4 98 99.4 98 48 h
2007 Peonim, et al One-Step PSA 85 85 89 79 -
2009 Hobbs, et al ABA-Card 100 96 - - -
2009 Laux, et al Seratec - - - - 72–96 h
2013 Peonim, et al InTec Products 80.4 92.3 77.6 93.5 -
If Semen, Whom Does it Belong to?
• Blood Group Type– Secretor : ABO, Lewis Blood Typing– Methods: Absorption Inhibition
• DNA : [email protected]
ABO blood typing and protein analysis may help eliminate a suspect (exclusion)
Since there are only a small number of types (ABO = 4 types), a match does not mean the stain definitely came from a certain person
DNA testing is very specific, thus it can identify a person, and is becoming just as easy as the above tests
Genetic Markers in Blood / Semen
