Elderly (elderly) according to the World Health Organization (WHO) in 2017, is someone who

has entered the age of 60 years and over. Research on age-related changes is an area of interest and

importance in recent times. The elderly often complain of pain, pain is an unpleasant sensory and

emotional experience associated with actual or potential tissue damage. (Kemenkes, 2017).

One of the most common pain complaints by the elderly is bone pain. Various conditions or

diseases can cause bone pain in the elderly, including: osteoporosis, osteomalacia, renal

osteodystrophy, osteonecrosis, malignancy or bone metastases. Measuring the degree of pain can use

the Numeric Rating Scale (NRS) in adults (elderly). The NRS scale starts from a scale of 1 – 10,

which consists of categories of mild, moderate and severe pain. Mild pain is pain that comes and goes,

were only discovered after appearing in the Monoclonal Gammopathy of Underterminated

Significance (MGUS) stage, which is a disorder that occurs due to plasma cell dyscrasias and is

known as one of the precursor tumors of MM. Clinical signs and symptoms of MM are known as

CRAB, which stands for Hyper-Calcemia (hypercalcemia), Renal failure (kidney failure), Anemia,

Bone pain with lytic lesions (bone pain with lytic lesions) (Malanga, Yan, & Stark, 2015).

advantages and disadvantages. Malignancy in MM patients can cause anemia. According to WHO,

the elderly are said to be anemic if the hemoglobin value is less than 12 g/dL in women and less than

13 g/dL in men. There was 85.3% anemia in MM and required transfusion. Anemia in MM patients is

caused by bone marrow replacement and direct inhibition of the erythropoiesis process, this change

causes a decrease in the production of vitamin B12 and folic acid.

Scattergram is the result of a plot of data that comes from the results of the scatter light that

passes through a cell. Forward Scattered lights (FSL) reflect cell size, Side Scattered lights (SSC)

reflect cell complexity, Fluorescent light (SFL) reflect total nucleic acid content and cell organelles.

These three signals are used for differentiation and counting of white blood cells, NRBC,

reticulocytes, and PLT-F, as well as detecting abnormal cells and immature cells with the help of

smaller size of lymphocytes compared to other types of leukocytes and their wavelength is 380 – 488

nm, which is at FL1 (Briggs, Longair, Kumar, Singh, & Machin, 2012) (Xu, Yu, Xie, Chen, & Zhang,

2017).

White blood cell differential (WDF) is a channel on the hematology analyzer found on the

Sysmex XN-series device. WDF can read leukocytes such as basophils, eosinophils, neutrophils,

lymphocytes and monocytes, using specific reagents containing detergent (lysercell WDF) and

fluorescent staining (fluorocell WDF). The use of WDF lysercell reagent is to lyse erythrocytes and

platelets, perforating the leukocyte membrane, which will cause external and internal structural

changes depending on the type of leukocyte. While the WDF fluorocell will stain the nucleic acid and

cytoplasmic organelles of leukocytes. In this WDF, there is a separation between monocytes and

and its contents (eg granules); while the Y or vertical axis is referred to as Side-Fluorescence Light

(SFL) which provides information about the amount of nucleic acid content possessed by cells

(Stiel et al., 2016).

The scattergram examination needs to be confirmed again by flowcytometry. T cells were

confirmed by the presence of CD4 and CD8, in the elderly the CD4 and CD8 values decreased, cell

memory increased, activation in the elderly decreased, oligoclonal dominance increased, and cytokine

production and effector generation decreased. In the aging process, slow changes and a long life span

of naive T cells can be maintained, but gradual involution of the thymus results in an inability to

replace naive T cells lost from the circulation. In addition, aging is also associated with decreased

function of naive T cells. Compared with young mice, 40% of CD8+CD28+ naive T cells in old mice

did not express CD62L and CCR7, receptors that play a role in migration to peripheral lymphatic

stromal cells. The number of B cells (CD19+) also decreases with advancing age. The proportion of

IgG-IgA-IgD+CD27-decreased with age and showed decreased susceptibility. B cells on flow

cytometry examination were confirmed by CD45+, CD3+, CD56+, CD16+ and in the elderly it

increased (Keim, Hao, Dayal, Janetzko, & Bak, 2010).

cell maturation is in the thymus. T cells are very important in lymphocytes to kill bacteria and help

other cell types in the immune system. As we age, many T cells or T lymphocytes lose their function

and ability to fight disease. The number of T cells will decrease with age so that the body is less able

to control disease compared to previous times. In addition, the aging process is also associated with a

decrease in the function of naive T cells. Compared with young mice, 40% of CD8+CD28+ naive T

In using the scattergram we can find the advantages and disadvantages, as for the advantages of

the scattergram, among others; 1). Clear data range, minimum and maximum points can be seen. 2).

The data displayed is accurate because it uses dots. 3). Can display positive and negative

relationships. 4). Graphics are easy to explain and view. 5). Easy method of graphing. Disadvantages

in using scattergram: 1). Cannot display relations that use more than 2 variables. 2). The amount of

data that can be observed is limited, because if you display a lot of data it will not be clear. 3). It is

difficult to accommodate data that uses decimal values. 4). Can only use variables whose data is

quantitative. 5). Cannot accommodate external data. 6). There is no object criteria for selecting the

best line (Seghezzi et al., 2018).

Pancione, & Rocco, 2016)

Profil scattegram limfosit dapat juga ditemukan pada berbagai keadaan, seperti untuk membantu

menentukan keadaan inflamasi dengan lebih lebih cepat dengan mengunakan parameter RE-LYMP

(Reactive Lymphocytes) dan AS-LYMP (Antibody-Synthesiszing Lymphocytes) mampu memberikan

penilaian mengenai limfosit teraktivasi. Parameter ini mampu membantu klinisi untuk mendiagnosis,

Lymphocyte scattegram profile can also be found in various circumstances, such as to help

determine the state of inflammation more quickly by using the RE-LYMP (Reactive Lymphocytes)

and AS-LYMP (Antibody-Synthesiszing Lymphocytes) parameters which can provide an assessment

of activated lymphocytes. These parameters can help clinicians to diagnose, provide therapy, and

parameter describes the entire lymphocyte population that has a high fluorescence intensity which

indicates the presence of a reactive lymphocyte population (Kawauchi, Takagi, Kono, Wada, &

Morikawa, 2014).

AS-LYMP parameters provide an overview of activated B lymphocytes (plasma cells) which

profile A SSC (A2, A3); SFL (B2, C2, D3). 3).On profile B SSC (A2, A3); SFL (B2, C2, D3, E3).

thereby suppresses its ability to perform bone resorption, RANKL, RANK, and OPG have a close

relationship with TNF and its receptors. If this is disturbed between osteoblasts and osteoclasts, it can

cause disturbances in the sensory nerve fibers of the bone and the nocireceptors in the bone, which are

located in the central nervous system, which causes pain in the bones. (Briggs et al., 2012)

(Longanbach, Miers, Keohane, Smith, & Walenga, 2016).

Based on the WDF lymphocyte scattegram profile in elderly subjects with bone pain and anemia,

the most WDF lymphocyte scattegram profiles were in the SSC (A2, A3), SFL (B2, C2, D3, E3)

areas, this is in accordance with research conducted by David et al, scattergram of WDF lymphocytes

with a predominantly violet color in the lymphocyte area and spread to areas suspected of increasing

the number of atypical lymphocytes and suspected towards plasma cells and abnormal lymphocytes,

high fluorescence intensity which indicates the presence of a reactive lymphocyte population. AS-

LYMP parameters in the elderly show low levels, because the production of B cell antibodies has

decreased, the combination of RE-LYMP and AS-LYMP parameters in the elderly is able to provide