CLINICAL CONFERENCE

HEMATOLOGY ONCOLOGY DIVISION

(New Case)
January 22nd, 2023
Dhody Setiamal/ Junior Divisi
Hardiyanti/ Madya Divisi
Viqa Faiqah, Cut Wirdatussa’adah, Syahrurrahman, Dina Fadhilah Monika
/ Senior Divisi
 PATIENT IDENTITY
M.R.D 12 years old (male)
MR Number 1006878
Date of Birth Dec 08th, 2011
Admission Date January 22, 2023

MEDICAL DIAGNOSIS

Aplastic anemia + Trombositopenia + Mild neutropenia

 Chief Complaint HISTORY TAKING
Pale
History of Present Illness
A boy 11 years old referred from toto kibala Hospital with diagnosis
pansitopenia et causa aplastic anemia differential diagnosis leukemia
The boy admitted to hospital with pale since 3 month ago before admitted to
hospital.
no fever, No seizures.
No cough, no shortness of breath
good appetite
Defecation: normal, yellow
Urination: normal, yellow
 HISTORY TAKING
History of Past Illness
- There was history of frequent fever 2 months ago
- There history of bleeding gums 1 month ago.
- There was no epistaxis, reddish urine and melena
- There was No history of joint pain
- History of weight loss is not noticed
- There was no family history of malignancy.
- History of living near rice fields.
- There was history of being treated 7 days 3 weeks ago at Totto kibala hospital and
received ,packed red cell/intravena 3 bags and Trombosit/intravena 9 bags
 PHYSICAL EXAMINATION
History of Vaccine
Frequency
Vaccine Not given 0 1 2 3 4

Hep B V
BCG V
DPT V
Hib V
OPV V
MMR V
Rotavirus √
Influenza √
Japanese Encephalitis √
PCV √
Varicella √
Hepatitis A √
Tifoid √

Vital Sign
General condition: moderate illness/
Wasted/GCS 15 (E4M6V5)
Blood pressure : 100/60mmhg
Heart Rate : 80 times/min
Temperature: 37,0°C
Respiration Rate : 20 times/min
SpO2 : 99 %
Pain Scale : 0 NRS
PHYSICAL EXAMINATION
Antropomethry
Body weight : 25kg
Length : 130 cm
Head circumference: 55 cm ( Normal 50-57 cm)
Anthropometry:
Weight for heigth: 25/30 x100%= 83% (Wasted)
Weight for age: 25/40 x100%= 62,5% (underweight)
Height for Age: 136/144 x100% = 94% ( normal stature)
Head circumference: 51 cm ( Normal 50-57 cm)
Weight for heigth: 25/30 x100%= 83% (Wasted)
Weight for age: 25/40 x100%= 62,5%
(underweight)
Height for Age: 136/144 x100% = 94% ( normal
stature)
 PHYSICAL EXAMINATION
There was pale. No icterus
No stomatitis Genitalia
Pharynx not Hyperemesis Palpable 2 testicles inside the scrotum size 3x2x2 cm
Tonsil T1-T1 not hyperemis
There was no Lymphadenopathy Extremities
Pulmo Warm acral, , CRT < 3 detik
Vesicular breath sounds.
No rhonki no wheezing.
Manifestations of spontaneous bleeding : pettekie
at face,gumbs and ekstremitas superior inferior
Cardiovascular
Rumpleede test: positif
I / II heart sound, Regular rhythm
Bleeding time (ivy metode) : 8 menit 30 second
no murmur

Abdomen
Peristalsis was normal,
Hepar and spleen not palpable
 LABORATORY FINDING
Toto kibala Toto kibala Wahidin
Laboratory Normal Value
03/01/23 05/01/23 22/01/23

Hb 4,9 9,3 7,8 12.0 – 16.0 gr/dL

WBC 4.000 4.340 3900 4.0 – 10.0/μL
ANC 1276 954 1185 >2000
PLT 21.000 26.000 3.000 150.000 – 400.000/mm3
MCV 84,7 76,6 76 80 -100 μm3
MCH 29,2 26 28 27 - 32 Pg
%NEUT 31,9 22 30,4 52 – 75 103/μL
%LYMPH 59,4 68,5 59 20 – 40 103/μL
%MONO 8,7 9,5 8,8 2 – 8 103/μL
Ret - - 0,52 0,5 – 1 /μL
 Wahidin
Laboratory 22/01/23
Normal Value

GDS 131 140 gr/dl

Ureum 25 10 - 50 mg/dl

Creatinine 0,53 <1.3 mg/dl

SGOT 36 < 38 u/l
SGPT 30 < 41 u/l
Albumin 4,5 3.5 – 5.0 mg/dl
136-145
Natrium 138

Kalium 3,8 3,5-5,1

Clorida 106 97-111
 LABORATORY FINDING
Peripheral Blood Smear of Toto kibala Hospital 5/1/2023

Erythrocytes: Normochrome (+), Hypochrome (+), Normocytes (++) microcytes (+),

Polychromasia (+), teardrop cells (+), Burr cells (+), pencil cells (-)
Leukocytes: reduced number, morphology within normal limits
Platelets: decreased number, aggregation (-)

Impression:
-Pancytopenia et causa suspected aplastic anemia dd/leukaemia

Peripheral Blood Smear of Wahidin Hospital 24/1/2023

Eritrosit: Normositik normokrom,anisositosis, ovalosit (+)

Leukosit: decreased, PMN>Limfosit,nomal morphology, young cell (-)
Trombosit: decreased, normal morphology

Impression:
Pansitopenia suspeck aplastic anemia
Bone marrow puncture Wahidin Hospital 25/01/2023:
Impresion: Aplasctic anemia
 ASSESMENT
1. Aplastic anemia
2. Trombositopenia
3. Mild Neutropenia
 TREATMENT
- Infusion Dextrose 5%
- Packed red cell trasnsfusion 170cc/intravena
- observed for tissue anoxia
- Trombosit transfusion 10 unit/12 hours/intravena
- observed spontaneous bleeding
- Sandimun/oral

Planning:
- Immunophenotyping
Planning
THANK YOU