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Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.

Introduction. The complete hematologic response is an integral part to achieve the complete cytogenetic response target and the major molecular response of imatinib mesylate therapy, although it does not determine the prognosis. The complete hematologic response in Indonesia is lower than in the world (74% vs. 95%). Sixty percent of chronic myeloid leukemia patients in Indonesia were administered hydroxyurea before imatinib mesylate. Chronic myeloid leukaemia (CML) patients in Indonesia are younger than in other countries. This study aimed to determine what prognostic factors which affect the complete hematological response of chronic phase CML patients who received imatinib mesylate in Indonesia. Methods. The study was done by retrospective cohort design using the medical records data of chronic myeloid leukemia patients who were treated at Teratai Clinic and hematology clinic RSCM and received imatinib mesylate therapy from January 2004-December 2011. Results. Most of the study subjects were male (61.5%), aged 26-40 years (47.4%), duration of diagnosis

Polycythemia or erythrocytosis is an increase in the number of red blood cells in circulation marked by the increase in hematocrit. Polycythemia is a case that still raises questions and dilemma for doctors. In this paper, it will be discussed about the diagnostic approach and management of polycythemia. The initial complaints of polycythemia are generally nonspecific, such as weakness and dizziness due to blood hyperviscosity. It is also essential to know accompanying diseases, routine medications, habits, and family histories of the patients. Patients with polycythemia commonly exhibit plethora. In vital sign examination, hypertension can be found in polycythemia vera. In general examination, we should look for signs that lead to secondary polycythemia, such as low oxygen saturation that can be found in secondary polycythemia. Initial workup that should be done is a complete blood count. Ferritin and transferrin saturation are evaluated to assess the iron status that can disguise the incidence of polycythemia, especially when the image of the blood smear indicates a microcytic hyperchromic. Advanced work up that can be done is genetic examination. In the case of polycythemia vera, the primary purpose of treatment is to prevent thrombotic events. In the case of secondary polycythemia, the aim of management is to identify the underlying disease and treat it, which one of them is phlebotomy.

Introduction. Patients with pulmonary tuberculosis (TB) had an increased risk for depression up to 1.53 times from a large cohort study. Studies have found an increase in the neutrophil - lymphocyte ratio (NLR) in various mood disorders including depression, also the value of the platelet-lymphocyte ratio (PLR) associated with major depression accompanied by psychotic symptoms. This study aimed to describe the peripheral blood characteristics, NLR, and PLR in pulmonary TB patients with depression. Methods. A cross-sectional study of 106 non-multidrug-resistant pulmonary TB patients was done at outpatient department of Cipto Mangunkusumo General Hospital, Jakarta from August to October 2018. The diagnosis of depression was made by interview according to Diagnostic and Statistical Manual of Mental Disorder-V (DSM-V) criteria, and severity of depression is determined using Beck Depression Inventory-II (BDI-II). The laboratory tests were done to obtain complete peripheral blood results, NLR, and TLR. Parametric test was used for numeric variables with even distribution, and nonparametric test for variables with uneven distribution. Results. From 106 patients with non-multidrug-resistant pulmonary TB, the proportion of depression was 32%. White blood cell count (p=0.024), and absolute lymphocte count (p=0.004) is lower in depressed TB patients compared to nondepressed TB patients. There were no significant relationship between NLR and TLR and the severity of depression in depressed pulmonary TB patients (p>0.05). Conclusion. White blood cell count and absolute lymphocyte count are lower in depressed pulmonary TB patients. Meanwhile, RNL and PLR are higher in depressed pulmonary TB patients eventhough not statistically significant.

Introduction. Health care workers (HCW) have a high risk of infectious substance exposure. Hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) are some diseases transmitted by body fluid or body tissue. Cipto Mangunkusumo Hospital Jakarta has been implementing post-exposure prophylaxis (PEP)s towards HIV, hepatitis B, and hepatitis C. This study aimed to identify the implementation of post-exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in Cipto Mangunkusumo Hospital Jakarta. Methods. A cross-sectional study was conducted to exposed workers in Cipto Mangunkusumo Hospital Jakarta between 2014-2016 who had been recorded by report. Demographic data were collected through medical record and interview was conducted to gather additional data. Statistical analysis was conducted with SPSS 20. Results. Among 196 reports, most HCW were female (69.9%), worked as nurse (38.3%), medical doctor (49.5%), and exposed percutaneously (93.4%). There were 183 risky exposures, with 19 (10.4%) reactive anti-HIV, 11 (6.0%) positive HBsAg, and 12 (6.6%) reactive anti-HCV in source of exposure. Almost all of the HCW has no HIV, hepatitis B, nor hepatitis C at the moment of exposure. Recommendation for antiretroviral (ARV) was given to 81 HCW, but only 49.4% completed the course. Anti-HIV follow up was done only by 21.3% workers. Recommendation of PEP for hepatitis B was given to 37 HCW. But, only 13.5% and 13.3% receive hepatitis B vaccination and hepatitis B immunoglobulin, respectively. Follow-up of HBsAg and anti-HBs on 3rd and 6th months were done by 41 (31.1%), 38 (28.8%), and 2 (1.5%) workers who were recommended to receive prophylaxis. In 182 workers recommended to do the follow-up of anti-HCV, 39 (21.4%), and 37 (20.3%) workers did the follow-up on 3rd and 6th month. Majority of exposed workers were not re-evaluated for HBsAg (64.9%) and anti-HCV (69.9%). Conclusions. The implementation of post-exposure prophylaxis for HIV, Hepatitis B, and Hepatitis C was still low especially in re-evaluation serologic marker. Comprehensive management is recommended including improving knowledge of health care workers, re-evaluation of operational procedure standard, and effective communication.

Introduction. Cardiovascular complications caused by endothelial dysfunction become one of the highest causes of mortality in patients with Rheumatoid Arthritis (RA). Rheumatoid Factor (RF) is an autoantibody that is commonly found in RA and is thought increasing the inflammatory response and endothelial dysfunction. Metabolic syndrome may also increase endothelial dysfunction. There have been no study assessing correlation between RF and endothelial dysfunction in RA patients without metabolic syndrome. Aim of this study was to determine the correlation between RF levels with VCAM-1 levels in RA patients without metabolic syndrome. Methods. Cross sectional design study of adult RA patients treated in Rheumatology Polyclinic of Cipto Mangunkusumo General Hospital without metabolic syndrome. Data collection was conducted from February to March 2018 from the previous research data taken from February 2016 to September 2017. The levels of RF and VCAM-1 were assessed through blood serum testing using the ELISA method. Correlation between the two variables was made using Spearman correlation analysis with SPSS 20.0 Results. A total of 46 subjects were included in the study. Most (95.7%) subjects were women with an average age of 44.43 years, median duration of 36 months, and most had moderate activity (52.2%). Most patients had a positive RF (63%). The correlation between RF levels and VCAM-1 levels had a weak correlation strength but was not statistically significant (r= 0.264; p= 0.076). Subjects with RF positive had higher levels of VCAM-1 (626.89 vs. 540.96 ng / mL). Conclusion. There is no correlation yet between RF and VCAM-1 in RA patient s without metabolic syndrome.

Introduction. Rheumatoid Arthritis is a chronic disease requiring a long-term medication affecting quality of life. Short Form 12 is a generic questionnaire to assess patients quality of life and has been validated in England. This study was designed to test reliability and validity of Indonesian version of SF-12 questionnaire. Methods. Sixty-five patients with clinically diagnosed RA using ACR/EULAR criterion were interviewed using Short Form 36 and Short Form 12 questionnaire. Validity was assessed with construct validity and external validity, while reliability tested with internal consistency and test-retest method. Results. Short-Form 12 (Indonesian Version) did not proved having a good validity, as it have a poor correlation between RE and MH domain in SF-36 and SF-12. Indonesian version of SF-12 shown a poor internal consistency (Cronbach Alpha: 0.561-0.754) but a good test and retest reliability ( intraclass correlation coefficient: 0.844-0.980, p

Acquired hemophilia A is a condition in which coagulation factor VIII become inactive due to autoantibody formation. This condition is related to pregnancy, malignancy, and autoimmune disease with skin disorder. In this case report, a 66 years woman with a post procedural bleeding with skin disorder. Later on, patient diagnosed with acquired hemophilia A with a factor VIII inhibitors related to bullous pemphigoid.