LABORATORY EXAMINATION ON HEMOPHAGOSITOSIS LYMPHOHISTIOSITOSIS (HLH) IN DR. SOETOMO GENERAL HOSPITAL, SURABAYA, INDONESIA: A CASE REPORT.

Hemophagocytic lymphohistiocytosis (HLH) is derived from the word hemophagocytosis, in which macrophages infiltrate tissues extensively and unspecifically phagocyte blood cells and bone marrow cells. HLH is rare, difficult to recognize and the mortality rate is high, especially in adults. Immediate diagnosis and therapy are essential. The introduction of HLH triggers is important as therapy is based on the underlying triggers. The patient in this study was a 72-year-old female presented with fever 1 week before admission. She had anemic conjunctiva and splenomegaly. Laboratory results were as follows: Hb: 9.2 g/dL, PLT: 73,000/µL, WBC: 3.400/µL, neutrophil: 0.6%, triglycerides: 284 mg/dL, ferritin: 7500 ng/mL. Bone marrow aspiration showed hypocellular marrow with increased angry macrophage. The patient received dexamethasone, Intravenous Immunoglobulins (IVIG), tranfusion of 1 bag of Packed Red Cell (PRC) and Thrombocyte Concentrate (TC). Patient showed symptoms as follows: fever (t=40oC), splenomegaly (abdominal ultrasound results), sitopenia (hb: 9.2 g/dL, % neutrophils: 0.6%, PLT: 73 x 103/µL), hypertriglyceridemia (284 mg/dL), hyperferritinemia (7500 ng/mL) and hemofagocytosis in the bone marrow. Based on the criteria of the updated HLH 2004, it was concluded that the patient was diagnosed with HLH. The total Hscore in this patient was 269, which is also eligible for enforcement of HLH diagnosis. In conclusion, diagnosis of HLH based on the existing scoring system should be one of the considerations in patients with cytoopenia with febris, especially when accompanied with a history of severe infection, malignancy, and previous use of immunosuppressants. [ABSTRACT FROM AUTHOR]