Page 115 - Abstract Book KONIKA 18

Allergy Immunology

P-AI-025
Autoimmune Hemolytic Anemia in Pediatric Systemic Lupus Erythematosus:
Retrospective Study in 1.5 Year Experience

Nadia Chairunnisa, Galuh Hardaningsih, Wistiani
Department of Child Health, Faculty of Medicine Universitas Diponegoro, Dr. Kariadi General Hospital, Semarang,
Central Java, Indonesia

Background Systemic lupus erythematosus (SLE) is a chronic multisystemic disease that may involve various
organs. Hematological manifestations have been reported in 39%–86% of childhood-onset. Autoimmune
hemolytic anemia (AIHA) is a type of SLE manifestation in 3%–20% of pediatric SLE patients. Objectives
To determine demographic characteristics, clinical and laboratory findings of AIHA in pediatric SLE patients.
Methods We analyzed demographic data, clinical and laboratory findings of 11 patients diagnosed with SLE
and AIHA who were hospitalized in RSUP dr. Kariadi Semarang from January 2020 - June 2021. Data was
collected from the complete medical record. Autoimmune hemolytic anemia was defined by the presence of
anemia (hemoglobin <10 g/dL) and evidence of hemolysis (positive Coombs test). Results All subjects were
female, the average age at SLE diagnosis was 12 years 1 month (9-14 years). Two out of eleven patients were
immediately diagnosed AIHA with SLE in their first admission, 3/11 patients after 6 months, 3/11 patients
after 1 year, and 3/11 patients after 3 years. Six patients had bicytopenia and 2 patients had pancytopenia.
Severe anemia (hemoglobin < 7.0 g/dL) occurred in 7 patients with lowest Hb level 1.9 g/dL, SLEDAI score
ranged 4-14 with anti-dsDNA level ranged 108.2-1509 IU/mL. Conclusion Autoimmune hemolytic anemia
in female adolescents must be differentiated with autoimmune disease, namely SLE.
Keywords: systemic lupus erythematosus; autoimmune hemolytic anemia; pediatric SLE

P-AI-026
Systemic Lupus Erythematosus with Uncommon Liver Involvement:
A Case Report

Lina Purnamasari, Priyanti Kisworini, Pricilia Gunawan H, Selli Muljanto, Budiyanto
Department of Child Health, Faculty of Medicine, Universitas Lambung Mangkurat, Ulin General Hospital,
Banjarmasin, South Borneo, Indonesia

Abstract
Background Liver involvement in Juvenile Systemic lupus erythematosus (JSLE) affects only 3-9%
population. It may be manifested as lupus hepatitis, SLE-overlap syndrome (autoimmune hepatitis/AIH),
or other causes. It is important to distinguish them because of their different prognoses. Objective To report
SLE case with uncommon liver involvement. Case A 11-years-old girl came with hemolytic anemia and
diagnosed as JSLE (C3 23,4mg/dL, C4 3,7mg/dL, positive anti-ds-DNA and ANA test), had been treated
with pulse methylprednisolone once 3 months before admission. During outpatient treatment, the compliance
was low, the drugs weren’t consumed for months. She had recurrent admission with intermittent fever, pale,
joints pain, decreased urination, swelling, yellowish sclera, hepatomegaly, and ascites. Laboratory results
were anemia (Hb 6,6g/dL), hypoalbuminemia (2,3g/dL), elevated transaminase (AST 737U/L, ALT 105U/L),
cholestasis (total bilirubin 14,28mg/dL, direct 10,16mg/dL), gamma-glutamyl-transpeptidase 1129U/L,
alkaline phosphatase 516U/L, INR 3,02, total cholesterol 253mg/dL, proteinuria +3, decreased renal function
with eGFR 41,1mL/min/1,73m2, negative IgM anti-HAV, anti-HCV and HBsAg. Abdominal ultrasound
showed hepatomegaly and ascites, no liver nodule or cirrhosis. Methylprednisolone pulse was administered
for three days, in conjunction with hydroxychloroquine, mycophenolate mofetil, and ursodeoxycholic
acid. She had significant improvement of clinical and liver function test (total bilirubin 3,42mg/dL, AST
70U/L, ALT 38U/L) several days after steroid therapy. However, we could not performed liver biopsy due
to limited resources. Close monitoring is essential for the patient. Conclusion Liver involvement in SLE is
rare and liver biopsy is essential in establishing the diagnosis. Close monitoring and proper management
play important role in its management.
Keywords: systemic lupus erythematosus; lupus hepatitis; autoimmune hepatitis

KONIKA XVIII Abstract Book 67