Page 230 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-008 (Prime e-Poster)
The Evaluation of Inflammation Factors (C-Reactive Protein Level) Based on
Bleeding Manifestation and Substitution Factors Exposure
in Hemophilia A Patients

Ati Rahmipurwandari, Dasril Daud, Nadirah Rasyid Ridha
Department of Child Health, Faculty of Medicine Universitas Hasanuddin, Makassar
Abstract
Background Hemophilia patients have a risk of recurring and prolonged bleeding that will affect the
inflammatory response to form C-Reactive Protein (CRP). The evaluation of CRP level based on bleeding
manifestation and substitution factors exposure in patients with hemophilia A has never been studies in
Indonesia. Objective To evaluate factors associated with inflammation (CRP level) based on bleeding
manifestation and substitution factors exposure in hemophilia A patients. Methods This cross sectional
study was based on primary data of children with hemophilia A 3 months - 18 years of age from Hospital
of Dr. Wahidin Sudirohusodo of Makassar, South Sulawesi. Measurement of inhibitor status, CRP level,
bleeding manifestation, and substitution factors exposure were conducted simultaneously. Results Of the
34 subjects, there are 26 hemophilia A patients with inhibitor and 8 without inhibitor. Bivariate analysis
showed significant correlation between CRP level with bleeding manifestation in hemophilia A group with
inhibitor (P=0.016; OR 0.004; 95%CI 0.004 to 0.484] with cut-off point is 3.67 mg/dL), but not in hemophilia
A without inhibitor (P=0.470). No significant correlation between CRP level with age when first exposed
(≤ 1 and > 1 years old) and intensity of the substitution factor exposure within a month (< 2 times and ≥ 2
times) in hemophilia A with inhibitor as well as without inhibitor. Conclusion There is a relationship between
inflammatory factors (CRP level) with bleeding manifestation in hemophilia A patients with inhibitors, the
cut-off point is 3.67 mg/dL.
Keywords: hemophilia; inflammation; inhibitors; bleeding; C-Reactive Protein

P-HO-009
Vitamin K Deficiency Bleeding with Eye Proptosis Manifestation:
A Case Report

Avian Andika, Teny Tjitra Sari
Department of Child Health, Faculty of Medicine Universitas Indonesia,Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia
Abstract
Background Vitamin K deficiency bleeding (VKDB, also known as acquired prothrombin complex deficiency,
APCD) was a rare coagulation disorder caused by vitamin K deficiency in infants with multiple bleeding
manifestations such as skin hemorrhage, gastrointestinal bleeding, umbilical bleeding, cephalhematoma,
and intracranial hemorrhage. There were high rate of mortalities and morbidities caused by VKDB.
Objective To demonstrate eye proptosis as an unusual bleeding manifestation of VKDB. Case A 5-month-
old boy came to the emergency unit with protruding left eye that grew larger since 6 hours prior to hospital
admission. The patient has history of predominantly breastfed, not given vitamin K prophylaxis at birth,
and has cholestasis since the neonatal period. Bulging fontanel was found from physical examination. From
ophthalmologic examination and orbital CT scan, the patient has retrobulbar hemorrhage causing left eye
proptosis. Few hours after admission, the patient develops seizure caused by intracranial hemorrhage. The
laboratory examination showed prolonged PT and aPTT, normocytic normochromic anemia, and cholestasis.
The patient was diagnosed with retrobulbar and intracranial hemorrhage caused by vitamin K deficiency
bleeding, compressive optic neuropathy and cholestasis. Vitamin K injection were done to normalized
PT and aPTT values and stop the bleeding, and canthotomy and cantholysis procedure performed by
ophthalmologic department to reduce orbital pressure. Conclusion One of the unusual manifestation of
VKDB is retrobulbar hemorrhage that presents with eye proptosis. Vitamin K injection remains to be the
mainstay therapy. Pediatricians should understand how to diagnose vitamin K deficiency bleeding early to
prevent mortalities and morbidities.
Keywords: vitamin K deficiency bleeding; proptosis

182 KONIKA XVIII Abstract Book