Page 241 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-026
The Impact of COVID-19 Pandemic on Routine Hospital Visit of Pediatric
Thalassemia Patients at Mohammad Hoesin Hospital Palembang

Michael Septian Sihombing, Dian Puspita Sari
Department of Child Health, Faculty of Medicine Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia

Abstract
Background The COVID-19 pandemic has forced the government and hospitals to change their policy
related to activities in public places and hospital services. These might influence routine management of
pediatric thalassemia patients who usually receive a regular blood transfusion and oral iron-chelating agents.
Objective To analyze the impact of COVID-19 pandemic on hospital visits and management of children
with thalassemia by comparing compliance before and during the pandemic. Methods A cross-sectional
study was performed from January 2019 to December 2020 at Mohammad Hoesin Hospital by reviewing
medical records of hospitalized paediatric Thalassemia patients then analyzed using paired sample t-test on
SPSS 23. Clinical compliance was determined by pre-transfusion Hb, ferritin level, and visitation before and
during the pandemic. Results There were 2587 thalassemia visits during the study period, 641 before the
pandemic, 1946 during the pandemic. The difference of monthly routine visit frequency before and during
pandemic was 53.4±35.9 vs. 162.1±38.90 patients per month (P=0.002); ferritin level was 2869.6±861.7 mg/
dL vs. 3992.9±451.1 mg/dL (P=0.001). Blood volume needed before and during the pandemic was 190±14.4
mL/day/person vs. 192±12.5 mL/day/person (P=0.226), while pre-transfusion Hb remained the same at
8.4±0.3 mg/dL. Conclusion The impact of COVID-19 in our transfusion service is surprisingly increased,
seen by a significant increase of monthly hospital visits and an unchanged level of pre-transfusion Hb.
However, ferritin level is increased during the pandemic that might be due to lack of iron-chelating agent
treatment from their previous hospitals.
Keywords: thalassemia; compliance; COVID-19; impact

P-HO-027
aPTT Mixing Study as an Initial Diagnostic Approach to Factor VIII Inhibitors
in Patient with Hemophilia A
Million Polfan, Olga Rasiyanti Siregar, Bidasari Lubis
Department of Child Health, Faculty of Medicine Universitas Sumatera Utara, Medan, North Sumatera, Indonesia

Abstract
Background Chief complication in patients with hemophilia A receiving FVIII replacement therapy is the
development of antibodies (inhibitor) to exogenous FVIII which will reduce its effectiveness in stopping
and/or preventing bleeding. Bethesda assay, the gold standard inhibitor detection test, is expensive and not
widely available to be applied as population screening method. Objective To report hemophilia A with FVIII
inhibitors case, detected by aPTT mixing study. Case RAS, 6 years old boy with hemophilia A, presented
to Polyclinic with progressively enlarged swelling in the left knee for 2 days (after bumping on a table).
He was limping because of the pain. No other active spontaneous bleeding nor bruising. No other family
member with hemophilia. He was screened with aPTT mixing study. Pre-aPTT 78.1” (33”) and post-aPTT
74.5” (33”), which was not corrected, meaning there was inhibitors. Bethesda assay result was FVIII inhibitor
31.68 BU (confirming hemophilia A with high titre inhibitor). Past medical history: At 8 months old, he
was diagnosed as hemophilia A. Spontaneous bleeding stopped after FVIII injection. He did not experience
bleeding/bruising again and wasn’t on therapy until he had bleeding again at 5 years old and was confirmed
as moderate hemophilia A (FVIII 1.7%). Since then, he had FVIII injection monthly. If the injection was
delayed, he often experienced swelling in the eyes and knees.Conclusion RAS was correctly identified
as hemophilia A with FVIII inhibitors by aPTT mixing study screening method. He might need immune
tolerance induction or bypassing agent if standard therapy become ineffective.
Keywords: hemophilia A; factor VIII inhibitors; aPTT mixing study; Bethesda assay

KONIKA XVIII Abstract Book 193