Page 244 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-032
Febrile Neutropenia in Pediatric Acute Lymphoblastic Leukemia
during Induction Phase in Ulin General Hospital Banjarmasin

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Gusti Muhammad Fuad Suharto , Andreas Budi Wijaya , Wulandewi Marhaeni , Edi Hartoyo ,
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Dewi Indah Noviana Pratiwi , Munawaroh Pasaribu 2
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Department of Pediatrics and Department of Clinical Microbiology , Ulin General Hospital,
Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, South Borneo, Indonesia
Abstract
Background Febrile neutropenia (FN) is among the leading causes of mortality and morbidity in oncologic
patients undergoing chemotherapy. Objective This study aimed to explore the clinicomicrobiological
profile and outcome of FN in pediatric acute lymphoblastic leukemia (ALL) during the induction phase of
chemotherapy. Methods A retrospective analysis from medical records was performed on FN episodes in
children under 18 years old diagnosed with ALL during the induction phase of chemotherapy using Indonesian
ALL Protocol 2018 from January 2020 to June 2021. Results There were 47 (78.3%) patients of 60 ALL
patients had FN. According to the stratified risk group, 9 (19.1%) were classified as standard-risk groups,
and 38 (80.9%) were classified as high-risk groups. There were 54 FN episodes, 42 (77.7%) had documented
focus infection, and the rest were fever without source. Pneumonia was the most common infection (25.9%).
Of 9 (16.7%) bacterial isolates, Klebsiella pneumoniae was the most common gram-negative isolate, while
Staphylococcus aureus was the most common gram-positive bacterial isolate. At initial hospitalization, the
first-line antibiotic regimen in these patients was Ceftriaxone, with a resistance rate of 44.35%. There were
19 (34%) deaths, of which 17 patients (89,5%) had septic shock. Conclusion Our study highlighted that
FN was common in ALL during the induction phase of chemotherapy. Pneumonia was the most common
infection. Klebsiella pneumoniae and Staphylococcus aureus were the most frequently isolated bacteria.
Furthermore, septic shock was the most common cause of death.
Keywords: acute lymphoblastic leukemia; febrile neutropenia; oncology; pediatric

P-HO-033
Blood-stained Tears as a Sign of an Infant with Hematologic Disorder:
A Case Report

Tioky Sutjonong, Bethseba Brontang Pulinggomang
Kalabahi Regional Hospital, Kalabahi Kota, East Nusa Tenggara, Indonesia
Abstract
Background Blood-stained tears also known as hemolacria is the presence of blood in the tears. Hemolacira
is a very unusual manifestation in infant with hematologic disorder. There are many etiologies of hemolacria
such as, infection, inflammation and trauma to the ocular, vascular lesions, idiopathic, and hematologic
disorder such as immune thrombocytopenic purpura (ITP). A thorough examination and investigation
should be done to find the etiology of hemolacria Objective To present about the possibility of hemolacria
as a sign of an infant with hematologic disorder. Case A 2 months old boy was referred by Public Health
Care facility to Kalabahi Regional Hospital with manifestation of blood-stained tears. The patient was also
having subconjunctival hemorrhage, multiple petechiae and black stool. Laboratory studies revealed a low
platelet of 15,000/µL and normochromic normocytic anemia. The patient was assessed with hematologic
disorder with suspected newly diagnosed immune thrombocytopenic purpura with differential diagnosis of
secondary thrombocytopenic and aplastic anemia. The patient was treated with PRC transfusion and oral
prednisone 2 mg/kg/day for 14 days and followed by 14 days of tapering off. The patient was recovered and
the platelet was increased to 117,000/µL. The patient was hospitalized for 6 days and discharged without any
complication. Conclusion Blood-stained tears can be a sign of a hematologic disorder. It is challenging to
find the etiology of hemolacria especially in remote area or limited resources hospital. A referral to secondary
or tertiary hospital should be made for further investigation to ruled out the other cause of hemolacria.
Keywords: blood-stained, tear; hemolacria, infant; hematologic; ITP

196 KONIKA XVIII Abstract Book