Page 250 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-044
Hypercoagulable State in Immunocompromised Children with COVID-19

Agus Fitrianto, Dewi Rosariah Ayu, Irma Rezky Ratu, Riski Muhaimin, Teny Tjitra Sari
Department of Child Health, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia,
Jakarta, Indonesia
Abstract
Background Coronavirus disease 2019 (COVID-19) is a systemic hyperinflammation disease which can
cause severe respiratory symptoms and extrapulmonary manifestations. Several studies have highlighted
that patients infected with the novel coronavirus can potentially develop coagulation abnormality. However,
the incidence of hypercoagulable state and thromboembolism (TE) in immunocompromised children are
not well established. Objective To demonstrate hypercoagulable state as complication of COVID-19 in
immunocompromised children. Case We report case series of 15 immunocompromised children with
COVID-19 admitted to Cipto Mangunkusumo Hospital. The diagnosis of COVID-19 was confirmed through
the reverse transcription-polymerase chain reaction (RT-PCR). Median of D-dimer was 2640 (290-7270)
g/L. The hypercoagulable state was indicated by increasing D-dimer more than 3 times upper limit of normal
(ULN) and followed by dopler ultrasound if clinical TE was suspected. There were 11 of 15 patients noticed
to have hypercoagulable state and 1 of them suffered from TE. All patients with hypercoagulable state
received anticoagulant prophylaxis whereas one patient with TE had anticoagulant therapy. All patients were
improvement and discharged from hospital without any complication. Conclusion Hypercoagulable state
should be considered as complication in immunocompromised children with COVID-19. Early diagnosis
and thromboprophylaxis can prevent TE event.
Keywords: hypercoagulable state; thromboembolism; COVID-19; immunocompromised children

P-HO-045
Vertebral Compression Fracture and Hypovitaminosis D
in Children with Thalassemia Major

Ludi Dhyani Rahmartani, Teny Tjitra Sari, Evita Karianni Bermanshah, Haryanti Fauzia Wulandari,
Pustika Amalia Wahidiyat
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National Hospital,
Jakarta, Indonesia
Abstract
Background Osteoporosis is a common complication in thalassemia major and has a multifactorial
pathogenesis. In TIF recommendation, a DEXA-scan is used to measure bone density in thalassemia
patients. However, most patients could not afford the DEXA-scan examination because it is not covered
by national insurance. The 2019 ISCD Pediatric Positions Task Forces stated that the diagnosis of pediatric
osteoporosis included the presence of a nontraumatic vertebral compression fracture (VF), without the
need for BMD criteria. In Indonesia, there has been no study for the prevalence of hypovitaminosis
D and vertebral compression fractures in children with thalassemia major and its correlation.
Objective To describe the prevalence of VF and hypovitaminosis D in children with thalassemia major.
Methods A cross-sectional study design was conducted in children with thalassemia major aged 7-18
years at the Thalassemia Center at Cipto Mangunkusumo National Hospital. Results This study obtained
165 subjects (50.1% girls). Fifty-two subjects (31.5%) have VF, and three of them have both thoracal and
lumbar fractures. The most common sites of VF were lumbar 5 and thoracic 11-12. The youngest subject
who has VF is 7-year-old. Osteopenia was found in 67.3% of patients. Vitamin D levels [25(OH)D] were
measured in 122 subjects, and hypovitaminosis D occurred in 77.9% of the subject (32.8% deficiency, 45.1%
insufficiency). Our study found no significant relationship between vitamin D levels on the incidence of
vertebral compression fractures (p>0,05). Conclusion To our knowledge, this is the highest prevalence of VF
among various studies that have been conducted. Vertebral X-ray is beneficial to detect bone density from
osteopenia to fracture in children with thalassemia major. Hypovitaminosis D is common in thalassemia,
and they require regular vitamin D administration.
Keywords: osteoporosis; vertebral fracture; thalassemia; children

202 KONIKA XVIII Abstract Book