SCENARIO 1

Immunohematology Tutorial Report

GROUP 19
Jihan Nabila Pranjasdhina 011711133183
Fiqih Faizara Ustadi 011711133184
Jihadna Prima Santika Ruslan Musanip 011711133185
Indah Shofie Marwati 011711133186
Hilmy Abyan Utama 011711133187
Rayhan Alma Shafannisa Heru 011711133188
Savero Mizan Jahidi 011711133189
Radika Naufal Hadi Surya 011711133190
Muhammad Alim Ananto 011711133192
Valerie Afiyah Marzuki 011711133193
Scenario

A man, 23 years old, came to public health center

because of fatigue after activities since 2 weeks ago,
bruises on arms and thighs, and fever since 2 days
ago.
Main Problem
Fatigue after activities since 2 weeks ago.

Keywords
• A man
• 23 years old
• Fatigue after activities since 2 weeks ago
• Bruises on arms and tighs
• Fever since 2 days ago
ANAMNESIS
Name : Mr. R • Fatigue after activities since 2 weeks ago.
Age : 23 years old • Bruises on arms and tighs.
• Fever since 2 days ago.
Address :Surabaya Timur
• No appetite.
Occupation : Fuel worker • No activity can be hold.
• No history of consumed drugs, only paracetamol.
• No history of the same disease in family.
• No history of thalassemia, unknown autoimmune disease .
• No history of trauma and traffic accidents.
• Dizziness.
 • PHYSICAL EXAMINATION • Dry skin.
PHYSICAL • Glasgow coma scale :
• No lymph nodes enlargement, no
icterus.
EXAMINATION compos mentis.
• Anemia conjunctiva.
• Vital signs • Vesicular breathing sounds,
negative-negative ronkhi,
• BP : 90/60 mmHg negative-negative bowel sounds.
• HR : 110x/min • Normal S1 and S2 heart sounds,
no murmurs.
• RR : 22x/min • No hepatomegaly, no
• Temp. : 380 splenomegaly.
• Abdomen supel.
• Height : 160 cm
• Positive ptekhiae, positive
• Weight : 55 kg ekimosis on arms and limbs.
• Pale on nails and palms.
• BMI : 21,5
 ADDITIONAL
QUESTIONS
+
INFORMATION
 • Hb : 6,8 g/dl • Urea : normal
LAB • Creatinine : normal
• MCV : 86 fL
EXAMINATION • MCH : 29 pg/cell • SGOT : 65 IU/L
• SGPT : 55 IU/L
• MCHC : 34 g/dl
• Indirect Bilirubin : 4,2 mg/dl
• WBC : 1.700/mikroliter
• Total Bilirubin : 6,5 mg/dl
• Platelets : • Normal PTT, APTT.
29.000/mikroliter
• Bone marrow examination :
• Hct : 25% hypocellular, bone marrow
space consist of fat and
• LED : rise stroma, no abnormal
infiltrate, no fibrosis.
Early Hypothesis

• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Dengue Haemorrhagic
Fever.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Malaria.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Anemia.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Thalassemia.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Leukemia.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Systemic Lupus
Erythematosus.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Drugs Allergies.
• Mr. R, 23 years old, fatigue after activities since 2 weeks because of Hyperthyroidism.
Early Concept Mapping
1st Learning Issues
• How is the patophysiology of fatigue, bruises, and fever?
• What are Dengue Haemorrhagic Fever associated with fatigue?
• What are Malaria associated with fatigue?
• What are Anemia associated with fatigue?
• What are Leukemia associated with fatigue?
• What are Thalassemia associated with fatigue?
• What are Systemic Lupus Erythematosus associated with fatigue?
• What are Drugs allergies associated with fatigue?
• What are Hyperthyroid associated with fatigue?
2nd Learning Issues
• What is the definition of aplastic anemia?
• What is the etiology of aplastic anemia?
• How is the pathophysiology of aplastic anemia?
• How are the signs & symptoms of aplastic anemia?
• How to Diagnose aplastic anaemia?
• What is supporting laboratory examination for aplastic anemia?
• What is the therapy for aplastic anemia?
•
 Final
Concept
Mapping
Critical Analysis
Scenario 1 discusses the problem of Mr. R, 23 years. Mr. R came to the public health center with the complaint fatigue after
activities since 2 weeks ago, bruises on arms and thighs, and fever since 2 days ago. From the main complaint of Mr. R`,
there were two differential diagnoses, from the hematology and immune system and endocrine disorders. From
hematology and immune system we divided into infection disorders such as Dengue Haemorrhagic Fever and Malaria,
haematology disorders such as Anemia, Thalassemia, and Leukemia, and autoimmune disease such as Systemic Lupus
Erythematosus and Drugs Allergy. To make a diagnosis, a history is needed, so that we can obtain valid information and
supported by a physical examination and supportive examination. On history, Mrs. M complains complaint fatigue after
activities since 2 weeks ago, bruises on arms and thighs, and fever since 2 days ago. There is no characteristic with fever.
Because there is no corresponding symptoms so endocrine disorders can be removed.
After we know that Mr. R suffered from hematology and immunologi disease. We make some differential diagnosis that
can cause fatigue, bruises, and fever i.e. Dengue Haemorrhagic Fever, Malaria, Anemia, Leukimia, Thalassemia, Systemic
Lupus Erythematosus, and Drugs Allergy. Mr. R explained that there is no history of Thalassemia and MCV result is 86 fl so
that Thalassemia can be removed. In supportive examination, we can know that the result of leukosit is 1700 mikroliter so
the diagnosis of leukemia in patients can be removed.
The patient does not have hepatomegaly and Hct 25% so Dengue Haemorrhagic Fever can be removed. so Malaria can be
removed. There are no clinical features that support, so Systemic Lupus Syndrome can be removed. There are no clinical
features that support, so Drugs Allergy can be removed.
Critical Analysis
Diagnosis leads to Anemia with some symptoms. In physical examination obtained vital sign data:: BP 90/60 mmHg,
HR 110x/min, RR 22x/min, temperature 38 degree, GCS compos mentis, no icterus, no lympho node enlargement,
Anemia conjunctiva.Vesicular breathing sounds, negative-negative ronkhi, negative-negative bowel sounds. Normal
S1 and S2 heart sounds, no murmurs. No hepatomegaly, no splenomegaly.Abdomen supel.Positive ptekhiae,
positive ekimosis on arms and limbs.Pale on nails and palms.

In the supportive examination obtained results of Blood Test: Hb 6,8g/dL (N = 12 – 15) Leukocyte 1.700/mm³ (N =
3,500-10.500), Neutrophil 86% (N = 70%-80%) Thrombocytes 29,000/mm³, reticulosit 0,3%, MCV 86 fl (N= 86-96
fl), MCH 29 pg/cell (N= 26-33 pg/cell), MCHC 34 g/dl (N=32+2 or 32-2 g/dl) . Then we divide the diagnosis of
Anemia into 3, microcytic, normocytic and macrocytic. Normocytic can be divided into hypoproliferative and
hyperproliferative. From hypoproliferative we divided into leukemia and anemia aplastic. From the discuss we got
bone marrow is hipocellular, no abnormal infiltration and no fibrosit. And we concluded that Mr. R had anemia
aplastic.

Anemia aplastic triggered by idiopatic, virus, benzene, and drugs. Treatment for anemia aplastic includes: supportif
and definitive therapy. Supportif therapy, Mr. R are PRC transfusion, anabolic steroid such as oksimetazolone and
danazole, immunosuppressan (ATG), and corticosteroid because we have to maintain anemia. Definitive therapy is
bone marrow transplantation to maintain bone marrow.
Group Opinion
Based on scenario given at the first tutorial meeting, we know that. A man, 23 years old, came to public health center because of
fatigue after activities since 2 weeks ago, bruises on arms and thighs, and fever since 2 days ago. Our discussion begin by finding the
main problem and keywords, then we ask for the additional information by doing history taking and physical examination.
We get history of fatigue after activities since 2 weeks ago, Anemia conjunctiva, by physical examination, history taking, then we ask
for additional information. We continue to take an early hypothesis that Mr. R, 23 years old, fatigue after activities since 2 weeks
because of Anemia.
Then we can make an early concept mapping so we can make first learning issues. At the online meeting, We discuss about our first
learning issues and additional information including the laboratory test result such as bone marrow examination that resulted in
hypocellular, bone marrow space consist of fat and stroma, no abnormal infiltrate, no fibrosis and the CBC result as its supportive
data.
From all the data, We diagnose that he gets Anemia aplastic. Treatment for anemia aplastic includes: supportif and definitive therapy.
Supportif therapy, Mr. R are PRC transfusion, anabolic steroid such as oksimetazolone and danazole, immunosuppressan (ATG), and
corticosteroid because we have to maintain anemia. Definitive therapy is bone marrow transplantation to maintain bone marrow.
Final Hypothesis

Mr. R, 23 years old, fatigue after activities since

2 weeks because of anemia, specifically aplastic
anemia.
THANK YOU
any questions?