Trombositopenia Berat pada Ibu Hamil dengan Sistemik Lupus Erythematosus yang Dilakukan Seksio Sesarea

  • Mariza Fitriati
  • Ratih Kumala Fajar Apsari Faculty of Medicine Universitas Gadjah Mada Yogyakarta
  • Sri Rahardjo Faculty of Medicine Universitas Gadjah Mada Yogyakarta
Keywords: trombositopenia berat, kehamilan, lupus eritematosus sistemik, seksio sesarea, severe thrombocytopenia, pregnancy, systemic lupus erythematosus, caesarean section

Abstract

Trombositopenia adalah hal yang umum muncul pada kehamilan normal, disebut trombositopenia berat bila jumlah trombosit <50.000 /µL. Komplikasi kehamilan oleh penyakit Lupus Eritematosus Sistemik (Systemic Lupus Erythematosus = SLE) dapat menimbulkan trombositopenia berat patologis. Karena peran penting trombosit dalam pembekuan darah, dilain pihak proses persalinan akan menimbulkan perdarahan, maka dibutuhkan jumlah dan fungsi trombosit yang cukup. Trombositopenia-SLE berderajat berat perlu mendapat terapi untuk meningkatkan jumlah dan fungsi trombosit sebelum menjalani persalinan. Upaya peningkatan jumlah trombosit pada trombositopenia-SLE diawali dengan kortikosteroid sebagai terapi awal, dengan terapi alternatif lanjutan imunosupresif, splenektomi, plasmaferesis, trombopoetic, dan konsentrat trombosit. Pada kasus ini trombositopenia tidak dapat teratasi, sehingga pemeriksaan fungsional pembekuan darah bleeding time dan clotting time digunakan untuk membantu memperkirakan kemungkinan terjadi perdarahan berkelanjutan. Perhatian utama pada pemilihan tehnik anestesi kasus ini adalah kemungkinan terjadi perdarahan berkelanjutan, dalam hal ini dipilih yang dipertimbangkan berisiko terkecil yaitu total intravenous anesthesia (TIVA) dengan ketamin. Perawatan pasca operasi dilaksanakan juga dengan tetap mewaspadai kemungkinan terjadi perdarahan berkelanjutan.

 

Severe Trombositopenia in Pregnant Woman with Sistemic Lupus Erythematosus Ongoing Caesarean Section

Abstract

Thrombocytopenia is a common occurrence in normal pregnancy, will classified as severe thrombocytopenia if platelet count <50.000/ µL. Pregnancy complicated by Systemic Lupus Erythematosus (SLE) can lead to pathological severe thrombocytopenia. As thrombocytes has a main role in haemostasis, and delivery process will always caused bleeding, thrombocytes needed in proper amount and function. Severe SLE-Thrombocytopenia has to treat aiming higher total thrombocytes and function before delivery. Effort in raising thrombocytes count on SLE-thrombocytopenia patients recommended starting from corticosteroid as first line treatment, followed by any alternatif therapy if thrombocytes count did not responds to corticosteroid therapy, such as immunosuppresif drugs, splenectomy, plasmapharesis, thrombopoetic drugs, and trombocyte concentrate. In this case, severe thrombocytopenia couldn’t be resolved, so then the bleeding time and clotting time taken as tools to estimate blood’s ability to coagulate. The main consideration on choosing anesthesia’s plan in this case is possibility condition to held uncontrolled bleeding. Therefore, the procedure with the lowest risk for maternal and fetal, total intravenous anesthesia with ketamin, had chosen. Caring for post operative SLE-thrombocytopenia patient should never ignoring vigilance for sustainable bleeding.

Author Biographies

Ratih Kumala Fajar Apsari, Faculty of Medicine Universitas Gadjah Mada Yogyakarta

Department Anesthesiology and Intensive Care General Hospital Dr. Sardjito Yogyakarta

Sri Rahardjo, Faculty of Medicine Universitas Gadjah Mada Yogyakarta

Departement Anesthesiology and Intensive Care General Hospital Dr. Sardjito Yogyakarta

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Published
2020-09-17
Section
Case Report