LAPORAN KASUS

SINDROMA EVANS PADA KEHAMILAN

Rohayat Bilmahdi Simanjuntak, Rudy a!iant", I!#a $ahid", Nu#i!$an a%an&"
" Su''a&ian H(matolo&i dan Onkolo&i M(dik
Ba&ian P(nyakit Dalam )K UNAND*RSUP D!+ M+Djamil Padan&
Abstrak
Sind!oma E,an- adalah .(nyakit h(matolo&i lan&ka yan& ditandai d(n&an kom'ina-i imun
t!om'o-ito.(nia /I0P1 dan autoimun h(molitik an(mia /AIHA1 'aik t(!jadi '(!-amaan atau
-(ku(n-ial tan.a (tiolo&i yan& j(la-+ Sind!oma E,an- dalam k(hamilan m(!u.akan kondi-i
yan& -an&at ja!an& dit(mukan+ Sind!oma E,an- .ada k(hamilan d(n&an kom.lika-i yan&
mun&kin t(!jadi yaitu an(mia yan& m(n&an%am ji$a /23453 6 ka-u-1, an(mia h(molitik
.o-t.a!tum '(!at .ada 75423 6 'ayi, .(!da!ahan i'u dan t!om'o-ito.(nia .ada janin+
P(n&a$a-an ant(natal !utin .ada i'u dan janin -(!ta .(nd(katan multidi-i.lin di.(!lukan
untuk m(minimalkan kom.lika-i 'a&i i'u dan anak+
Metode : La.o!an ka-u-
Studi Kasus
S(o!an& .a-i(n .(!(m.uan u-ia 89 tahun, datan& dalam :!a,id :7P;A;H; .!(t(!m, 7247<
min&&u d(n&an k(luhan .u%at, mudah m(ma!, l(tih l(-u dan &u-i '(!da!ah, -(!ta !i$ayat
mudah m(ma! -(jak .a-i(n k(%il+ Pada .(m(!ik-aan dit(mukan konjun&ti,a an(mi-, dan
(kimo-i- dikulit, &am'a!an da!ah t(.i no!mo-itik no!mok!om, dan .olik!oma-i+ H(mo&lo'in=
7,5 &!*dl, t!om'o-it= <;+333 *mm7, M>H= 7?,7 .&, M>V= ;3? @mA, M>H>= 75,2 &*dl,
!(tikulo-it= 85,3 6, S:O0= <? u*L, S:P0= 2 u*L, 'ili!u'in total= 8,BB m&*dl, 'ili!u'in di!(k=
;,3; m&*dl, 'ili!u'in indi!(k= ;,B< m&*dl, AP00= 2;,5 d(tik, P0= ;;,8 d(tik, Direct
antiglobulin test /DA01= .o-iti, H'-A&= non !(akti, Anti H>V= 3,B, Ra.id t(-t HIV= Non
!(akti, K!it(!ia ARA = ; da!i ;; k!it(!ia, P(m(!ik-aan BMP tidak di!(kom(nda-ikan ol(h
American Society of Hematology, US: )(tomat(!nal= &!a,id 77472 min&&u, d(n&an janin
hidu.+ P(n&o'atan di'(!ikan 0!an-u-i CR> 2 unit, m(til.!(dni-olon 7D;85 m& int!a,(na
-(lama 7 ha!i /0a..(!in& o1 dilanjutkan m(til.!(dni-olon 7D;< m& .(!o!al+
Kesimpulan
Sind!oma E,an- .ada k(hamilan di'(!ikan t(!a.i lini .(!tama yan& .alin& umum di&unakan
yaitu ko!tiko-t(!oid d(n&an t!an-u-i da!ah+ P(m'(!ian ko!tiko-t(!oid .ada ka-u- ini
m(m'(!ikan !(-.on yan& 'aik, dimana t(!jadi .(nin&katan kada! H' dan t!om'o-it+ >a!a
.(!-alinan adalah -(-uai indika-i o'-t(t!i, d(n&an ta!&(t t!om'o-it adalah E 53 D ;3
9
*L
-('(lum .(!-alinan+
Keyword : E,an- -ynd!om( in .!(&nan%y, AIHA, I0P
CASE REPORT
EVANS SN!ROME "N PRE#NANC
Rohayat Bilmahdi
D(.a!tm(nt o Int(!nal M(di%in(, )a%ulty o M(di%in( Andala-, Padan&
Abstra$t
E,an- -ynd!om( i- a !a!( h(matolo&i%al di-(a-( %ha!a%t(!i#(d 'y th( %om'ination o
immun( th!om'o%yto.(nia / I0P 1 and autoimmun( h(molyti% an(mia / AIHA 1 o%%u!- (ith(!
-imultan(ou-ly o! -(Fu(ntially $ith no %l(a! (tiolo&y+ E,an- -ynd!om( in .!(&nan%y $ith
%om.li%ation- that may o%%u! i- a li(4th!(at(nin& an(mia /234536 o %a-(-1, -(,(!(
.o-t.a!tum h(molyti% an(mia in 75423 6 o inant-, mat(!nal h(mo!!ha&( and
th!om'o%yto.(nia in monito!in& !outin( ant(natal (tal mat(!nal and (tal $(ll a- !a.id
im.l(m(ntation o .!oto%ol t!(atm(nt $ith a multidi-%i.lina!y a..!oa%h i- !(Fui!(d to
minimi#( %om.li%ation- and im.!o,( th( %han%( o d(-i!(d out%om(- o! 'oth moth(! and
%hild+
Case Study
A (mal( .ati(nt a&(d 89 y(a!-, %am( in &!a,id :7P;A;H; .!(t(!m , 7247< $((k-
$ith %om.laint- o .allo!, (a-y '!ui-in&, 'l((din& &um- and $(a!y, a- $(ll a- a hi-to!y o
(a-y '!ui-in& -in%( %hildhood+ On (Damination ound %onjun%ti,a .allo!, and (%%hymo-i-, th(
.(!i.h(!al 'lood .i%tu!( o an(mia, th!om'o%yto.(nia, $ith in%!(a-(d !(ti%ulo%yt(- /85+3 61,
di!(%t anti&lo'ulin t(-t /DA01 .o-iti,(+ 0hu- m(t th( %!it(!ia o! dia&no-i- o E,an- -ynd!om(
a!( /;1 autoimmun( h(molyti% an(mia $ith .o-iti,( di!(%t >oom'- t(-t, /81 immun(
th!om'o%yto.(nia .u!.u!a o%%u! %on%u!!(ntly o! -imultan(ou-ly, and /71 th(!( i- no %au-( o
th( di-(a-( i- (--(ntially+
Con$lusion
E,an- -ynd!om( in .!(&nan%y &i,(n i!-t4lin( th(!a.y i- mo-t %ommonly u-(d
%o!ti%o-t(!oid $ith a 'lood t!an-u-ion, $hi%h in a%ut( %i!%um-tan%(-, a 'lood t!an-u-ion
may '( !(Fui!(d to all(,iat( th( -ym.tom-+ >o!ti%o-t(!oid- in thi- %a-( &i,(- a &ood !(-.on-(,
$ith an in%!(a-( in h(mo&lo'in and .lat(l(t l(,(l-+ Mod( o d(li,(!y in .!(&nant $om(n $ith
E,an- -ynd!om( d(.(nd- on o'-t(t!i% indi%ation-, $ith th( .lat(l(t- ta!&(t in .!(&nant $om(n
$ith E,an- -ynd!om( i- E 53 D ;39 * L .!io! to la'o! and d(li,(!y a- th( !i-k o %(-a!(an
d(li,(!y i- .!(-(nt $ith (,(!y la'o!+ Un.!o,(n 'l((din& %om.li%ation- a--o%iat(d $ith mod(
o d(li,(!y, and mu-t '( don( 'y %a(-a!(an d(li,(!y $ith o'-t(t!i% indi%ation- only+