PERDARAHAN INTRAKRANIAL PADA BAYI DENGAN KOLESTASIS: SEBUAH LAPORAN KASUS
Keywords:
Perdarahan intrakranial, defisiensi kompleks protrombin didapat, DKPD, kolestasis, sepsis, bayiAbstract
Abstrak
Perdarahan intrakranial merupakan salah satu penyebab kecacatan dan kematian bayi yang dapat disebabkan oleh adanya suatu defisiensi kompleks protrombin didapat (DKPD). DKPD ini memicu bayi mengalami gangguan koagulasi dengan salah satu pemicunya adalah kolestasis. Pada laporan kasus ini, bayi perempuan berusia 1 bulan 8 hari datang dengan keluhan kejang dan penurunan kesadaran secara mendadak, disertai demam dan kulit berwarna kekuningan. Pada pemeriksaan fisik ditemukan ubun-ubun besar membonjol, dengan hasil CT-scan kepala menunjukkan adanya perdarahan intrakranial. Pemeriksaan darah didapatkan anemia berat (4.2 gr/dL), leukositosis (29.060/uL), trombositopenia (36.000/uL), serta kenaikan kadar prokalsitonin (>50 ng/mL). Ditemukan juga pemanjangan prothrombine time (PT), activated partial thromboplastine time (APTT), kenaikan enzim hati, serta kenaikan bilirubin direk>20% dari bilirubin total. Pasien kemudian didiagnosis mengalami perdarahan intrakranial akibat DKPD, kolestasis, dan sepsis, diberikan tatatalaksana berupa injeksi vitamin K, transfusi fresh frozen plasma (FFP), transfusi packed red cell (PRC), asam ursodeoksikolat, antibiotik, citicoline, dan fenitoin. Pada hari ke-20 perawatan pasien menunjukkan perbaikan klinis sehingga dipulangkan.
Kata kunci: Perdarahan intrakranial, defisiensi kompleks protrombin didapat, DKPD, kolestasis, sepsis, bayi
Abstract
Intracranial haemorrhage inducing disability and death in infants can be caused by an acquired prothrombin complex deficiency (APCD). This APCD triggers the baby to experience coagulation disorders with one of the underlying etiology is cholestasis. In this case report, a baby girl (1 month 8 days) came with seizures and sudden loss of consciousness, accompanied by fever and icteric skin. On physical examination, a bulging fontanel was found, with the head CT scan showing intracranial haemorrhage. Blood tests showed severe anemia (4.2 gr/dL), leucocytosis (29.060/uL), thrombocytopenia (36.000/uL), and increased procalcitonin levels (>50 ng/mL). There was also prolongation of prothrombin time (PT) and partial thromboplastin time (APTT), elevated liver enzymes, as well as an increase in direct bilirubin >20% of total bilirubin. The patient was then diagnosed with intracranial bleeding due to APCD, cholestasis, and sepsis and was given vitamin K injection, fresh frozen plasma (FFP) transfusion, packed red cell (PRC) transfusion, ursodeoxycholic acid, antibiotics, citicoline, and phenytoin. On the 20th day of treatment, the patient showed clinical improvement, so she was sent home.
Keywords: Intracranial haemorrhage, acquired prothrombin complex deficiency, APCD, cholestasis, sepsis, infant
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