Indonesia consist of many island inhabited by many ethnic groups with different social economic condition. As in other parts of the world, anemia is still one of the major health problem in Indonesia. The reported anemia prevalence differs in each area and age groups, ranging from 5.4% in well nourished preschool children to 56.3% in primary school children; and 19% to 62.5% in pregnant women. The causes of anemia mostly reported were nutritional like iron deficiency, abnormal hemoglobin besides other conditions. In Cipto Mangunkusumo Hospital as the national referral hospital in Indonesia, in the adults groups, the cause of anemia reported were 14% with iron deficiency, 54% aplastic, 16% hemolytic and 16% other causes. Whereas in the child health department the cause were 29% nutritional deficiency, 31% thalassemia, 10% aplastic, 4% hemolytic and 26% other causes. Thalassemia is quite often reported in Indonesia. In 1955 Lie-Injo first reported the HbE as the most frequently found abnormality among many ethnic groups in Indonesia, ranging from 2.5% to 13.2%. In later studies the prevalence reported varies very much. It was reported as 9.5% in newborns, 22% in pregnant women, and 15.95% to 60% in athletes. The carrier frequency in some areas was between 6-10%, while the pattern of mutation varied widely within each region. Hemophilia cases in Indonesia is still not diagnosed adequately, only 530 cases were reported. The problems were lack of diagnostic laboratories and awareness. As many as 56.9% of the hemophilia patients who received cryoprecipitate were reported positive with HCV antibody. Hematological malignancy is now also became an increasing problem in Indonesia, in child health department the prevalence of leukemia was 57%, and lymphoma 13% among other malignancies. In National Cancer hospital, the prevalence leukemia as diagnosed using morphology and flowcytometry, were 51.4% AML, 19.7% B-ALL, 14.6% T-ALL, 4.5% preB-ALL, with 9.8% cases with co expression, and 30% other malignancies. Due to geographical situation, economic condition and lack of diagnostic laboratory facility many abnormalities were unable to be diagnosed properly.

AbstrakIdentifikasi petanda permukaan sel yang dikenal sebagai kelompok antigen diferensiasi ( Rapid and precise diagnosis of leukemias is critical so that apropriate treatment can be initiated without delay. With the development of new treatment modalities it is also essential to have accurate prognostic factors. The most widely accepted and applied classification of leukemias is based on morphological and cytochemical criteria, proposed by the FAB group.

BACKGROUND: Myelodysplastic syndrome (MDS) is a heterogeneous group of hematopoietic stem cell disorders which is characterized by ineffective hematopoiesis and risk of progression into acute myeloid leukemia. The diagnosis and classification of MDS are determined from the findings of dysplasia in one or more cell lineage and the percentage of blast cell on bone marrow examination. However, it should be noted that an abnormality in one marrow cell lineage does not necessarily translate to the corresponding clinical phenotype. Here, we present a case of MDS with multilineage dysplasia (MLD) (erythrocyte, leukocyte, and thrombocyte) from bone marrow aspiration, but with anemia as the sole clinical manifestation (single cytopenia). CASE REPORT: A 78-year-old male patient came to our clinic on July 10, 2020, with chief complaint of worsening fatigue which started approximately 1 year before visit. His vital signs during the visit were stable and no other abnormalities observed other than pale conjunctivae. Complete blood count showed macrocytic anemia with no abnormalities in leukocyte count and thrombocyte count, which suggested a single cytopenia. Peripheral blood smear was negative for megaloblasts and hypersegmented neutrophils. The patient’s bone marrow examination showed MDS with MLD. This result was in contrast to complete blood count examination which only showed anemia (single cytopenia). CONCLUSION: This case showed that there could be discrepancy between clinical manifestations of the cytopenia with bone marrow dysplasia, which highlighted the importance of conducting bone marrow examination to properly classify MDS type.

Background: The majority of stage III non-small cell lung cancer (NSCLC) patients are not candidates for surgery. Five-year survival in patients with unresectable NSCLC is less than 10%. Several trials using platin-based combination chemotherapy, administred concurrently with radiotherapy showed impressive results along with significant toxicity. We supposed that weekly regimen combined with concomitant radiation would demonstrate lower toxicity. Methods: Prospective phase II study. Chemotherapy naive patients with newly diagnosed inoperable NSCLC stage IIIA/B, performance status 0-1 were involved. Four cycles of low-dose paclitaxel 100 mg/m 2 weekly for 3 of 4 weeks (reduced to 50 mg/m 2 during radiation therapy) combined with four weekly carboplatin AUC 6 were administred, fully on outpatient basis. Patients received concomitant normofractionated external beam irradiation 65,0-75,0 Gy to primary tumor and regional lymph nodes since the second cycle. After the end of treatment patients were followed in two months period. In case of tumor recurrence patients were treated by the second line of chemotherapy. Results: 24 patients were involved, male/female 23/1, median age 60 years (range 45-73), stage IIIA 6 (25%), stage IIIB 18 (75%). Squamous cell 12 (50%), adenocarcinoma 7 (29%), undifferentiated 5 (21%). 89 cycles were administred (264 doses of paclitaxel). Median number of cycles was 4 (range 1-4). Median number of paclitaxel doses was 12 (range 3 -12). Only 11 paclitaxel doses had to be delayed. Neutropenia grade 3/4 was found in 4 patients (17%), leukopenia grade 3/4 in 5 patients (21%), anemia grade 3/4 in 2 patients (8%), esophagitis grade 3-4 in 6 patients (25%), pneumonitis grade 3/4 in 2 patients (8%), loss of weight grade 3/4 in 1 patient (4%). 20 patients finished the concomitant radiation therapy. No toxic death occurred. Partial response was found in 17 patients (71%), stable disease in 3 patients (12%) and progression in 4 patients (17%). Median progression free survival was 38 weeks (range 6-117). Median survival was 71 weeks. 13 patients (54%) survived one year. Median follow-up was 19 months. Conclusions: Weekly low-dose paclitaxel combined with four weekly carboplatin chemotherapy concomitantly with radiotherapy is a well tolerated and effective treatment with low toxicity. This combined treatment modality is a reasonable option for patiens with locally advanced inoperable NSCLC in performance status 0-1.