Introduction : Chronic myelogeneous leukemia (CML) is a myeloproliferative neoplasm that can progress into various conditions. Transformation of CML into acute lymphoblastic leukemia (ALL) is a rare case. Case :  A 22-year-old male with history of CML since 2014 and positive BCR-ABL p210 in 2017 came with complaint of weakness. Physical examination showed hepatosplenomegaly. CBC results Hb  7.1 g/dL, WBC 290,620/μL, platelet 434,000/μL. Blood smear evaluation (BSE) suggested CML blastic crisis dd AML-M5. Patient’s condition got worse. CBC result showed  WBC 96,770/μL and  platelet 7,000/μL in 2 weeks later. BSE was dominated by mononuclear cells with scanty blue cytoplasm, no granules, no auer rods, loose chromatine and indistinct nucleoli, suggesting lymphoblasts with a proportion of 60%. Bone marrow aspiration (BMA) and immunophenotyping was done to confirm BSE. The BMA result was dominated by lymphoblast, consistent with ALL. The immunophenotyping result was CD10+, CD34+(0,99%), CD79a+, HLA-DR+, and CD20+.  Molecular examination showed positive RUNX1 and NRAS while negative FLT3, NPM1 and del(5q). Discussion : BCR-ABL gene can be found both in CML and ALL. CML transformation into ALL had been reported to be related with deletion of a transcription gene. Diagnosis of ALL can be established by BMA and immunophenotyping. CD34+ expression of lymphoblast in ALL can be varied, but in this case was minimal. Conclusion : Patient with history of CML showed an ALL picture based on BSE, BMA and immunophenotyping suggesting CML transformation into ALL although CD34+ expression was minimal.

Acute Coronary Syndrome (ACS) includes ST-Elevation Myocardial Infarction (STEMI), non-ST Elevation MyocardialInfarction (NSTEMI), and Unstable Angina (UA). Platelet plays an essential role in ACS pathogenesis. Immature PlateletFraction (IPF) and platelet indices can predict platelet activations. Platelet indices consist of platelet count, Mean PlateletVolume (MPV), Platelet Distribution Width (PDW), plateletcrit (Pct). This study aimed to analyze the differences of IPF andplatelet indices among ACS patients. This study was an observational analytical cross-sectional study conducted inDr. Soetomo Hospital during May-September 2019. The subjects consisted of 30-STEMI, 25-NSTEMI, and 24-UA patients.The EDTA-samples were measured for platelet indices and IPF using Sysmex XN-1000. The differences between IPF andplatelet indices among STEMI, NSTEMI, and UA patients were analyzed using Kruskal-Wallis and Mann-Whitney test. The IPFvalues were significantly higher in STEMI patients than NSTEMI and UA patients. The IPF values of NSTEMI patients werehigher than UA patients. The MPV, PDW, and P-LCR were significantly higher in STEMI and NSTEMI compared to UA. TheMPV, PDW, and P-LCR values of NSTEMI patients were significantly higher than UA patients. The significant differencesbetween STEMI and NSTEMI toward UA might be caused by the more severe thrombotic conditions in myocardial infarctionpatients than UA. The IPF values were significantly different among each type of ACS patients gave an opportunity using thisparameter to differentiate the ACS types. The MPV, PDW, and P-LCR were significantly higher in myocardial infarctionpatients than UA patients, which also allowed them to use those parameters to differentiate both conditions.

Introduction : Cervical cancer is a gynecology cancer with the highest incidence in the Dr.Soetomo Hospital, Surabaya. Neoadjuvant chemotherapy with cisplatin has been used to increase radiosensitivy of cancer cells before radiotherapy done in advanced stage cervical cancer patients. This research aimed to know the differences of CD4-T lymphocyte profile in stage IIIB patient before and after chemotheraphy administration.Methods : This research was done in February-September 2018. Seventeen patients out of 31 stage IIIB cervical cancer patients planned to receive neoadjuvan chemotherapy with cisplatin every 3 weeks for 3 series were checked for the CD4+ T lymphocyte count and percentage. The examinations were done before the first and after the third chemotherapy administration.Results : Mean±SD of the CD4-T lymphocyte count before chemotherapy was 817±314 cells/μL and mean±SD of the CD4-T lymphocyte  percentage was 38.96±8.47%. While mean±SD of the CD4-T lymphocyte count after chemotherapy was 881±335 cells/μL and mean±SD of the CD4-T lymphocyte percentage was 39.01±8.50%. There was no significant  difference of CD4-T lymphocyte count between before and after chemotherapy (p=0.471). There was also no significant difference of CD4-T lymphocyte percentage between before and after chemotherapy (p=0.866). Both the CD4-T lymphocyte count and percentage tended to increase in postchemotherapy condition.Conclusion : The CD4-T lymphocyte count and percentage were not significantly different between before and after chemotherapy administration in stage IIIB cervical cancer patients. Both the CD4-T lymphocyte count and percentage tended to increase in postchemotherapy condition.

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