Manajemen pendarahan gingiva akibat pansitopenia pada pasien dengan suspek anemia aplastik     Management of pancytopenia gingival bleeding in patients with suspected aplastic anaemia

Fika Faradillah Drakel; Dewi Zakiawati; Nanan Nur'aeny

doi:10.24198/jkg.v34i1.33530

Manajemen pendarahan gingiva akibat pansitopenia pada pasien dengan suspek anemia aplastik
Management of pancytopenia gingival bleeding in patients with suspected aplastic anaemia

Fika Faradillah Drakel, Dewi Zakiawati, Nanan Nur'aeny

Abstract

Pendahuluan: Pansitopenia merupakan suatu keadaan yang ditandai oleh adanya anemia, leukopenia serta trombositopenia akibat gangguan pada sumsum tulang yang menyebabkan proses produksi sel hematopoietik menjadi tidak normal. Salah satu manifestasi rongga mulut pada pansitopenia adalah pendarahan gingiva. Perawatan pendarahan gingiva telah banyak dilakukan dengan pemberian obat kumur feracrylum 1%, atau dengan cara mengompres lokasi pendarahan menggunakan kain kasa yang ditetes dengan lidokain. Laporan kasus ini bertujuan untuk memaparkan manajemen perawatan pendarahan gingiva pada pasien pansitopenia dengan suspek anemia aplastik. Laporan kasus: Seorang pria berusia 50 tahun dengan keluhan lemah badan, demam, melena dan gingiva berdarah sejak dua tahun yang lalu, tidak disertai rasa sakit pada gingiva dan area lainnya dalam rongga mulut. Pasien ini dirawat bersama oleh bagian Ilmu Penyakit Dalam dan Ilmu Penyakit Mulut. Pemeriksaan rongga mulut menunjukkan adanya pendarahan pada gingiva regio rahang atas kiri dan bawah kiri. Hasil pemeriksaan penunjang menunjukkan hemoglobin: 7,1g/dL, hematokrit: 18%, eritrosit 1,46x10⁴/μL, leukosit 2,5x10³/μL, trombosit 7,2x10⁴/μL. Hasil pemeriksaan sumsum tulang yang pertama sulit dinilai. Transfusi darah diberikan dua labu perhari selama enam hari, area pendarahan pada gingiva dilakukan kompres menggunakan asam traneksamat selama satu sampai tiga menit kemudian dilanjutkan kumur asam traneksamat selama satu menit. Hasil setelah terapi selama 6 hari, tidak ditemukan lagi pendarahan pada gingiva. Simpulan: Terapi lokal kompres dan kumur asam traneksamat dapat menjadi pilihan perawatan yang sangat efektif untuk menghentikan pendarahan gingiva pada pasien pansitopenia, selain terapi transfusi darah tetap dilakukan untuk mengembalikan kadar normal komponen dalam darah.

Kata kunci: anemia aplastik; asam traneksamat; pansitopenia; pendarahan gingiva

ABSTRACT

Introduction: Pancytopenia is a condition characterised by anaemia, leukopenia and thrombocytopenia due to disorders of the bone marrow that cause the production process of hematopoietic cells to become abnormal. One of the oral manifestations of pancytopenia is gingival bleeding. Gingival bleeding treatment has been mainly carried out by administering 1% Feracrylum mouthwash or compressing the bleeding site using gauze dripped with lidocaine. This case report aimed to describe the management of pancytopenia gingival bleeding in patients with suspected aplastic anaemia. Case report: A 50-year-old male with the chief complaint of weakness, fever, melena, and gingival bleeding two years prior, without gingival pain and other oral cavity areas. This patient was treated simultaneously by the Department of Internal Medicine and Oral Medicine. Examination of the oral cavity revealed bleeding in the left maxillary and left mandibular gingiva. Investigation results showed haemoglobin level was 7.1g/dL, hematocrit 18%, erythrocytes 1.46x10⁴/μL, leukocytes 2.5x10³/μL, and platelets 7.2x10⁴/μL. However, the first bone marrow examination result was still challenging to assess. Therefore, two flasks of blood transfusions were given per day for six days. The bleeding gingival area was compressed using tranexamic acid for one to three minutes, followed by tranexamic acid gargling for one minute. After six days of therapy, no more gingival bleeding was detected. Conclusion: Local compress therapy and tranexamic acid gargling can be effective treatment options to stop gingival bleeding in pancytopenia patients; blood transfusion therapy needs to remain carried out to restore normal levels of blood components.

Keywords: aplastic anaemia; tranexamic acid; pancytopenia; gingival bleeding

Keywords

anemia aplastik; asam traneksamat; pansitopenia; pendarahan gingiva; aplastic anaemia; tranexamic acid; pancytopenia; gingival bleeding

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DOI: https://doi.org/10.24198/jkg.v34i1.33530