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All Journal GANESHA MEDICINA
Putu Arya Nugraha
Department of Internal Medicine, Faculty of Medicine, Universitas Pendidikan Ganesha/ Buleleng General Hospital, Buleleng, Bali, Indonesia
Health Professions Medicine & Pharmacology Public Health

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Diagnostic Challenges of Acute Limb Ischemia Rutherford IIa with Pancytopenia Nyoman Budhi Wirananda Setiawan; I Ketut Andriyasa; Putu Arya Nugraha; Made Widiastika; Dwiputra Yogi Pramarta; Ni Made Nova Andari Kluniari
Ganesha Medicina Vol. 6 No. 2 (2026):
Publisher : Universitas Pendidikan Ganesha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23887/gm.v6i2.111031

Abstract

Pancytopenia is a hematological condition associated with impaired blood cell production and an increased risk of bleeding, making arterial thrombosis an uncommon clinical finding. The coexistence of pancytopenia and acute limb ischemia presents significant diagnostic and therapeutic challenges. This case report aims to describe the complexity of diagnosing and managing acute limb ischemia in a patient with underlying pancytopenia. An 87-year-old woman with a known history of pancytopenia presented with pain and blackish discoloration of the right great toe. Laboratory evaluation revealed severe anemia, leukopenia, and thrombocytopenia. Doppler ultrasonography demonstrated atherosclerosis with multiple thrombi in the femoral and anterior tibial arteries. Peripheral blood smear showed abnormal erythrocyte and platelet morphology. A diagnosis of acute limb ischemia with pancytopenia was established. Management posed a clinical dilemma, as anticoagulation was required to prevent ischemic progression, while severe thrombocytopenia increased the risk of bleeding. After multidisciplinary discussion, conservative treatment with heparin was initiated. The patient’s family declined invasive diagnostic and therapeutic procedures, including bone marrow examination and thrombectomy. This case highlights the importance of considering a broad differential diagnosis in pancytopenia and emphasizes the need for individualized management strategies when acute limb ischemia occurs in patients with high bleeding risk.
Profile Hospital Anxiety and Depression Score (HADS) in Hemodialysis Patient Putu Arya Nugraha; Ni Made Nova Andari Kluniari
Ganesha Medicina Vol. 6 No. 1 (2026)
Publisher : Universitas Pendidikan Ganesha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23887/gm.v6i1.95894

Abstract

Chronic kidney disease (CKD) is a major global health problem. In 2020, approximately 2.5 million people worldwide underwent hemodialysis. Comprehensive management, including a biopsychosocial approach, is required for patients with CKD undergoing hemodialysis. Depression and anxiety are common comorbid conditions among patients with CKD, with an estimated prevalence of approximately 25% in this population. The Hospital Anxiety and Depression Scale (HADS) questionnaire is widely used to assess anxiety and depression in patients with various medical conditions and has been proven to be a valid instrument for use in the general population. This study was a cross-sectional study aimed at describing the characteristics of anxiety and depression among hemodialysis patients at RSUD Buleleng. Among the 94 subjects, 65% were men, and most had anemia (94%). Only 36.17% had a high level of education. Based on HADS assessment results, 17.04% had mild anxiety, 1.06% had moderate anxiety, and 81.9% had no anxiety. The HADS assessment for depression showed that 12.76% had mild depression, 2.14% had moderate depression, and 85.1% had no depression.
Co-Authors Dwiputra Yogi Pramarta I Ketut Andriyasa Made Widiastika Ni Made Nova Andari Kluniari Ni Made Nova Andari Kluniari Nyoman Budhi Wirananda Setiawan