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All Journal Medical Journal of Indonesia Majalah Patologi Indonesia Jurnal Penyakit Dalam Indonesia
Lugyanti Sukrisman
Divisi Hematologi-Onkologi Medik, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Health Professions Medicine & Pharmacology Public Health

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The Pattern of Microorganism on Adult Acute Leukemia PatientsDuring Bacterial Surveillance and Febrile Neutropenia at CiptoMangunkusumo Hospital Sukrisman, Lugyanti
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Introduction. The standard intensive chemotherapy in acute leukemia patients will cause severe neutropenia and infection (febrile neutropenia) with high fatality rate. The availability of accurate data on causative pathogens is essential to the appropriate selection of empirical therapy and usually obtained from bacterial surveillance. This study was intended to evaluate bacterial pathogens found on surveillance and during febrile neutropenia in acute leukemia patients undergoing chemotherapy at Cipto Mangunkusumo Hospital and to provide information for antimicrobial policy in the hospital. Methods. A retrospective study from data of bacterial surveillance of acute leukemia patients undergoing chemotherapy during 2008-2010 in isolation room for acute leukemia patients at 8th floor of ‘Gedung A’ Cipto Mangunkusumo Hospital, Jakarta. The isolates for surveillance data were obtained from cultures from feces culture, nasal and throat swab, preputium swab and other sites (urine, sputum, skin infection - as indicated) from acute leukemia patients before and during intensive chemotherapy. Blood sample for blood culture was collected from central venous catheter and peripheral veins using Bactec during febrile neutropenia, and the other specimens (swab, urine, feces cultures) were collected according to the standard laboratory procedure. All specimens were collected by nurses in isolation room and bacterial cultures were performed at microbiology division of Clinical Pathology Department Cipto Mangunkusumo Hospital. Results. There were 1,127 isolates of acute leukemia patients (acute myeloid leukemia - AML or acute lymphocytic leukemia - ALL) that could be analyzed. Gram positive bacteria was significantly higher than gram negative bacteria from all cultures, from respiratory tract (514 out of 675 isolates; 76.1%) and blood culture (Staphylococcus epidermidis and Streptococcus anhemolyticus – 81 out of 103 isolates; 78.7%). Regarding bacterial surveillance in colon, only 8 out of 45 E. coli isolates from feces can be analyzed for sensitivity to ciprofloxacin/cotrimoxazole and the other 37 isolates were sensitive to other antimicrobials that not commonly used for gut decontamination in acute leukemia. The sensitivity pattern of the other isolates could not be analyzed to the antibiotics recommended for the management of febrile neutropenia due to wide range of antibiotics tested. Conclusion. From 1,127 isolates found among acute leukemia patients undergoing intensive chemotherapy at Cipto Mangunkusumo Hospital, it was found that gram positive was the most common bacteria found on upper respiratory tract from bacterial surveillance and from blood culture during febrile neutropenia
The Proportion of Acute Transfusion Reaction at Outpatient Blood Transfusion Unit in Tertiary Hospital in Indonesia Zein, Ahmad Fariz Malvi Zamzam; Sukrisman, Lugyanti
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 2
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Introduction. Acute transfusion reaction (ATR) is an important issue related to patient safety. The prevalence of ATR at tertiary hospital in Indonesia is 0.5%. This study was aimed to determine the proportion of ATR in outpatient blood transfusion unit at tertiary hospital. Method. This retrospective study implemented data from medical records of adult patients who underwent blood transfusion in outpatient blood transfusion unit, Cipto Mangunkusumo Hospital between August – October 2014. The blood components included packed red cells (PRC), thrombocyte concentrate (TC), fresh frozen plasma (FFP), and cryoprecipitate. We recorded the administration of premedication and ATR-related symptoms/signs. The ATR report was based on WHO classification. Results. There were 1,010 blood transfusions during the study period. The distribution of blood components were PRC (n=802, 79.4%), PC (n=74, 7.3%), FFP (n=43, 4.3%), and cryoprecipitate (n=91, 9.0%). The premedication was administered in 21 transfusions (2.1%). There were 11 ATRs with WHO category 1 (1.1%), no other categories were reported. Based on blood component, the ATR occurred predominantly in PRC transfusion (0.6%), followed by FFP (0.3%), cryoprecipitate (0.1%), and TC (0.1%), respectively. Conclusion. The proportion of ATR in outpatients blood transfusion unit at Cipto Mangunkusumo Hospital was 1.1%. All reported ATR were category 1 in this study. The ATR was predominantly in PRC transfusion.
Neutrophil Lymphocyte Ratio as A Predictor of The First Onset Acute Neutropenia After R-CHOP Chemotherapy in Diffuse Large B-cell Lymphoma Patients Christine, Griskalia; Sukrisman, Lugyanti; Sutandyo, Noorwati; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Background. Diffuse Large B-cell Lymphoma (DLBCL) is the most common lymphoma in Indonesia. R-CHOP chemotherapy has a moderate risk for neutropenia / febrile neutropenia. Lymphocytes can describe host immunity, while neutrophils and monocytes can describe the inflammatory response. No study has assessed differential count of leukocytes as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. This study aimed to determine the relationship between differential count of leukocytes before chemotherapy as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. Methods. A retrospective cohort study was conducted among 18–60 years old DLBCL patients with ECOG 0–1 and no comorbidity related to chemotherapy 18–60 years old. Subjects were given with the first 3 cycles of R-CHOP chemotherapy without G-CSF prophylaxis. Results. Of the 95 patients, first onset acute neutropenia after chemotherapy occurred in 83 (87.4%) subjects or 83 (55.3%) cycles of 150 chemotherapy cycles. Febrile neutropenia occurs in 50.6% of the onset of neutropenia. Severe neutropenia occurs in 34 (41.0%) cycles of 83 neutropenic episodes. The first onset of acute neutropenia was the most common at 7–15 days after chemotherapy. The AUC of neutrophil lymphocyte ratio was 0.74 (95% CI 0.65–0.82); while absolute lymphocytes, absolute neutrophils, absolute monocytes, and monocyte lymphocyte ratios were 4.1 neutrophil lymphocyte ratio were able to predict the first onset of acute neutropenia after RCHOP chemotherapy in DLBCL patients (sensitivity 71.1%; specificity 64.2%; positive predictive value 71.1%; negative predictive value 64.2%). Conclusion. Neutrophil lymphocyte ratio before chemotherapy > 4.1 is a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients.
Predictors of Health-Related Quality of Life in Adult HemophiliaPatients in Cipto Mangunkusumo Hospital Prasetyawaty, Findy; Sukrisman, Lugyanti; Setyohadi, Bambang
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 3
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Introduction. Currently, one of the main focus of hemophilia treatment is to increase health-related quality of life. Due to financial constraints, factor VIII substitution is used only on demand in Indonesia, which might contribute to musculoskeletal complications and affect the quality of life of adult hemophilia patients. This study aimed to evaluate quality of life of adult hemophilic patients and its related factors. Methods. A cross-sectional study on hemophilia patients aged 18 years or older was conducted at the Hematology-Medical Oncology outpatient clinic, Cipto Mangunkusumo Hospital Jakarta from March to May 2012. The radiologic assessment for arthropathy used the Arnold-Hilgartner score and health-related quality of life was assessed by the SF-36 questionnaire, using norm-based scoring system with normal value of 45 (individual) and 47 (group scale score). Subjects were categorized based on the level of factor VIII or IX and clinical severity (the number of bleeding episodes during the last 12 months). Results. In 66 subjects aged 18-57 (median 28) years old, the scores of the SF-36 ranged from 42.1 (role physical) to 60.9 (vitality). The physical and mental component summary scored 40.0 and 57.7. Clinical severity (p=0.001) and the severity of arthropathy (p=0.034) significantly influenced the SF-36 scores. The multivariate analysis showed that clinical severity significantly influenced the SF-36 scores (p=0.004; AUC 73%). The combination of clinical severity and severity of arthropaty increased the AUC to 76.6%. Conclusions. Health-related quality of life in adult hemophilia showed poor results in physical components. The clinical severity and arthropathy were predictors of health-related quality of life in adult hemophilic patients. The combination of clinical severity and arthropathy had better value in predicting health-related quality of life in adult hemophilia.
Diagnosis and Treatment of Acquired Hemophilia A (AHA) with Bullous Pemphigoid Sihombing, Rasco Sandy; Silalahi, Henry Ratno Diono; Shatri, Hamzah; Sukrisman, Lugyanti; Rinaldi, Ikhwan; Prasetyawati, Findy; Novianto, Endy; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Arterial and Venous Thrombosis in Patients with Myeloproliferative Neoplasms Sukrisman, Lugyanti
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
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Introduction. Myeloproliferative neoplasm (MPN) is a hematologic disorder that consists of polycythemia vera (PV), essential thrombocythemia (ET and primary myelofibrosis (PMF) and complication of thrombosis is frequently found in patients with MPN. This study was conducted to observe complication of thrombosis in patients with MPN. Methods. A descriptive study was conducted among patients with MPN at MMC Hospital. Clinical data was obtained from medical records of patients with MPN who sought treatment with investigator between 2010 and 2018 and the data was collected consecutively. Evaluation on JAK2 mutation was performed at either the Research and Development Laboratory of Dharmais Cancer Hospital or Kalgen® Laboratory. Complication of thrombosis was found based on radiological data, which could provide evidences on the presence of thrombosis except for complication of sudden deafness and erythromelalgia, which were found based on clinical diagnosis. Results. We found 23 subjects with MPN during the study period, which consisted of 12 subjects with PV, 8 subjects with ET, 2 subjects with PMF and 1 subject with post-ET MF. Evaluation on JAK2 mutation was performed in 16 out of 23 subjects. Thirteen subjects showed mutation of JAK2 gene except in 2 subjects with PMF and 1 subject with ET, who did not show V617F mutation of JAK2 gene. Subject with JAK2 mutation aged between 45 – 71 years. Complications were found in 12 out of 23 MPN subjects including ischemic stroke, DVT, portal vein thrombosis, thrombosis of mesenteric veins and arteries, non-ST elevated myocardial infarction (NSTEMI), peripheral artery disease (PAD), sudden deafness and erythromelalgia. The thrombotic complications occurred in subjects with polycythemia vera, essential thrombocythemia and myelofibrosis, either primary or the post-ET. Ischemic stroke is the most common complication, i.e. in 6 out of 12 (50%) of those with thrombotic complication and in all of subjects with polycythemia vera. There were 2 subjects experienced 2 multiple thromboses at unusual sites with consecutive episodes despites anticoagulant therapy, i.e. thrombosis of portal vein followed by mesenteric artery; and thrombosis of portal vein and mesenteric vein simultaneously followed by non-ST elevated myocardial infarction (NSTEMI) in less than 2 months. Both subjects experienced multiple thromboses during full-dose of anticoagulant therapy. Conclusions. Complication of thrombosis in MPN patients may exist in the form of arterial and venous thrombosis with ischemic stroke as the most common complication in subjects with polycythemia vera. Multiple thrombosis and splanchnic thrombosis as portal vein, mesenteric vein and artery thrombosis can also be found in subjects with MPN.
Dapatkah D-dimer Digunakan sebagai Penanda Koagulasi pada Kanker? Sukrisman, Lugyanti
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 1
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Pasien kanker mempunyai risiko tinggi untuk mengalami trombosis, terutama tromboemboli vena (TEV). Pasien kanker yang mengalami TEV mempunyai risiko mortalitas yang lebih tinggi dibandingkan dengan pasien kanker tanpa TEV.
Systemic amyloidosis following inflammatory bowel disease, follicular lymphoma, and diffuse large B-cell lymphoma: a case report Sukrisman, Lugyanti; Makmun, Dadang; Krisnuhoni, Ening
Medical Journal of Indonesia Vol. 33 No. 3 (2024): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.247428

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Systemic amyloidosis is a rare disorder characterized by the widespread deposition of misfolded amyloid proteins in several organs, leading to organ failure and potentially death if not promptly recognized. The occurrence of inflammatory bowel disease (IBD), follicular lymphoma, and diffuse large B-cell lymphoma (DLBCL) developing into systemic amyloidosis is uncommon. Here is a case of a 55-year-old Asian woman with a history of IBD, follicular lymphoma, and abdominal DLBCL who developed systemic amyloidosis affecting her gastrointestinal, cardiac, and renal organs. Gastrointestinal symptoms (abdominal pain and melena) initially manifested in this patient with systemic amyloidosis. She underwent treatment with three cycles of rituximab and bendamustine. However, she passed away after 2 months of hospitalization due to multiple organ failure. Hence, physicians must be vigilant in recognizing amyloidosis as a potential complication of lymphoma or other inflammatory diseases, as early recognition can contribute to improved clinical outcomes.
The Role of Bone Marrow Biopsy Morphology and Clinical Characteristics in Facing the Challenges of Diagnosing Primary Myelofibrosis, Polycythemia Vera, and Essential Thrombocythemia at Cipto Mangunkusumo Hospital Rifani, Liyona; Stephanie, Agnes; Sukrisman, Lugyanti; Mira Lubis, Anna; Francisca Ham, Maria
Majalah Patologi Indonesia Vol. 32 No. 1 (2023): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Anatomik Indonesia (PDSPA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55816/mpi.v32i1.567

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BackgroundMyeloproliferative neoplasm (MPN) is a neoplasm characterized by the proliferation of one or more myeloid cells and their derivatives. The limitations of molecular examination in Indonesia make the diagnosis of MPN based on clinical and histopathological examination very crucial. The aim evaluate the clinicopathological profile of primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocythemia (ET) and identify the typical morphological characteristics of bone marrow biopsy.MethodsA retrospective study of cases diagnosed with MPN was conducted at the Department of Anatomic Pathology FMUI/RSCM in 2015-2019. Clinical data and evaluation of bone marrow morphology consisting of cellularity, erythroid myeloid ratio, cluster and megakaryocyte morphology, blast cells, fibrosis, osteosclerosis, and sinus dilatation were analyzed.ResultsA total of 172 cases were diagnosed as MPN BCR-ABL1-negative (PMF: 74; ET: 56; PV: 42). On routine blood examination, there was an increase in hemoglobin (Hb) and hematocrit (Ht) in PV, a decrease in Hb in PMF and an increase in platelets in ET (p<0.001). Splenomegaly is mostly found in PMF. Myeloid erythroid ratio was decreased in PV, normal in ET and increased in PMF (p<0.001). Megakaryocytes were arranged in loose clusters in 88.1% of PV cases and 96.4% of ET, dense clusters were found in 91.9% of PMF cases. Staghorn-like megakaryocytes were found in all ET cases and bulbous/cloud-like megakaryocytes were found in 97.3% of PMF cases. Most cases of PV (90.5%) and all cases of ET showed pre-fibrotic bone marrow (grade 0-1), while 77% of PMF cases showed fibrosis grade 2-3.ConclusionIn diagnosing PV, ET, and PMF, correlation between clinical data, laboratory, and bone marrow histomorphological evaluations, especially cellularity, myeloid:erythroid ratio, cluster and megakaryocyte morphology, degree of fibrosis, osteosclerosis, and sinus dilatation is required.
Co-Authors Achmad, Harry R. Ahmad Fariz Malvi Z Zein Al Rasyid Andhika Rachman Andri Maruli T Lubis, Andri Maruli T Angela BM Tulaar Anwar, Irma Wahyuni Arini Setiawati Aru W Sudoyo Bambang Setyohadi Bambang Setyohadi Chozie, Novie A. Cleopas M Rumende, Cleopas M Cleopas Martin Rumende Cleopas Martin Rumende Dadang Makmun Dharma, Rahayuningsih Djajadiman Gatot E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Efta Yudiarsah, Efta Em Yunir Em Yunir, Em Endy Novianto Endy Novianto, Endy Ening Krisnuhoni Errol U. Hutagalung Findy Prasetyawati Findy Prasetyawati, Findy Findy Prasetyawaty Findy Prasetyawaty, Findy Francisca Ham, Maria Griskalia Christine Griskalia Christine Henry Ratno Diono Silalahi Henry Ratno Diono Silalahi, Henry Ratno Diono Ifran Saleh Ika Prasetya Wijaya Ikhwan Rinaldi Ina S Timan, Ina S Jan S Purba, Jan S Jusuf Misbach Karmel L Tambunan, Karmel L Karmel L. Tambunan Kurniadi Husodo, Kurniadi Marcel Prasetyo Mira Lubis, Anna Muchtaruddin Mansyur Nadia A Mulansari, Nadia A Noorwati Sutandyo Noorwati Sutandyo Rasco Sandy Sihombing Rasco Sandy Sihombing, Rasco Sandy Rifani, Liyona S. B. Gunawan Sally A Nasution, Sally A Saptawati Bardosono Sari, Teny T. Shufrie Effendi, Shufrie Siti Setiati Siti Setiati Sofyanuddin Sofyanuddin Stephanie, Agnes Suroto Suroto T. Djumhana Atmakusuma, T. Djumhana