Article Per Year (5 Year)
p-Index From 2021 - 2026
0.61
P-Index
This Author published in this journals
All Journal Archives of The Medicine and Case Reports Sriwijaya Journal of Internal Medicine
Desak Agung Indah Praharsini Dewi
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

Published : 2 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 2 Documents
Search

 1 
Cold Agglutinin Disease Presenting with Acute Encephalopathy in an Elderly Patient with Multiple Comorbidities: A Case Report and Laboratory Diagnostic Perspective Desak Agung Indah Praharsini Dewi; I Gusti Ayu Wiradari Tedja; Made Ayu Vita Prianggandanni
Sriwijaya Journal of Internal Medicine Vol. 3 No. 2 (2026): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v3i2.246

Abstract

Introduction: Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia caused by monoclonal immunoglobulin M autoantibodies that bind to red blood cells at temperatures below 37 degrees Celsius. CAD typically manifests with chronic hemolytic anemia in elderly patients, but presentations with acute, severe complications remain infrequent. Case presentation: We report a 70-year-old male patient who presented with acute decreased consciousness lasting 2 hours, preceded by one week of cough and fever. Initial clinical evaluation suggested sepsis-associated encephalopathy. However, a comprehensive laboratory investigation, including peripheral blood smear and direct Coombs test, revealed CAD as the underlying diagnosis. Critical laboratory finding was marked mean corpuscular hemoglobin concentration elevation to 43 g/dL, exceeding physiologic maximum and indicating erythrocyte agglutination interference. Positive Coombs test with immunoglobulin G sensitization and positive cold agglutinin titer confirmed the diagnosis. The patient had significant comorbidities, including chronic kidney disease Stage V, type 2 diabetes mellitus, and heart failure with coronary artery disease. The patient subsequently underwent supportive care with cooling precautions, and clinical improvement was noted. Conclusion: This case exemplifies how careful attention to laboratory pattern recognition, particularly supraphysiologic mean corpuscular hemoglobin concentration values, can facilitate the diagnosis of CAD in elderly patients presenting with acute multisystem complications. The role of clinical pathology in the diagnostic identification of rare hematologic disorders deserves emphasis in medical education and clinical practice.
Transfusion-Refractory Warm Autoimmune Hemolytic Anemia with Dual Direct Antiglobulin Test Positivity and Marked Monocytosis in an Elderly Patient: A Case Report I Gusti Ngurah Bayu Paramartha; Dewa Gde Agung Wikananda Besang; Desak Agung Indah Praharsini Dewi
Archives of The Medicine and Case Reports Vol. 7 No. 2 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i2.882

Abstract

Warm autoimmune hemolytic anemia represents a significant clinical challenge in adult hematology, with corticosteroid refractoriness occurring in approximately thirty to forty percent of cases. Management becomes substantially more complex in elderly patients with multiple comorbidities, where standard immunosuppressive therapy frequently fails and alternative therapeutic strategies become necessary. A sixty-three-year-old male with three months of documented warm autoimmune hemolytic anemia presented with acute hemolytic crisis manifested by severe anemia (hemoglobin declining from five point three to four point four grams per deciliter over four days) and accelerated hemolysis. Direct antiglobulin testing demonstrated dual positivity with immunoglobulin G one plus and complement component three-d two plus, indicating complement-mediated hemolysis. Notably, marked monocytosis ranged from seventy to seventy-four percent across serial complete blood counts. The patient demonstrated rapid immunosuppressive treatment failure with escalated triple therapy (methylprednisolone, mycophenolate mofetil, azathioprine) failing within four days of initiation. Transfusion refractoriness was evident despite premedication protocols. Concurrent medical conditions included hypertensive heart disease with documented coronary artery disease, newly diagnosed type two diabetes mellitus with suboptimal glycemic control, benign prostatic hyperplasia requiring catheterization, and clinical immunosuppression complications. The patient was referred to a tertiary academic medical center for advanced therapeutic decision-making. In conclusion, this case illustrates the diagnostic and therapeutic complexity of warm autoimmune hemolytic anemia with complement activation in an elderly population, highlighting the necessity for rapid escalation to advanced therapeutic modalities beyond conventional immunosuppression when clinical deterioration occurs despite maximal standard therapy.
Co-Authors Anak Agung Oka Lely Anak Agung Sri Agung Aryastuti Dewa Gde Agung Wikananda Besang I Gusti Ayu Wiradari Tedja I Gusti Ngurah Bayu Paramartha Made Ayu Vita Prianggandanni