Lung cancer is the leading cause of cancer death in Asia. In Indonesia, it contributes the highest number to cancer incidence in male and is ranked fifth in female cancer incidence. Determinated attempts have been delivered to eliminate cancer with chemotherapy being the most important management strategy for advance stage lung cancer. As most medicines come with side effects, so does chemotherapy. Beside killing the target cells, the cytotoxic compound of cancer drug may also seriously alter normal cells. Therefore, formidable toxic effect of chemotherapy to normal tissue becomes the main problem, which clinicians should consider. Myelotoxicity is one of the most common chemotherapy-induced adverse events. It takes place in bone marrow-producing regions causing netropenia, thrombocytopenia and anemia. Each of those cytopenias requires separate intervention. This article will review the physiology of hematopoiesis, pathophysiology of cytopenias, and current guidelines and recommendations for prevention and treatment of myelotoxicity of cytotoxic chemotherapy.
A real-time reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard in diagnosis for infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the false-negative result is the problem in the prevention and control the pandemic of coronavirus disease 2019 (COVID-19). A false-negative of RT-PCR test needs to be evaluated when the patient showed a high clinical suspicion for COVID-19. We report a 36-year-old man with four times negative RT-PCR results, but clinical, radiological (chest X-ray and chest CT scan), and serological examinations showed a high suspicion of COVID-19. History of close contacted with COVID-19 confirmed patient was reported, and the wife of our case was also RT-PCR tested positive for SARS-CoV-2 in the next few days strengthen the COVID-19 diagnosis of our case patient. It is important to use the combination of RT-PCR, chest X-ray, chest CT scan, clinical manifestations, antibodies test, and exposure history of patients to diagnose COVID-19 and decide the early isolation and appropriate treatment.
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