Almost 40% of Non Small Cell Lung (NSCLC) patients develop Malignant Pleural Effusion (MPE). Nowadays, clinicians prefer to perform a repetitive thoracentesis rather than a definitive procedure, which causes pleural loculations and inflammation. This study aimed to identify risk factors of repeated thoracentesis MPE in NSCLC. This was an observational analytic study with a retrospective cohort design held at Prof.Dr. I.G.N.G Ngoerah General Hospital from January 2018 to June 2022. There were 95 subjects who participated in this study. The median time of repetitive thoracentesis MPE in NSCLC is 3 days (95% CI 1,9-4). The difference in location tumor in the peripheral was 3 days (2.25-3.74) while in the central was 7 days (4.24-9.75), p=0.21. The difference in histology type, Adenocarcinoma was 3 days (1.86-4.13) while squamous cell carcinoma was 4 days (2.53-5.46), p=0.69. Pleural fluid cytology positive was 6 days (2.78-9.22) while negative was 3 days (1.83-4.16), p=0.51. The EGFR mutation positive was 4 days (2.48-5.52) while negative 3 days (1.68-4.31), p=0.78. LDH levels ≥821 IU/L was 3 days (1.49-4.50) while <821 IU/L was 4 days (2.32-5.67), p=0.81. The size of pleural effusion massive was 3 days (1.88-4.11) while non-massive was 4 days (0.93-7.06), p=0.49.
BACKGROUND: Clinical manifestation of coronavirus disease (COVID-19) could be asymptomatic, mild to severe, even mortality. Although various hematological complications associated with COVID-19 infection have been reported, the finding of autoimmune hemolytic anemia (AIHA) is a novel case. CASE REPORT: A 59-year-old woman was admitted to our emergency room because of a 5-day period of fever with cough and shortness of breath. At admission, she was takipnea, jaundice, and had an oxygen saturation of 60% on room air. Laboratory studies showed hemoglobin (Hb) 3.68 g/dL, high reticulocyte (14.4%), and hyperbilirubinemia. Chest X-ray showed bilateral pneumonia with positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. Although she got packed red cell (PRC) transfusions in 7 days, her Hb remained low and bilateral infiltrate still increased. That’s why we considered direct Coombs test and it returned positive. AIHA was diagnosed and treatment with hydrocortisone 100 mg IV twice daily was given for the first 72 h. The maintenance dose with methylprednisolone 16 mg twice daily was continued for 7 days admission. Then, Hb value increased to 11.03 g/dL and she was discharged home without any compliments. CONCLUSION: In the current epidemiological situation, AIHA needs to be considered as a complication of COVID-19 infection in a patient who presents with jaundice and severe anemia without any underlying chronic disease, which is need blood transfusions, steroid medication use, or blood cancer.
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