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Case Discussion

Dr. Kemal Fariz Kalista

​

Faculty of Medicine, Universitas Indonesia

Cipto Mangunkusumo Hospital

Jakarta, Indonesia

​

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History

  • 19 yo female
  • Decompensated cirrhosis ec biliary atresia post Kasai (3 months old)
  • Jaundice and recurrent ascites
  • LDLT was performed Sep 2022
  • Donor was her mother, left liver graft, GRWR 0.83
  • After operation, small for size, well managed, discharge

​

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Physical exam

  • No jaundice
  • Lung and heart normal
  • Splenomegaly Schuffner 4
  • No edema

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Lab recap

​

9/12

27/2

5/4

22/8

Hb

8.6

9.7

10.8

10.1

Ht

28.4

31.8

35.1

31.3

WBC

4600

1790

2760

1750

PLT

52000

39000

34000

37000

AST

59

103

22

46

ALT

63

135

46

46

Bil t

4

3.17

2.9

2.1

Bil d

2.9

2.12

1

0.6

Bil i

1.1

1.05

1.9

1.3

ALP

​

289

192

151

GGT

​

37

50

26

Albumin

4

3.9

4.2

​

30/10/23

10/01/24

07/02/24

03/04/24

06/05/24

9.8

11.0

9.9

10.4

9.3

30.8

33.9

31.1

32.5

28.3

1580

2200

1440

1430

1610

29000

38000

29000

26000

29000

21

28

24

21

38

21

39

25

19

47

1.64

2.03

2.37

2.45

​

0.77

0.83

0.64

0.69

​

0.87

1.20

1.73

1.76

​

174

146

145

​

​

18

19

14

​

14

​

​

​

​

​

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Lab recap

​

9/12

27/2

5/4

19/6

22/8

Na

136

140

141

142

​

K

3.7

4.1

3.6

3.8

​

CL

103

110

112

110

​

Ur

17

30

34

19

​

Cr

0.2

​

0.3

0.3

​

eGFR

191

​

167

​

​

RBG

107

126

91

115

​

Tac

6.3

10.4

9

9.4

10.4

PT

​

13/11

14/11

12/11

​

INR

​

1.36

1.4

1.2

​

23/09/23

29/11/23

07/02/24

06/03/24

03/04/24

​

​

140

​

​

​

​

4.0

​

​

​

​

110.6

​

​

​

​

​

23.5

​

​

​

​

0.40

​

​

​

​

151.5

​

132

150

​

​

​

9.7

6.9

8.3

7.1

7.3

​

​

​

​

​

​

​

​

​

​

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Liver Doppler US

No sign of thrombus

Doppler flow on HV, HA and PV normal

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Diagnosis

  • Post Living Donor Liver Transplant ec Biliary atresia
  • Pancytopenia ec hypersplenism

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Medication

  • Methylprednisolon 1x4 mg�Urdafalk 3x500 mg�Prograf 2x2 mg�Lansoprazole 1x30 mg�Vit D 1x2000IU�

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Discussion

  • Pancytopenia due to hypersplenism, improved not so well, is there any treatment to improved hypersplenism? Role of spleen embolization?