FVIII inhibitor surveillance in children with hemophilia A in Indonesia:a report from the Indonesian Pediatric Hematology-Oncology Working Group

Background@#Factor VIII (FVIII) inhibitor diagnosis and surveillance in Indonesia are challenging owing to geographic conditions and the lack of laboratory facilities nationwide for inhibitor assays. This study aimed to determine the prevalence of FVIII inhibitors in children diagnosed with hemophilia A (HA) in Indonesia. @*Methods@#A cross-sectional study was conducted in 12 hospitals in eight provinces of Indonesia between 2020 and 2021. Factor VIII inhibitor screening was performed in a central hemostasis laboratory for all children with HA (≤18 yr) who had received a minimum of 10 exposure days to clotting factor concentrates. The FVIII inhibitor titer was determined using the Bethesda assay. @*Results@#Children (388) were enrolled in this study, including 219 (56.4%), 131 (33.8%), and 38 (9.4%) with severe, moderate, and mild HA, respectively. The prevalence of children who developed FVIII inhibitors was 37 out of 388 (9.6%). Factor VIII inhibitors were found in 25/219 (11.4%) severe, 11/131 (8.3%) moderate, and 1/38 (2.6%) children with mild HA. Thirteen children had low-titer inhibitors and 24 had high-titer inhibitors, with a median of 9.44 (1.48‒412.0) Bethesda Units. Among 13 children with low-titer inhibitors, eight underwent a confirmation test, of which five tested negative and were classified as transient. A significant difference in annual joint bleeding rate was found between patients with low and high inhibitor titers and those without inhibitors (P ＜0.001). @*Conclusion@#Factor VIII inhibitor prevalence in Indonesia was relatively low. However, the risk factors that may contribute to FVIII inhibitor development among Indonesian patients require further study.

Risk Factors Affecting Symptoms Of Depression In Mothers Of Children With Leukemia

The prevalence of depression in mothers of children with leukemia undergoing chemotherapy was as high as 91%, while the risk factors are still unclear. To analyze the risk factors for symptoms of depression in mothers of children with leukemia undergoing chemotherapy. A cross-sectional study was conducted in 41 mothers of children with leukemia undergoing chemotherapy at Haji Adam Malik Hospital from February to May 2016. Subjects were selected by consecutive sampling technique. The mothers were interviewed to obtain demographic data. Symptoms depression level was assessed using Beck's Depression Inventory (BDI). The relationship between mothers age, gender of child, education level, socioeconomic status, and symptoms of depression in mothers were analysed using Chi-square test and Independent t-test. The risk factors were identied using logistic regression test. Variables with P<0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value <0.05 was considered statistically signicant. The mean age of mothers in this study was 37.12 years (SD 6.92). Symptoms of depression proportion in this study was 61%. The lowest prevalence rate of depression (32%) is seen in mothers with a college diploma or bachelor's degree. There was a statistically signicant relationship between education level, socioeconomic status, and symptoms of depression in mothers. Based on the results of multivariate analysis; low education level (OR=0.11; 95% CI, 0.02-0.62) and middle and high income (OR=0.13; 95% CI, 0.02-0.72) remained signicant risk factors of symptoms of depression in mothers. Low eduation level and middle and high income increase the risk for symptoms of depression in mothers of children with leukemia undergoing chemotherapy.