Problems and Strategies of Blood Transfusion in Thalassemia during Covid-19 Pandemic in Indonesia

Transfusion-dependent thalassemia is the most severe form of thalassemia in which patients require a regular blood transfusion to maintain their haemoglobin level. COVID-19 pandemic has disrupted the routine measure in controlling chronic diseases like thalassemia. This study aims to measure the difference in pre-transfusion haemoglobin level and frequency of transfusion before and during pandemics. This retrospective cross-sectional study utilized medical records data of 101 transfusion-dependent thalassemia (TDT) patients treated in Cipto Mangunkusumo Hospital (CMH) from 2019-2021. The dependent variables of this study were pre-transfusion haemoglobin level and transfusion attendance. The pre-pandemic phase was defined from March 30, 2019, to March 29, 2020, whereas the during-pandemic phase was from March 30, 2020, to March 29, 2021. Up to 59.4% of subjects had suboptimal Hb level of < 9.0 g/dL even before the pandemic and it increased to 71.3% during a pandemic. Transfusion frequency of pre-pandemic and during-pandemic phases showed no significant difference (p-value = 0.990). The mean pre-transfusion haemoglobin level before the pandemic was 8.71 g/dL and it decreased to 8.46 g/dL (p-value <0.001). Our study showed poorer control of pre-transfusion Hb levels during the pandemic and decreased transfusion frequency. This puts them at a higher risk of developing many longterm complications.

Mental Wellbeing among Children with Cancer during COVID-19 Pandemic in Indonesia: A Cross-sectional Study

Introduction Coronavirus disease 2019 (COVID-19) has affected both physical and mental aspect of people worldwide, especially the high-risk group such as pediatric cancer patients. Children with cancer were considered both clinically and mentally vulnerable during this pandemic. They were also affected by the self- isolation, quarantine, and social distancing policy taken as a respond to public threat. Objectives To evaluate the impact of social distancing and health protocol during COVID-19 on the mental health profile of children with cancer in Indonesia. Methods A cross-sectional study evaluating the mental health of children with cancer during COVID-19 pandemic was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2020. An online questionnaire was used to collect demographics of parents and children, children's Strength and Difficulties Questionnaire ( SDQ) score, and parents' Self-Reporting Questionnaire (SRQ). SDQ score consists of five subscales, including the emotional symptoms, conduct problems, hyperactivity, peer relationships problems and prosocial behavior. Cancer types were grouped into retinoblastoma, nonretinoblastoma (other solid tumors), and leukemia. Results There were 156 valid responses, consisting of 42 patients with retinoblastoma, 34 patients with nonretinoblastoma ( other solid tumors), and 80 patients with leukemia. Pandemic-related lifestyle changes did not significantly impact emotional or behavioral problems. Children with normal total SDQ (odds ratio [OR]: 473, p = 0.001) and emotional scores (OR: 3.19, p = 0.07) had parents with normal SRQ scores (<6). Leukemia patients with shorter diagnosis period had worse hyperactivity score ( p = 0.01). On the contrary, leukemia inpatients had better prosocial scores than outpatients (p = 0.03). More bilateral retinoblastoma patients (p = 0.04) with longer duration of cancer diagnosis (p = 0.03) faced peer problems.