HLA-B 15:13 Positive in an Indonesian Patient with Phenytoin-Induced SJS/TEN

ABSTRACT Steven-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe forms of delayed hypersensitivity reaction with an underlying immunologic mechanism involving the interaction between HLA and drug molecules. A-35-year-old Javanese-Indonesian-male, with a history of seizures, presented with skin peeling, mucosal erosions, and purulent eye discharges. He was clinically diagnosed as overlapping SJS/TEN, and both phenytoin and valproic acid became the suspected drugs. Unfortunately, the seizure relapsed and alternative antiepileptic drugs were urgently needed. HLA typing was then performed, revealing the presence of HLA-B*15:13, which has been proven to be correlated with phenytoin adverse reaction by previous study. Thus, phenytoin was totally discontinued and he only prescribed monotherapy valproic acid. Given the high prevalence and common use of phenytoin in clinical practice, HLA evaluation before phenytoin prescription in Indonesia is important. Further studies are recommended to provide more evidence regarding the role of HLA-B*15:13 in phenytoin-induced severe hypersensitivity reactions in Indonesia

The Difference of Plasma Prothrombin Time Value in the Production of Adsorbed Plasma Using Various Concentrations of Barium Sulphate in Dl: Soetomo General Hospital, Surabaya, Indonesia

Detection ofa factor deficiency in the case of coagulation prolongation is veIY imp01tant. in this case a factor deficient plasma is required. This research provides a simpler method to produce factor deficient plasma. using barium sulphate as an adsorbent with Prothrombin Time (PD of more than 60 seconds as a target. The aim of this study is to analyze the difference ofPT value in various concentrations of barium sulphate. Pooled nonnal plasma (Pl'\lP) was made fi'om citrated blood and basic PT value was measured. Nine plain tubes were prepared with 1 mL of Pi\lP for each tube. Barium sulphate 200-1000 mg/ml plasma was then added to each tube. Finally. PT value of each tube was measured. The presence of barium sulphate <800 mg/ ml plasma made no significant changes in PT. Conversely. the presence of2':800 mglml plasma increased PT more than 5 times compared to nonnal PT. Adsorbed plasma lack vitamin K dependent factors because barium sulphate binds to a -polypeptide. and removes all vitamin K dependent factors. The barium sulphate concentration used to make adsorbed plasma in this research was different with previous research. It was found that barium sulphate with 2':800 mglml plasma can significantly change the PT value. and effectively reach the PT target of adsorbed plasma as a basic reagent for substitution study. In conclusion. different concentrations of barium sulphate used resulted in different PT values. Optimal concentration of barium sulphate to make adsorbed plasma was 2':800 mg/ml plasma