Case of methemoglobinemia in an infant with cyanosis

Methemoglobinemia refers to a group of hemoglobinopathies which characterized by an increase of the hemoglobin (Hb) amount, in which oxidation of ferrous iron to ferric iron is observed with the loss of the ability to reversibly bond with oxygen and the development of hemic hypoxia. Cyanosis is the most common symptom of methemoglobinemia and is the reason for the differential diagnosis of cardiovascular and respiratory diseases. Timely determination of the cause of cyanosis in a newborn can be a difficult task. By origin, cyanosis in children at birth and in the first weeks of life is cardiac, respiratory, cerebral, metabolic, and hematological. The prognostic value of cyanosis is different for different diseases. Pronounced and persistent cyanosis in diseases of the lungs and heart indicates a high degree of respiratory or heart failure and prognostic unfavorable. Most of the causes of acute cyanosis is an immediate threat to the life of the patient. Prolonged tissue hypoxia in patients with persistent cyanosis leads to the development of secondary erythrocytosis, an hematocrit increase, blood viscosity, which worsens the microcirculation in tissues, aggravating the deficit of tissue respiration. If cyanosis is detected in infants, differential diagnosis should include hemoglobinopathies, in particular, methemoglobinemia. A carefully collected medical history, the exclusion of all possible causes of cyanosis and hypoxemia, and the assessment of methemoglobin in the blood allow a timely diagnosis. The purpose of the article is to describe the clinical observation of methemoglobinemia in an infant with a detailed discussion of the characteristics of the case.

HUBUNGAN JUMLAH DAN LAMANYA MEROKOK DENGAN VISKOSITAS DARAH

AbstrakSaat ini jumlah perokok, terutama perokok remaja terus bertambah, khususnya di negara-negara berkembang. Keadaan ini merupakan tantangan berat bagi upaya peningkatan derajat kesehatan masyarakat.Setiap kali menghisap asap rokok, apakah sengaja atau tidak, berarti juga mengisap lebih dari 4000 bahan kimia dan 200 diantaranya beracun, diantaranya nikotin, gas CO dan tar.Karbon monoksida (CO) menimbulkan desaturasi hemoglobin, menurunkan langsung persediaan oksigen untuk jaringan seluruh tubuh termasuk miokard. Fakta menyatakan bahwa perokok bernafas pada 250 ml CO dari setiap bungkus rokok. CO mengurangi kemampuan eritrosit untuk membawa oksigen dan tubuh mengkompensasi hal ini dengan memproduksi lebih banyak eritrosit. Dengan demikian, CO meningkatkan viskositas darah, sehingga mempermudah penggumpalan darah.Tujuan dari penelitian ini untuk mengetahui hubungan jumlah dan lamanya merokok dengan viskositas darah. Penelitian ini menggunakan metode studi deskriptif analitik, dengan menggunakan desain penelitian Cross Sectional Study. Penelitian ini terdiri dari 30 orang laki-laki perokok dengan umur berkisar 16-40 tahun. Kadar viskositas darah ditentukan dengan menggunakan alat Viskosimeter Oswald.Data dianalisis dengan menggunakan SPSS dan hasil analisis statistik dinyatakan bermakna bila didapatkan harga p < 0,05.Hasil dari penelitian menunjukkan tidak terdapat peningkatan viskositas darah laki-laki perokok dari viskositas darah normal (viskositas darah normal 3-4 kali viskositas air) rerata 1,64150 cP ± 0,184573 (viskositas air 0,6947cP). Terdapat korelasi positif antara jumlah rokok yang dihisap setiap hari dengan viskositas darah ( r = 0,228 dan p > 0,05). Terdapat korelasi positif antara lamanya merokok dengan viskositas darah (r = 0,318 dan p > 0,05).Hasil dari penelitian ini dapat disimpulkan bahwa terdapat hubungan antara jumlah rokok yang dihisap setiap hari dan lamanya merokok dengan viskositas darah.Kata kunci : Viskositas Darah, PerokokARTIKEL PENELITIAN138AbstractRecently number of smoker, especially young smoker increasingly increase, especially in the developing countries. This condition is heavy challenge to exert incrasing the public health degree.Every smoke, both intentionally or not, it also means suck more 4000 chemical matters and 200 have poison, include nicotine, CO and tar.Carbon monoxide (CO) result hemoglobin desaturation, direct decrease oxygen store for tissue in body included myocard. In fact suggest that the smokers breath on 250 ml CO from a pack of cigarette. CO reduce erythrocyte capability to carry oxygen and the body compensate it with producing more erythrocyte. Thus, CO increase blood viscosity, so that facilitate blood clotting.The aim to this study is to know association of number and duration of smoke with blood viscosity. This study using analytic descriptive study method, with using Cross Sectional Stud design. This study include 30 somker men with 16-40 years ages. The blood viscosity level is defined with Oswald’s viscosimeter.Data is analyzed using SPSS and its statistical analyses result is significant with p <0,05.Result indicate that there are not increasing blood viscosity of smoker men form normal blood viscosity (normal blood viscosity is 3-4 water viscosity) with mean 1,64150 cP ± 0,184573 (water viscosity = 0,6947 cP). There are positive correlation between number of cigarette smoked everyday with blood viscosity (r = 0,228 and p >0,05). There are positive correlation between duration of smoke and blood viscosity (r = 0,318 and p >0,05).The result of this study can be concluded that there are association between number cigarette smoked everyday and duration of smoke with blood viscosity.Key word : Blood viscosity, smoker.