Sharing experience in treating with EHL product , Banjarmasin Wulandewi Marhaeni SMF IKA RSUD Ulin / FK Universitas Lambung Mangkurat Banjarmasin

Indonesia Banjarmasin South Kalimantan , 38,744.23 km2

Demographic of South Kalimantan The population of Banjarmasin city is 692 793 people The population of South Kalimantan Province is 4,119,794 people The numbers of hospital in the province of South Kalimantan : 22 government hospitals 19 private hospitals Centre haemophilia in RSUD Ulin (3rd level) in Banjarmasin

Population of patients served by haemophilia centre Children and adult Patient numbers Haemopilia A : 24 Patients ( children 21, adult 3 ) Haemophilia B : 5 Patients (children 4, adult 1) VWD : 1 patient

Staff working with haemophilia at Ulin General Hospital Banjarmasin Patients have access to hospital 24 hours at the centre Staff Medic 2 haematologist pediatrician 1 haematologist internis 14 nurses in haematology ward 1 urologist 1 pediatric surgery 1 orthopedic surgery 4 doctor physiotherapist 2 dentist

Cases number per year Hemarthrosis 40 Gum bleeding 17 Haematoma 87 Circumcision 6/4 Intracranial haemorrhage 3 Melena 2 Bleeding from another site 5

Coagulation products used Haemohilia A Plasma pdFVIII Haemophilia B PCC Human coagulation FIX

Treatment methode 100 % on demand

Experience with EHF By Donation 10 patients received donation 9 patients haemophilia A 1 patient haemophilia B

Procedure for obtaining donation Indonesian Hemophilia Society announcement for donation Indonesian Hemophilia Society South Kalimantan branch propose request for donation Application be considered by the board Application approved Branch  received a letter of acceptance The Branch taking EHL donation from Jakarta after coordination with the board

Prepare before propose donation Consolidation with hemophiliacs family and the team of doctor at the centre of hemophilia ( Ulin Hospital) Select Patients Procedures Schedule for implementation of the action Told member to take AHF from Jakarta

Donation receipt schedule In May 2016 for 4 children In November 2016 for 3 children In March 2017 for 3 children

List of patients receiving EHL no Patients Action Level F VIII / F IX hemophilia vial Total I Unit 1 M (15 yo/35 kg) circumcision 1.83% A 10 10,000 2 F (9 yo/23kg) 2% 3 RAS ( 8 yo/23kg) 1.99% 4 MRF(6,7 yo/22kg) 7,500 5 MNA(6,7yo/17kg) 0.83% 8 6,000 6 SW (11 yo/27kg) 5% 7 AG (5.5 yo/21 kg) 20 15,000 MAM(8 yo/20kg) 9 MF(7.7 yo/19kg) ICL (8 yo/25 kg) hemarthrosis 3% B 2,000

Preparation for circumcision in patients with hemophilia used EHL product in ulin Hospital Coordination with urologist / pediatric surgery/ anesthetist Laboratory check Patients were given AHF until coagulation test normal Patients were given EHL before and after circumcision Patients were given EHL once a day until the wound is healed

Donation for patients with haemophilia A We accept donation for 9 patients Prepare for circumcision The average length of stay 9 days No side effect 2 patients got re bleeding after discharge

Donation for patients with hemophilia B 1 hemophilia B patient receive donation Hemarthrosis on knee joints Receive 2 vials EHL ( 2000 IU) No side effect Haemarthrosis heal properly

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