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Latar belakang Sindroma evan (Evans syndrome) merupakan penyakit yang sangat jarang, dimana terjadi suatu keadaan anemia hemolitik otoimun yang bersamaan dengan immune thrombocytopenia (ITP). Penyakit ini diperkenalkan pertama kali pada tahun 1951 oleh Evan dkk Kasus Seorang laki-laki pegawai toko 23 tahun datang dengan keluhan cepat lelah dan perdarahan gusi hilang timbul selama 4 bulan terakhir.Laboratorium hemoglobin 4,8 gr%, trombosit 11.900 /mm, leukosit 11.090/mmk, retikulosit yaitu 12,4 %. Pada pemeriksaan gambaran darah tepi ditemukan sferosit pada eritrosit dan giant trombosit. Ureum, kreatinin, natrium, kalium, kalsium normal . Protein total 8,4 gr/dl albumin 3,2 gr/dl. Didapatkan hiperbilirubinemia (4,48 mg/dl) dengan dominasi bilirubin indirek (2,20 mg/dl). Didapatkan peningkatan dari kadar ANA sebesar 79 U, tetapi anti Ds-DNA tidak meningkat (201,9 U). Pemeriksaan coomb pada penderita ini menunjukkan hasil yang positif baik direk (+3) maupun indirek (+2).Selanjutnya pasien diberikan injeksi intravena metilprednisolon 125 mg/12 jam dan siklosporin oral 50 mg/12 jam selama 5 hari dilanjutkan pemberian metilprednisolon dan siklosporin oral sampai pasien pulang dan selama dirumah. Kesimpulan Anemia hemolitik otoimun dan immune thrombocytopenia yang terjadi bersamaan (sindroma Evan) merupakan kelainan yang jarang dijumpai. Penegakan diagnosis disertai dengan menyingkirkan penyebab anemia dan trombositopenia imun sekunder yang lain. Pemberian steroid dan imunosupresan pada sebagian besar pasien masih menunjukkan hasil yang cukup baik dalam mencapai keadaan remisi.

Patients with active cancer (cancer on treatment, those planning to start treatment, and those immediately post-treatment) consider getting the COVID-19 vaccine, like the other vulnerable populations, to reduce the severe risk of SARS-CoV-2 infection. We suggest patients with cancer should be vaccinated with a non-lived COVID-19 vaccine. Specific consideration belongs to the type of cancer, current treatment, phase of disease along the cancer continuum, and optimal timing for vaccination; they should talk to their hematologist-medical oncologist. Vaccination with the live-attenuated and replicating-vector vaccine is strongly discouraged in patients with active cancer receiving chemotherapy and during other immunocompromising therapies. For patients those receiving intensive chemotherapy (e.g., induction or consolidation therapy in acute leukemia), anti-B-cell antibodies, hematopoietic stem cell transplantation (HSCT), and other immunocompromised conditions, we suggest postponing SARS-CoV-2 vaccination until reaching stable lymphocyte counts due to the risk of vaccine infectivity. Cancer survivors are considered to have the same risk as other persons with matched aged and other risk factors. They also should be vaccinated as early as possible. There are various other risk factors for cancer patients which must consider related to complications of COVID-19, such as age, other comorbid diseases, demographic and social factors. All of these factors should be judged as a comprehensive evaluation of an individual patient. The use of masks, physical distancing, hygienic activities such as washing hands with soap and hand sanitizers are still needed during this pandemic. Caregivers and households should certainly be included in the vaccination strategies.

A newly emerging pandemic of coronavirus disease 2019 caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide The ongoing substantial research endeavor to comprehend its associated coagulopathy requires proportional progress on guidance establishment Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is expected to be a precursory formulation for prospective guideline development © 2020, Sanglah General Hospital All rights reserved

The treatment for ineligible transplant multiple myeloma is melphalan prednisone. Curcumin has an anti-inflammatory and antiangiogenesis in cancer-directed to nuclear factor-kappa B (NF-kB) pathway. Interleukin 6 (IL-6), vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and lactate dehydrogenase (LDH) were also involved in the pathogenesis of myeloma. No clinical study has evaluated the efficacy of curcumin in myeloma patients. To evaluate the efficacy of curcumin as adjuvant into melphalan prednisone in myeloma patients.33 myeloma patients at Dr. Kariadi General Hospital, Semarang, Indonesia during 2016-2017 were randomly assigned single-blindedly into MPC (n=17) and control group (n=16). The MPC group was treated with melphalan 4 mg/m2, prednisone 40 mg/m2 for 7 days, and curcumin 8 gram daily for 28 days. The MP control group was treated with melphalan, prednisone, and placebo. The primary endpoint was the overall remission. Pre- and post-treatment was examined for NF-κB, VEGF, TNF-α, IL-6, LDH, and CRP levels All data analyses were per protocol.There was a significant difference in overall remission between the MPC and MP control groups [75%vs 33.3%, xCurcumin has an efficacy in improving overall remission and decreasing NF-κB, VEGF, TNF-α, and IL-6 levels in myeloma patients