Hemolytic anemia incident in leprosy patients receiving multi-drug therapy at Haji Adam Malik Central Hospital, Medan-Indonesia.

Wan Tisya Muhaira , Mila Darmi, Ramona Dumasari Lubis

Wan Tisya Muhaira
Dermatology and Venereology Resident, University of North Sumatra. Email: [email protected]

Mila Darmi
Consultant in Leprosy Subdivision, Department of Dermatology and Venereology Faculty of Medicine University of North Sumatra

Ramona Dumasari Lubis
Consultant in Leprosy Subdivision, Department of Dermatology and Venereology Faculty of Medicine University of North Sumatra
Online First: August 08, 2018 | Cite this Article
Muhaira, W., Darmi, M., Lubis, R. 2018. Hemolytic anemia incident in leprosy patients receiving multi-drug therapy at Haji Adam Malik Central Hospital, Medan-Indonesia.. Bali Medical Journal 7(2). DOI:10.15562/bmj.v7i2.774

Introduction: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae ,which is an obligate intracellular bacteria. The therapy of leprosy involves a combination of drugs called multi-drug therapy and one of the drugs included in this therapy is dapsone. Dapsone has a hematotoxic effect because of its toxic metabolite called hydroxilamine. The most common side effect of this drug is hemolytic anemia. Hemolytic anemia occurs when the production of erythrocytes is not balanced with their destruction, causing the lifespan of erythrocyte to become shorter and the bone marrow fails to compensate for this.

Methods: This research is a pre experimental study with a pre-post design, involving 15 leprosy patients that were diagnosed by clinical and laboratory examination. We conducted measurements of hemoglobin, MCV, MCHC, and reticulocyte count before and after the MDT therapy for 3 months.

Results: In this study, the incidence of hemolytic anemia after 3 months receiving MDT was 66.7%. There was decreased hemoglobin level (mean 11.320 g/dl), increased reticulocyte count (mean 2.341%), normal level of MCV (mean 88.807 fL), and decreased level of MCHC (mean 31.920 g%). There were significant differences in hemoglobin level, MCHC level, and reticulocyte count before and after 3 moths of MDT.

Conclusion: There was a significant difference in the number of hemolytic anemia before and after MDT with a p-value < 0.05.


Rea TH, Modlin RL. Leprosy. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editor. Fitzpatrick’s dermatology in general medicine. 8th ed. New York, McGraw-Hill. 2012. p.1786-96.

Bryceson A, Pfaltzgraff RE. Introduction. Mycobacterium leprae. Leprosy. 3th ed. New York: London Churchill Livingstone. 1990. p.1-10.

Amirudin MD, Hakim Z, Darwis E. Diagnostik Penyakit Kusta. In: Daili ESS, Menaldi SR, Ismiarto SP, Nilasari H, editor. Kusta. 2nd ed. Balai Penerbit FK UI. Jakarta. 2003. p.12-32.

Departemen Kesehatan RI Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan. Buku Pedoman Nasional Pemberantasan Penyakit Kusta. 2007. 18:1-75.

Phumla S. Drug Induced Hemolytic Anemia. Clinical pharmacology, 25, June, 2007. p.286-88.

Zhu YI, Stiller MJ. Dapson and Sulfones in Dermatology: Overview and Update. Journal American Academy of Dermatology. 2001; 45: 420-34. doi:10.1067/ mjd.2001.1147 33.

Sago J, Hall RP. Dapsone. In: Tharp MD, editor. Dermatologic Therapy. Blackwell Publishing, Inc. 2002; 15: 340-51. doi: 10.1046/j.1529-8019.2002. 01543.

Bacman D, Kuhn A, Ruzicka T. Dapsone and Retinoids [internet]. In: Cutaneous Lupus Erythematosus, Part IV. 2005. Springer Berlin Heidelberg. doi:10.1007/3-540-26581-3_27.

Coleman MD. Dapsone: Modes of Action, Toxicity and Possible Strategies for Increasing Patient Tolerance. British Journal of Dermatology. 1993; 129: 507-13.

Beutler E. Destruction of erythrocytes. In: Kaushansky K, Litchman MA, Beutler E, Kipps TJ, Seligsohn U, Prchal JT, editor. William Hematology. 8th ed. McGraw-Hill, 2010. Chapter 32.

Oehadian A. Pendekatan klinis dan diagnosis anemia. CKD-194, 2012;39(6): 407-12.

Deps PD, Nasser S, Guerra P, Simon M, Birshner RC, Rodrigues LC. Adverse Effects from Multi Drug Therapy in Leprosy: a Brazilian Study. Lepr Rev (2007) 78, 216-22.

Bryceson A, Pfaltzgraff RE. Symptom and sign. Leprosy. 3rd ed. New York: London Churchill Livingstone; 1990. p.25-56.

Tosepu R, Effendy DS, Imran LOA, Asfian P. Epidemiology study of leprosy patients in the district of Bombana Southeast Sulawesi Province, Indonesia. Int J Res Med Sci. 2015 May; 3(5): 1262-1265. doi: 10.5455/2320-6012.ijrms20150541.

Varkevisser CM, Lever P, Alubo O, Burathoki K, Idawani C, Moreira TMA. Gender and leprosy: case studies in Indonesia, Nigeria, Nepal and Brazil. Lepr rev. 2009; 80:65-76.

Scheelbeck PFD, Balagon MVF, Orcullo FM, Maghanoy AA, Abellana J, Saunderson PR. A Retrospective Study of The Epidemiology of Leprosy in Cebu: An Eleven-Year Profile. Plos Neglected Tropical Diseases. 2013 September; 7(9):e2444. p.1-12. doi: 10.1371/journal.pntd.000.2444.

Infodatin. Pusat Data dan Informasi Kementrian Kesehatan RI. 2015. Available from: http://www.depkes.go.id [cited 2015 Nov 23rd].

Kumar RBC, Singhasivanon P, Sherchand JB, Mahaisavariya P, Kaewkungwal, Peerapakorn S, et al. Gender differences in epidemiological factors associated with treatment completion status of leprosy patients in the most hyperendemic district of Nepal. Southeast Asian J Trop Med Public Health. June, 2004;35(2):334-339.

Al-sieni AI, Al-Layati WZ, Al-Abbasi FA. Temporal Adverse Effect in Leprosy Saudi Patients Receiving Multi Drug Therapy. Clinical and Experimental Pharmacology. 2013;4(1):1-4. doi:10.4172/2161-1459.1000141.

Halim NKD, Ogbeide E. Haematological Alterations in Leprosy Patients Treated with Dapsone. East Africa Medical Journal. 2002; 79(2): 100-2.

Singh H, Nel B, Dey V, Tiwari P, Dulhani N. Adverse effect of multi drug therapy in leprosy, a two years’ experience (2006–2008) in tertiary health care in the tribal region of Chhattisgarh state (Bastar, Jagdalpur). Lepr Rev (2001) 82, 17-24. doi: 0305-7518/11/064053+08.

Muller A, Jacobsen H, Healy E, McMickan S, Istace F, Blaude MN, et al. Hazard classification of chemicals inducing haemolytic anaemia: An EU regulatory perspective. Regulatory Toxicology and Pharmacology. August 2006; 45(3):229-241.

Prchal JT. Production of erythrocyte. In: Kaushansky K, Lichtman MA, Beutler E, Kipps TJ, Seligsohn U, Prchal JT. Williams Hematology. 8th edition. Mc Graw Hill. 2010. Chap.32.

Guillaud C, Loustau V, Michel M. hemolytic anemia in adults: main causes and diagnostic procedures. Expert Rev Hematol. 5(2),2012:229-41. doi: http://dx.doi.org/10.1586/ehm.12.3

Deps P, Guerra P, Nasser S, Simon M. Hemolytic anemia in patients receiving daily dapsone for the treatment of leprosy. Lepr Rev (2012) 83, 305-7.

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