STATUS PASIEN TGL : _____/ 4 / 2024

DIVISI ALERGI - IMUNOLOGI

NAMA :

TERDIAGNOSIS TANGGAL :
RM :
TTL / USIA : ACR 1997 SLEDAI SCORE
1. Ruam malar Kejang
DIAGNOSIS : 2. Ruam diskoid Psikosis
BB : 3. Fotosensitif Organic brain syndrome
TB : 4. Ulkus oral Gangguan visual
LPT : 5. Artritis non erosif Gangguan SSP
STATUS GIZI : 6. Pleuritis/perikarditis Lupus headache
TD : 7. Kelainan ginjal CVA
8. Kelainan neurologi Vaskulitis
ANAMNESIS 9. Kelainan hematologi Artritis
10. Kelainan imunologis Miositis
11. ANA test Urinary cast
TOTAL Hematuria
Proteinuria
SLICC CRITERIA 2012 Piuria
Kriteria klinis Rash
1. Lupus kutaneus akut Alopesia
2. Lupus kutaneus kronik Ulkus mukosa
3. Ulkus oral Pleuritis
4. Alopesia Perikarditis
5. Sinovitis Komplemen darah rendah
PEMFIS 6. Serositis Anti ds-DNA
7. Renal Demam
8. Neurologi Trombositopenia
9. Anemia hemolitik Leukopenia
10. Leukopenia TOTAL
11. Trombositopenia
AWAL
Imunologis: Mex SLEDAI
1. ANA Neurological disorders (8)
LAB (TGL___/___/2024) 2. Anti dsDNA Kidney disorders (6)
RET 3. Penurunan C3 C4 Vasculitis (4)
WBC 4. Coombs' tes Hemolysis/thrombocytopenia (3)
HB TOTAL : _____klinis_____imunologis Myositis (3)
MCV/MCH Arthritis (2)
PLT Mucocutaneous disorders (2)
%LIMF Kriteria EULAR 2019: Serositis (2)
%NEUT ANA Fatigue fever (1)
%MONO Kriteria Klinis Leukopenia (1)
LED Konstitusional (Demam) TOTAL SKOR
UR/CR Hematologi
GOT/GPT Neuropsikiatri TERAPI :
GDS Mucocutaneus
NA/K/CL Serosal
Renal
IMUNOLOGI (___/___/____)
COOMB'S TEST Kriteria Imunologis:
ANA Antifosfolipid Antibody
ANA IF Komplemen C3 (___) dan C4 (___)
C3 / C4 Anti dsDNA PLANNING :
ANTI dsDNA TOTAL SKOR :

URINALISA :