Involving the Immune Mechanism” dr Mayang Anggraini Naga

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1 Involving the Immune Mechanism” dr Mayang Anggraini Naga
SESI 14 “Diseases of Blood & Blood-forming Organs & Certain Disorders Involving the Immune Mechanism” (Penyakit darah & Organ Pembentuk Darah & Gangguan Mekanisme Imunitas tertentu) BAB III Disusun oleh dr Mayang Anggraini Naga

2 DESKRIPSI Pembahasan meliput tentang gangguan darah,
struktur dan kekhususan Bab III “Diseases of Blood & Blood-forming Organs & Certain Disorders Involving the Immune Mechanism” disertai pelatihan cara menentukan dan memilih kode diagnosis gangguan darah, organ pembentuk darah dan mekanisme imunitas.

3 TUJUAN INSTRUKSIONAL UMUM
Paham tentang istilah jenis-jenis gangguan darah, organ pembentuk darah dan gangguan mekanisme imunitas dan cara menentukan kode dengan benar, cara menentukan dan mendokumentasikan kode klasifikasi ganda, tambahan dan suplementer

4 TUJUAN INSTRUKSIONAL KHUSUS
Menjelaskan: - definisikan istilah gangguan darah, organ pembentuk darah dan gangguan imunitas - struktur dan kekhususan serta peraturan yang berlaku bagi pemilihan kode diagnosis gangguan darah, organ pembentuk darah dan mekanisme imunitas dan memilih nomor kode diagnosis terkait dengan benar

5 POKOK & SUBPOKOK BAHASAN
- Reading: “Disorders of The Blood” - Struktur dan kekhususan Bab III dan Peraturan- peraturan yang menyertai berbagai nomor kode diagnoses gangguan darah, organ pembentuk darah dan mekanisme imunitas - Pelatihan pencarian kode melalui ICD-10 volume 3 dan volume 1

6 READING 5: “DISORDERS OF THE BLOOD”
Abnormalities can occur in any of the components of blood – the red blood cells (RBCs), white blood cells (WBC), platelets and numerous constituent of plasma. Anemia is by far the most common blood disorders. It has many different possible causes. In polycythemia there are too many red cells. In leukemia excessive numbers of immature white blood cells crowd out the normal cells from the bone marrow. Defects in the platelets and in the clotting mechanisms may lead to any of various bleeding disorders. Unwanted clot formation (thrombosis) may result from circumstances that overactivate the clotting mechanisms.

7 Known causes of blood disorders includes the following:
READING 5: (Lanjutan-1) Deficiencies of the proteins in blood plasma include hypoalbuminemia and agamaglobulinemia. Known causes of blood disorders includes the following: Genetic Disorders In theses disorders there is an inherited abnormally in the production of some component of blood. People with sickle cell anemia and thalassemia produce an abnormal type of hemoglobin that makes their red blood cells more fragile, those with hemophilia fall to produce enough of one of the proteins involved in blood clotting. Disorders of this kind are present from birth and continue throughout life.

8 Loss of regular amounts of blood over an extended
READING 5: (Lanjutan-2) Nutritional Disorder Loss of regular amounts of blood over an extended period may mean that iron is lost faster than it can be replaced in the diet (anemia iron-deficiency) If insufficient amounts of the vitamins B12 or folic Acid reach the bone marrow, it produces fewer red blood cells which are abnormally large (anemia megaloblastic). The vitamin deficiency may be due to a poor diet or more often in developed countries, to a failure to absorb vitamin B12 correctly from the intestinal tract.

9 Multiplication of bacteria in the blood with the production
READING 5: (Lanjutan-3) Infcetion Multiplication of bacteria in the blood with the production of toxins is termed bacteremia and septicemia. Many other microorganisms (viruses, fungi, protozoa and other parsites)) may infect the blood at some stage in their life cycle. Some organism (notably those responsible for malaria) may actually attack and destroy red blood cells and so cause anemia (Anemia hemolytic).

10 All types of leukemia are the result of a type of cancer
READING 5: (Lanjutan-4) Tumors All types of leukemia are the result of a type of cancer of the bone marrow, causing overgrowth of abnormal white blood cell and destruction of the healthy marrow. In polycythemia vera a similar process occurs, except that mainly red cells are produced to excess. Another type of bone marrow cancer called multiple myeloma can cause an excess of certain proteins in the blood plasma.

11 Carbon monoxide directly impairs the functioning of red
READING 5: (Lanjutan-5) Poisons Carbon monoxide directly impairs the functioning of red cells by displacing oxygen bound to hemoglobin within the cells. Lead poisoning causes defective red blood cell production. Some snake and spider venoms destroy red cells and/or provoke clotting. Septicemia describes the presence of poisons produced in the blood by bacteria; toxemia describes the presence of metabolic poisons in the blood.

12 Certain drugs can cause blood abnormalities as a side effect.
READING 5: (Lanjutan-6) Drugs Certain drugs can cause blood abnormalities as a side effect. For example: - co-trimoxazole, - thiazide diuretics, and - carbimazole may depress the production od white blood cells and/or platelets, chloramphenicol and sulfonamides may depress all blood cell production, methrotrexate and phenytoin may interfere with red cell production. Too high a dose of anticoagulant drugs can cause a bleeding tendency through excessive disruption of clotting mechanisms.

13 High dosis of radiation (received at the time of therapy or
READING 5: (Lanjutan-7) Radiation High dosis of radiation (received at the time of therapy or from nuclear explosions or radioactive leaks from nuclear reactors) can severely damage the bone marrow, causing depression of all blood cell production (anemia aplastic) Other disorders Albumin – an important protein in the blood plasma – may become deficient either as a result of liver disease, or kidney disease (loss of albumin in the urine). Liver disease may also cause hyperbilirubinaemia, anemia, and deficiencies of some of the clotting factors. Kidney disease causes uremia sometimes anemia and also complex changes in blood chemistry.

14 Blood disorders are investigated principally by:
READING 5: (Lanjutan-8) Investigation Blood disorders are investigated principally by: - various blood tests, such as: - the blood count, - blood smear, and - blood clotting tests.

15 STRUKTUR & KEKHUSUSAN BAB III DISEASES OF BLOOD & BLOOD FORMING ORGANS & DISORDERS INVOLVING THE IMMUNE MECHANISM (D50-D89) [Hal ) Excludes: gangguan autoimune sistemik NOS (M35.9) kondisi tertentu yang berasal mula sejak periode perinatal (P00-P96) komplikasi dari kehamilan, persalinan dan masa nifas (O00-O99) malformasi kongenital, deformasi, abnormalitas kromosomal (Q00-Q99)

16 STRUKTUR & KEKHUSUSAN BAB III (Lanjutan-1)
gangguan endokrin, nutrisional, dan metabolik (E00-E90) HIV diseases (B20-B24) cedera, keracunan & konsekuensi tertentu dari akibat penyebab dari luar (external causes) (S00-T98) neoplasms (C00-D48) gejala, tanda, hasil temuan klinis, laboratoris abnormal NEC (R00-R99)

17 STRUKTUR & KEKHUSUSAN BAB III (Lanjutan-2)
Bab dibagi dalam Blok: D50-D53 Anemia nutrisional D55-D59 Anemia hemolitik D60-D64 Anemia aplastik & anemia-2 lain D65-D69 Defek pembekuan darah, purpura & kondisi perdarahan lain-lain D70-D77 Penyakit darah dan gangguan organ pembentuk darah lain-lain D80-D89 Gangguan tertentu yang melibatkan mekanisme imune

18 Kategori-kategori ber-astrisk (*)
D63* Anemia pada penyakit kronik yang terklasifikasi di tempat lain D77* Gangguan darah dan organ pembentuk darah lain-lain pada penyakit terklasifikasi di tempat lain. Nutritional anaemias (D50-D53) (Hal ) Termasuk ke kelompok ini adalah: D50 Anemia karena kekurangan zat besi Includes: anemia aciderosik dan anemia hipokromik Punya 4 subkategori D anemia post-perdarahan Excludes: anemia post-perdarahan akut (D62) anemia kongenital akibat janin kehilangan darah (P61.3)

19 Nutritional anaemias (D50-D53) (Lanjutan)
D50.1 Sideropenic dysphagia Kelly-Paterson syndrome Plummer-Vinson syndrome D50.8 Anemia defisiensi zat besi lain-2 D50.9 Anemia defisiens zat besi, unspecified D51 Anemia karena defisiensi (kekurangan) Vitamin B12 Excludes: vitamin B12 deficiency (E53.8) Punya 6 subkategori sesuai rincian sebab kekurangan Vitamin B12-nya: D51.0; D51.2; D51.2; D51.3; D1.8; D51.9

20 D52 Anemia defiseiensi folate
Punya 4 subkategori sesuai rincian sebab defisiensi folatnya. D52.0; D52.1; D52.8; D52.9 dengan D52.8 bisa dilengkapi dengan additional external code ` (kode sebab luar) untuk menjelaskan obat penyebabnya bila diketahui). D53 Anemia nutritional lain-2 Includes: megaloblastic anaemia unresponsive to vitamin B12 or folate therapy (anemia megaloblastik yang tidak dapat diatasi dengan terapi vitamin B12 dan folat). Punya 5 subkategori (semua memiliki excludes: …)

21 Haemolytic anaemias (D55-D59) [Hal. 252-255]
D Anemia karena gangguan enzyme Excludes: drug-induced enzyme deficiency anaemia (D59.2) Punya 6 subkategori sesuai rincian enzyme penyebab D56 Thalassaemia Excludes: hydrops fetalis due to haemolytic disease (P56,-) Punya 7 subkategori, rincian sesuai jenis gangguannya. D57 Gangguan-2 Sickle-cell D58 Anemia lain hemolitik herediter

22 D59 Anaemia hemolytic acquired (didapat setelah lahir)
D59.0 Anemia hemolitik autoimune drug-induced. D59.2 … D59.6 … Use additional … untuk merinci sebab luar (code di Bab XX) untuk merinci jenis obat penyebabnya. Apabila sebutan obatnya dalam istilah generiknya  telusuri melalui Table of Drugs and Chemicals, di Seksi 3 ICD-10 Volume 3

23 Aplastic & Other anaemia (D60 – D64) [Hal. 256-257]
D60 Acquired pure red cell aplasia [erythroblastopenia]\ Includes: red cell aplasia (acquired) (adult) (with thymoma) D61 Other aplastic anaemias Excludes: agranulocytosis (D70) D61.1 dan D61.2 ada Use additional external cause code (Chapter XX),if desired, to identify cause Punya 6 (enam) subdivisi D62.x Acute posthaemorrhagic anaemia Excludes: congenital anaemia from fetal blood loss (P61.3)

24 Aplastic & Other anaemia (D60 – D64) (Lanjutan)
D63* Anaemia in chronic diseases classified elsewhere D63.0* Anaemia in neoplastic disease (C00-D48!) D63.8* Anaemia in other chronic disease classified elsewhere D64 Other Anaemias Perhatikan Excludes: … D64.1 dan D64,2 ada Use additional external … D64.4 Congenital dys-erythropoietic anaemia Excludes: …

25 Coagulation Defects, Purpura and Other Haemorrhage Conditiona (D65 – D69) [Hal. 258 – 261]
Gangguan pembekuan darah, purpura dan kondisi perdarahan lain-lain. D65 Desseminated intravascular coagulation [defibrination syndrome] Termasuk di sini [DIC] = dessimeniated intravascular coaglation Perhatikan excludes: … D66 Kekurangan faktor VIII (pembekuan darah) Termasuk di sini Haemophilia: - NOS, - A - Classical:

26 D65-D59 (Lanjutan-1) D67 Hereditary factor IX deficiency Termasuk di sini Christmas disease. D68 Other coagulation defects Perhatikan excludes: … Punya 7 Subkategori. Rincian sesuai jenis Factor yang deficient (Factor I, II, V, VII, X, XII, XIII, XI, dan defisiensi VIII dengan defect vaskuler) Pada D68,0 dan D68.4 ada Excludes: … Pada D68.2 dijumpai sebutan beberapa faktor pembekuan darah Pada 68.3 ada Use additional ….

27 D69 Purpura & other haemorrhage conditions
Perhatikan excludes: … D Allergic purpura D ada Excludes: … D Other nonthrombocytopenic purpura D Idiopathic thrombocytopenic purpura D Other primary thrombocytopenia ada Excludes: … D Secondary thrombocytopenia Use additional external cause code (Chaper XX, if desired, to identify cause. D Thrombocytopenia, unspecified Perhatikan perbedaan thrombocytopenia di nomor-2 code di atas.

28 D69.8 Other specified haemorrhagic conditions
Capillary fragility (hereditary) Vascular pseudohaemophilia D69.9 Haemorrhage condition, unspecified Penyakit-2 Darah & Organ Pembentuk Darah Lain (D70 - D77) [Hal. 262 – 266] D70 Agranulocytosis Termasuk ini neutropenia, neutropenic splenomegaly Ada perintah Use additional external cause code … Ada Excludes: …

29 D71 Fungsional disorders of polymorphonuclear neutrophils
Penyakit-2 Darah & Organ Pembentuk Darah Lain (D70 - D77) [Hal. 262 – 266] (lanjutan) D71 Fungsional disorders of polymorphonuclear neutrophils Cell membrane receptor complex [CR3] defect Chronic (childhood) granulomatous disease Congenital dysphagocytosis Progressive septic granulomatosis D72 Other disorders of white blood cells Ada Excludes: … Punya 4 subkategori D72.0; D72.1; D72.8; D72.9 D73 Penyakit limpa Termasuk di sini hiper- dan hiposplenism Punya 8 subkategori dengan rincian jenis gangguan- nya.

30 D74 Methaemoglobinaemia
Gangguan bisa kongenital atau acquired (lengkapi dengan Bab XX untuk rincian external cause) Hanya punya 3 subkategori D75 Other diseases of blood and blood-forming organs Ada Excludes: … Punya 5 subkategori D75.0 Familial erythrocytosis D75.1 Secondary polycythaemia Excludes: … D Essential thrombocytosis Excludes. D Other soecified diseases of blood and blood forming organs (Basophilia) D D. of blood and blood foring organs, unspec.

31 D76 Penyakit tertentu yang melibatkan jaringan
D76 Penyakit tertentu yang melibatkan jaringan lymphoreticular & system reticulohistiocytic Excludes: … Punya 4 subdivisi. D76.0 Langerhans cell histiocytosis, NEC D76.1 Haemophagocytic lymphohistiocytosis D76.2 Haemphagocytic syndrome, infection- associated Use additional … to identify infectious agent/disease D76,3 Other histiocytosis syndromes D77* Gangguan darah dan organ pembentuk darah pada penyakit yang terklasifikasi di Bab lain ICD-10.

32 Certain disorders involving the immune mechanism (D80 – D88) [Hal
Includes: defects in the complement system (defek ada pada sistem komplemen) immunodeficiency disorders, except [HIV] disease sarcoidosis Excludes: autoimmune disease (systemic)NOS (M35.9) functional disorders of polymorphonuclear neutrophils (D71) [HIV] disease (B20-B24) D80 Immunodeficiency with predominantly antibody defect Punya 10 subkategori, rincian sesuai tipe heredi- ternya (autosomal, X-linked, atau tipe Imunoglobu- lin-nya (IgA, IgG, IgM, defisien atau hiper atau hipo- atau defek.

33 D81 Combined immuno-deficiencies
Excludes: autosomal recessive agamma- globulinaemia (Swiss type) (D80.0) Punya 10 subkategori, rincian sesuai tipe defisiensinya. D82 Immunodeficiency associated with other major defects (Defisiensi imune berkaitan dengan defek-2 menonjol lain) Excludes: ataxia telangiectasia [Louis-Bar] (G11.3) Punya 7 subkategori, rincian sesuai jenis defek utamanya. B82.0, B82.1, B82.2, B82.3, B82.4 B82.8 dan B82.9

34 D83 Common variable immunideficiency
Punya 5 subkategori, rincian sesuai tipe defisiensi imunitas yang menon-jol. D84 Imunodefisiensi lain-2 Punya 4 divisi, rincian sesuai tipe yang tidak terkelompok ke nomor kode D80-D83 . D86 Sardcoidosis Punya 6 subkategori, rincian sesuai site lokasi gangguannya. D89 Other disorders involving the immune mechanism, NEC Excludes: … Punya 5 subkategori: D89.0, D89.1, D89.2, D89.8 dan D89.9

35 SOAL-SOAL LATIHAN Cari nomor kode ICD-10 bagi diagnoses di bawah ini: polycythemia (447) No: 2. leukemia (334) No: 3. thrombosis (534) No: hypoalbuminemia and agamaglobulinemia (280) (35) No: No: 5. thalassemia (532) No: 6. hemophilia (257) No: 7. anemia iron-deficiency (42) No: 8. anemia megaloblastic (44) No: bacteremia and septicemia (69) (493) No: No: 10. Anemia hemolytic) (43) No: multiple myeloma (363) No:

36 Soal Latihan (Lanjutan)
Anemia kongenital akibat janin kehilangan darah No: Anemia akibat gangguan enzyme No: Anemia deficiency asam foliat akibat terapi untuk mengatasi gangguan saraf No: Anemia karena malaria tertiana No: Anemia disertai splenomegaly No: Anemia pada penderita cacing tambang No: Anemia akut post perdarahan No: Idiopathic purpura nonthrombocytopenic No: Iridocyclitis pada sarcoidosis No: ADA deficiency No: Haemophagocytic syndrome, akibat infeksi streptococcus No;

37 SOAL-SOAL LATIHAN (Lanjutan)  Lihat Seksi 3 Volume 3
Apakah nama obat di bawahnya generiknya? ICD-3 Generik Bukan G Khasiat 1. co-trimoxazole, (656) v thiazide diuretics, (665) v diuretic (NEC) v v 3. carbimazole (647) v 4. chloramphenicol (650) kemicetin v 5. sulfonamide (729) 6. methotrexate (698) 7. phenytoin (713) 8. phenobarbital (712) sodium phenobarbiturate (725) v vitamin (NEC) (741) v