Mandaya Royal Hospital Puri has successfully treated a case of myasthenia gravis (MG) crisis or myasthenic crisis in a patient diagnosed with MG. In this case, the medical team utilized plasmapheresis or plasma exchange therapy. The outcome was excellent and promising—70-80% of the patient’s condition improved just two days after the procedure.
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Testimony of a Myasthenia Gravis Crisis Patient Who Underwent Plasmapheresis at Mandaya Royal Hospital Puri
The patient initially felt confused about the illness. They reported muscle weakness, symptoms such as being unable to tilt or lift their head, difficulty swallowing, and slurred speech. Eventually, the patient was diagnosed with MuSK-type MG.
The patient had visited several neurologists but had not received satisfactory results. They also sought treatment in Penang, Malaysia, where they underwent a blood test and had to wait about a month for the results. In the meantime, they returned to Indonesia.
Unfortunately, upon returning, the patient experienced an MG crisis, including breathing difficulties. They searched for a doctor in Indonesia who could treat MG and found Dr. Luh Ari Indrawati, Sp.N, Subsp. E.N.K.(K), who practices at Mandaya Royal Hospital Puri.
After arriving at Mandaya Royal Hospital Puri, the patient immediately went to the Emergency Department (ER) to consult with Dr. Luh Ari. They were admitted to the Intensive Care Unit (ICU) and placed on a ventilator due to severe respiratory issues.
Since the patient was already in a myasthenic crisis, Dr. Luh Ari immediately initiated plasmapheresis treatment.
According to the patient, the plasmapheresis procedure was comfortable and lasted about two hours.
Two days after the procedure, 80% of the patient’s symptoms improved, they were taken off the ventilator, breathing returned to normal, and they could eat like usual.
The patient underwent plasmapheresis three times at Mandaya Royal Hospital Puri, and their condition gradually improved.
“Based on the initial assessment, the patient’s symptom severity score was 37 out of a maximum of 50, based on the MGSC (Myasthenia Gravis Symptom Clusters) scale. After receiving plasmapheresis at Mandaya, the score dropped to 0, and the patient is now fully recovered,” explained Dr. Luh Ari.
Understanding Plasmapheresis: An Advanced Solution for Managing Myasthenia Gravis Crisis
Plasmapheresis is a form of apheresis, a medical technique that allows doctors to remove or replace specific components of the blood. In some conditions, it’s necessary to remove or replace these components to help improve a patient’s condition. In plasmapheresis, the component being removed is plasma.
Plasma is the liquid part of the blood that contains antibodies, proteins that normally help protect the body. However, in MG, these antibodies attack healthy cells, causing a variety of disruptive symptoms.
During plasmapheresis, a machine separates the patient’s plasma from their blood cells. The problematic plasma is discarded and replaced with a substitute fluid. The aim is to eliminate abnormal antibodies so the patient’s symptoms improve.
Although plasmapheresis can help alleviate severe symptoms of MG, it does not replace standard treatments. According to Dr. Luh Ari, prescribed medications must still be continued even after plasmapheresis.
“The goal of plasmapheresis is to stabilize the crisis phase. However, routine medications such as immunosuppressants must still be administered,” she emphasized.
Plasmapheresis Doctor Schedule at Mandaya Royal Hospital Puri
In addition to Dr. Luh Ari, Mandaya Royal Hospital Puri also has a team of experienced internal medicine specialists in hematology-medical oncology (KHOM) who are highly qualified to perform plasmapheresis: dr. Toman T.J. Lumban Toruan, Sp.PD-KHOM and dr. Alvin Tagor Harahap, Sp.PD-KHOM
Here is their practice schedule at Mandaya Royal Hospital Puri:
1. dr. Luh Ari Indrawati, Sp.N, Subsp. E.N.K.(K)
A neurologist specializing in autoimmune neurological diseases like MG. She also treats rare conditions such as:
- Stiff Person Syndrome (SPS)
- Duchenne Muscular Dystrophy (DMD)
- Amyotrophic Lateral Sclerosis (ALS)
- Guillain-Barré Syndrome (GBS)
Available hours at Mandaya Royal Hospital Puri:
- Thursday: 14:00 – 19:00 WIB
- Saturday: 14:00 – 19:00 WIB
2. dr. Toman T.J. Lumban Toruan, Sp.PD-KHOM
An internal medicine specialist in hematology-medical oncology who studied at the Faculty of Medicine, University of Indonesia, and received advanced training at the National University Hospital. He is experienced in cancer treatments, including:
- Chemotherapy
- Immunotherapy
- Targeted therapy
- Bone marrow transplant
- CAR T-Cell Therapy
Available hours:
- Tuesday: 12:00 – 15:00 WIB
- Thursday: 12:00 – 15:00 WIB
3. dr. Alvin Tagor Harahap, Sp.PD-KHOM
An internal medicine specialist in hematology-medical oncology, educated at the University of Indonesia. He is experienced in:
- Chemotherapy
- Immunotherapy
- Targeted therapy
- Bone marrow transplant
- CAR T-Cell Therapy
Available hours:
- Wednesday: 18:00 – 20:00 WIB
- Saturday: 10:00 – 12:00 WIB
If you would like to consult with Dr. Luh Ari, Dr. Toman, or Dr. Alvin regarding plasmapheresis, don’t hesitate to visit Mandaya Royal Hospital Puri.
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