Hemokromatosis

Hemokromatosis
kenali tanda dan gejala hemokromatosis

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Definisi

Hemokromatosis adalah suatu kondisi yang menyebabkan tubuh menyerap terlalu banyak zat besi dari makanan yang Anda makan. Kelebihan zat besi disimpan di organ tubuh Anda, terutama pada organ hati, jantung, dan pankreas. Terlalu banyak zat besi dapat menyebabkan kondisi yang mengancam jiwa, seperti penyakit lever, penyakit jantung dan diabetes.

Ada beberapa jenis hemokromatosis, namun jenis yang paling umum disebabkan oleh perubahan gen yang diturunkan melalui keluarga. Hanya sedikit orang yang memiliki gen tersebut yang pernah mengalami masalah serius. Gejala biasanya muncul di usia paruh baya.

Perawatan termasuk mengeluarkan darah dari tubuh Anda secara teratur. Karena sebagian besar zat besi tubuh terkandung dalam sel darah merah, pengobatan ini dapat menurunkan kadar zat besi.

Zat besi merupakan mineral yang ditemukan dalam makanan tertentu. Tubuh Anda membutuhkan zat besi untuk membantu hemoglobin dalam sel darah membawa oksigen ke seluruh tubuh, membuat sel darah merah, dan menghasilkan hormon tertentu.

Biasanya, usus Anda menyerap jumlah zat besi yang tepat dari makanan yang Anda makan. Tetapi pada hemokromatosis, tubuh menyerap zat besi berlebih dan menyimpannya di organ, terutama jantung, hati dan pankreas. Terlalu banyak zat besi bisa menjadi racun. Dan dapat menyebabkan, aritmia (detak jantung tidak teratur), gagal jantung, sirosis hati, pembesaran hati, kanker hati, gagal hati, artritis (kerusakan sendi), diabetes, masalah dengan limpa, kelenjar adrenal, kelenjar hipofisis, kandung empedu atau tiroid, masalah pada sistem reproduksi, seperti disfungsi ereksi pada pria dan menopause dini pada wanita, kulit yang mungkin terlihat lebih abu-abu atau perunggu dari biasanya, jika kondisi ini tidak diobati dapat mengakibatkan kematian.

 

Baca Juga: Gagal Jantung - Definisi, Penyebab, Gejala, dan Pengobatannya

 

Penyebab

Ada dua jenis hemokromatosis, masing-masing dengan penyebab yang berbeda. Perubahan genetik yang diwariskan adalah penyebab paling umum. Kondisi ini disebut hemokromatosis primer, hemokromatosis herediter atau hemokromatosis klasik.

Pada hemokromatosis primer, kelainan DNA berasal dari kedua orang tua dan menyebabkan tubuh menyerap terlalu banyak zat besi.

Sedangkan pada hemokromatosis sekunder, perawatan medis atau kondisi medis lainnya menyebabkan kelebihan zat besi. Contohnya meliputi anemia (kurangnya jumlah sel darah merah), transfusi darah, pil besi atau suntikan, dialisis ginjal atau cuci darah dalam jangka waktu yang lama, penyakit hati seperti infeksi hepatitis C atau penyakit perlemakan hati.

 

Faktor Risiko

Pria memiliki risiko terkena hemokromatosis lebih tinggi dibanding wanita. Wanita kehilangan zat besi saat mereka mengalami menstruasi atau melahirkan. Tubuh wanita juga menyimpan lebih sedikit zat besi. Hemokromatosis juga lebih sering terjadi pada orang tua karena toksisitas zat besi membutuhkan waktu bertahun-tahun untuk berkembang.

Faktor lain yang meningkatkan kemungkinan berkembangnya hemokromatosis selain penyalahgunaan alkohol dan riwayat keluarga, antara lain menderita penyakit-penyakit berikut seperti radang sendi, diabetes, serangan jantung, disfungsi ereksi, dan penyakit lever.

 

Gejala

Beberapa orang dengan hemokromatosis tidak memunculkan gejala. Gejala awal sering tumpang tindih dengan kondisi umum lainnya.

Gejala mungkin termasuk:

  • Nyeri sendi
  • Sakit perut
  • Kelelahan
  • Kelemahan
  • Diabetes
  • Kehilangan gairah seks
  • Gagal jantung
  • Gagal hati
  • Kulit berwarna perunggu atau abu-abu
  • Memori berkabut

Hemokromatosis paling umum terjadi pada saat lahir. Tetapi kebanyakan orang tidak mengalami gejala sampai di kemudian hari, biasanya setelah usia 40 tahun pada pria dan setelah usia 60 tahun pada wanita. Wanita lebih mungkin mengalami gejala setelah menopause, ketika mereka tidak lagi kehilangan zat besi akibat menstruasi dan kehamilan.

 

Diagnosis

Diagnosis dari hemokromatosis dapat ditegakkan dengan melakukan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang.

Proses anamnesis dilakukan dengan melakukan wawancara medis antara dokter dan pasien. Hal yang dapat ditanyakan untuk mendiagnosis hemokromatosis, antara lain keluhan utama pasien, keluhan penyerta, riwayat penyakit terdahulu, riwayat penyakit keluarga, riwayat penggunaan obat-obatan tertentu, dan riwayat aktivitas sehari-hari.

Selanjutnya dilakukan pemeriksaan fisik. Pemeriksaan fisik yang dilakukan adalah pemeriksaan tanda vital yakni pemeriksaan tekanan darah, suhu tubuh, laju napas, dan nadi. Kemudian dokter akan melakukan pemeriksaan dari kepala hingga ujung kaki untuk memeriksa organ dalam.

Dokter juga dapat melakukan pemeriksaan penunjang. Pemeriksaan penunjang yang dilakukan antara lain pemeriksaan laboratorium darah guna memeriksa kadar zat besi dalam darah, tes genetik untuk melihat jenis hemokromatosis yang dialami adalah jenis hemokromatosis yang diturunkan, biopsi hati dengan mengambil sebagian kecil jaringan lever untuk diperiksa dibawah mikroskop, dan MRI untuk melihat gambar organ secara detail.

 

Tata Laksana

Perubahan pola makan dan perawatan lain dapat membantu meringankan gejala hemokromatosis. Hal ini juga dapat membantu mencegah atau menunda kerusakan lebih lanjut pada organ Anda:

  • Perubahan pola makan: Dokter mungkin akan meminta Anda untuk menghindari suplemen dengan zat besi. Anda mungkin juga perlu menghindari makanan yang mengandung terlalu banyak zat besi dan membatasi vitamin C. Batasi konsumsi alkohol Anda juga, karena tidak baik untuk hati Anda.
  • Terapi khelasi besi: Obat ini menghilangkan zat besi ekstra dari tubuh Anda. Obat diminum di rumah atau disuntikkan ke dalam darah oleh penyedia layanan kesehatan.
  • Proses mengeluarkan darah terapeutik: Prosedur ini menggunakan jarum dan tabung untuk mengeluarkan darah dan zat besi yang dikandungnya dari tubuh Anda.

Perawatan perlu sering diulang, jadi Anda akan menjalani tes darah secara teratur untuk mengukur kadar zat besi. Jika kondisi lain menyebabkan hemokromatosis, Anda mungkin memerlukan pengobatan untuk kondisi tersebut.

 

Komplikasi

Jika tidak diobati, hemokromatosis dapat menyebabkan sejumlah komplikasi. Komplikasi ini terutama dapat memengaruhi persendian dan organ Anda. Kelebihan zat besi cenderung disimpan oleh organ hati, pankreas dan jantung. Komplikasi dapat meliputi:

  • Sirosis. Jaringan parut permanen pada hati. Sirosis dapat meningkatkan risiko kanker hati dan komplikasi lain yang mengancam jiwa.
  • Diabetes. Kerusakan pankreas dapat menyebabkan diabetes.
  • Masalah jantung. Kelebihan zat besi di jantung akan memengaruhi kemampuan jantung mengedarkan darah yang cukup untuk kebutuhan tubuh. Kondisi ini disebut gagal jantung kongestif. Hemokromatosis juga dapat menyebabkan irama jantung yang tidak normal, yang disebut aritmia.
  • Masalah reproduksi. Kelebihan zat besi dapat menyebabkan disfungsi ereksi dan hilangnya gairah seks pada pria. Sedangkan pada wanita, hal ini dapat menyebabkan tidak adanya siklus menstruasi.
  • Perubahan warna kulit. Timbunan zat besi dalam sel kulit bisa membuat kulit Anda tampak berwarna perunggu atau abu-abu.

 

Baca Juga: Kanker Hati - Definisi, Penyebab, Gejala, dan Pengobatannya

 

Pencegahan

Hemokromatosis tidak dapat dicegah, namun Anda dapat mencari bantuan untuk mengontrol kadar zat besi Anda. Dengan mengidentifikasi dan mengobati hemokromatosis sejak dini, penyedia layanan kesehatan dapat membantu Anda menghindari komplikasi.

 

Kapan Harus ke Dokter?

Segera temui dokter Anda jika Anda mengalami salah satu dari gejala diatas. Jika Anda memiliki anggota keluarga dekat yang menderita hemokromatosis, tanyakan kepada dokter Anda tentang konseling genetik. Konseling dan tes genetik dapat memeriksa apakah Anda memiliki gen yang meningkatkan risiko hemokromatosis.

 

Mau tahu informasi seputar penyakit lainnya? Cek di sini, ya!

 

 

Writer : dr Lovira Ai Care
Editor :
  • dr. Monica Salim
Last Updated : Selasa, 11 Juni 2024 | 09:36

Cleveland Clinic - Hemochromatosis (2021). Retrieved 3 April 2023, from https://my.clevelandclinic.org/health/diseases/14971-hemochromatosis-iron-overload

Mayo Clinic - Hemochromatosis (2021). Retrieved 3 April 2023, from https://www.mayoclinic.org/diseases-conditions/hemochromatosis/symptoms-causes/syc-20351443

WebMD - Hemochromatosis (2022). Retrieved 3 April 2023, from https://www.webmd.com/a-to-z-guides/what-is-hemochromatosis#091e9c5e8159ba60-1-2

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      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • WebController.php#377aicare_prod_new144msselect * from `posts` where `status` = 1 and `publish_date` <= '2025-04-06 13:52:27' and `content_type` = 'article' and `posts`.`deleted_at` is null order by RAND() limit 7
      Bindings
      • 0: 1
      • 1: 2025-04-06 13:52:27
      • 2: article
      Hints
      • Use SELECT * only if you need all columns from table
      • ORDER BY RAND() is slow, try to avoid if you can. You can read this or this
      Backtrace
      • app/Http/Controllers/WebController.php:377
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • WebController.php#391aicare_prod_new14.07msupdate `posts` set `views_count` = 1430 where `id` = 6872
      Bindings
      • 0: 1430
      • 1: 6872
      Backtrace
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new14.07msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 6872, 'App\\Models\\Admin\\Post', 'updated', '2025-04-06 13:52:27', '2025-04-06 13:52:27')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 6872
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-04-06 13:52:27
      • 8: 2025-04-06 13:52:27
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new1.48msselect * from `users` where `users`.`id` = 44 limit 1
      Bindings
      • 0: 44
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.33msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4222 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4222
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.09msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5779 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5779
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new11.36msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 793 and `categories`.`deleted_at` is null
      Bindings
      • 0: 793
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#11aicare_prod_new1.31msselect * from `categories` where `categories`.`id` = 4 and `categories`.`deleted_at` is null limit 1
      Bindings
      • 0: 4
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.partials.article-popular:11
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.9msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 9194 and `categories`.`deleted_at` is null
      Bindings
      • 0: 9194
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.09msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8500 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8500
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.85msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 808 and `categories`.`deleted_at` is null
      Bindings
      • 0: 808
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#11aicare_prod_new1.11msselect * from `categories` where `categories`.`id` = 5 and `categories`.`deleted_at` is null limit 1
      Bindings
      • 0: 5
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.partials.article-popular:11
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.05msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8323 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8323
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.39msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4658 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4658
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.27msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4659 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4659
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.16msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4283 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4283
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new8.87msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4282 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4282
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new8.8msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2081 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2081
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new920μsselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new900μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#551aicare_prod_new12.51msselect * from `term_policies`
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Post
    59Post.php#?
    App\Models\Admin\Category
    21Category.php#?
    App\User
    4User.php#?
    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
    3TermPolicy.php#?
    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
    1Faq.php#?
        locale
        id
        _token
        hT7p2hBvdnykpyleFnlfhz1fzZw6GXCyMUrF9Nr5
        _previous
        array:1 [ "url" => "https://ai-care.atmatech.id/healthpedia-penyakit/hemokromatosis" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        path_info
        /healthpedia-penyakit/hemokromatosis
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:19 [ "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] "x-real-ip" => array:1 [ 0 => "3.141.104.233" ] "x-forwarded-for" => array:1 [ 0 => "3.141.104.233" ] "x-forwarded-proto" => array:1 [ 0 => "https" ] "x-forwarded-scheme" => array:1 [ 0 => "https" ] "host" => array:1 [ 0 => "ai-care.atmatech.id" ] "connection" => array:1 [ 0 => "keep-alive" ] ]
        request_cookies
        []
        
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