Comprehensive Clinical Evaluation Crucial for Flight Fitness in Hajj Pilgrims with Anemia

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FORMOSA NEWS

Doby Indrawan and Kautsar Citra Nirmala from Maulana Malik Ibrahim State Islamic University examined the complexities of determining flight fitness for Hajj pilgrims with anemia through a case study evaluated in May 2025. Published in July 2026, this research is crucial for reforming predeparture health screening protocols so they do not rely solely on numerical laboratory thresholds, but rather prioritize holistic patient safety amid the challenges of air travel and physical Hajj rituals.

The Hajj pilgrimage is a major international mass gathering that demands high physical endurance under extreme temperatures and long-haul flights. Meanwhile, anemia is frequently found in women of reproductive age due to menstruation or gynecological conditions like uterine leiomyoma. Although commercial aviation standards set specific minimum hemoglobin (Hb) thresholds, emergency medical interventions such as intravenous fluid administration often induce hemodilution, artificially lowering lab results and creating dilemmas for medical staff at embarkation points.

This research utilized an in-depth case study approach on a 46-year-old female patient from Blitar, East Java, who underwent final predeparture medical screening for the Hajj on May 14, 2025. The research team analyzed the patient's comprehensive clinical evaluation, tracked hemoglobin changes before and after intravenous fluid administration, and assessed clinical symptoms such as fatigue, dizziness, and active uterine bleeding before issuing a flight deferral and hospital referral decision.

Based on the research findings, several critical facts were revealed:

• The patient recorded an initial hemoglobin level of 8.2 g/dL, which subsequently dropped to 7.9 g/dL after receiving intravenous fluids due to hemodilution effects.
• Despite stable vital signs, the patient continued to report chronic fatigue and experienced active menstrual bleeding caused by uterine leiomyoma.
• The embarkation medical team made a definitive decision to declare the patient temporarily unfit to fly and referred her to a designated Hajj Referral Hospital for definitive management.
• Flight fitness assessments must not rely solely on a single hemoglobin number, but must integrate symptom severity, bleeding status, and physiological capacity.

According to Doby Indrawan and Kautsar Citra Nirmala, reforming national Hajj health screening policies is an urgent priority. This approach brings broad positive impacts to aviation medicine and pilgrim healthcare services, encouraging frontline physicians to avoid rigid adherence to laboratory numbers alone in order to guarantee optimal safety for pilgrims both inside aircraft cabins and during demanding physical rituals in the Holy Land.

Author Profiles

• Doby Indrawan: Researcher and medical practitioner at the Faculty of Medicine, Maulana Malik Ibrahim State Islamic University.
• Kautsar Citra Nirmala: Researcher and academic at Maulana Malik Ibrahim State Islamic University specializing in clinical and healthcare services.

Research Source

• Article Title: Flight Fitness Assessment in a Hajj Pilgrim with Symptomatic Iron-Deficiency Anemia Secondary to Uterine Leiomyoma: A Case Report and Clinical Decision-Making Perspective
• Journal Name: International Journal of Integrated Science and Technology (IJIST), Vol. 4, No. 7, July 2026, pp. 481-494
• DOI/URL: https://doi.org/10.59890/ijist.v4i7.30