Protocols - Hemorio

POLYCYTHEMIA VERA
LABORATORIAL TESTS
- Hemogram, reticulocytes, hematoscopy
- Biochemistry with hepatogram and lipidogram
- Dosage of erythropoietin
- Chest X-Ray and abdominal ultrasound
- Myelogram with conventional cytogenetics
- Molecular biology of SP or MO to research BCR-ABL
- Echocardiogram
- Ferritin
- Bone marrow biopsy
- Other tests according to the clinical indication
DIAGNOSE CRITERIA (See also appendix I - Screening)
RISK STRATIFICATION
> 60 years old or history of DVT Cardiovascular risk factors *
LOW NO NO
INTERMEDIATE NO YES
HIGH YES Not applied
Diabetes Mellitus, Hypertension, tabagism, dyslipidemia, obesity
TREATMENT: All subjects
PHLEBOTOMY -> target Ht < 45% in men and < 42% women
+
AAS 100 mg / day -> start with PLAT < 1500.000
+
MODIFIABLE RISK FACTORS TREATMENT
Phlebotomies – see HEMOTHERAPIC PROTOCOLS
HIGH RISK
- CURRENT THROMBOSIS OF PHLEBOTOMY + AAS
- THROMBOCYTOSIS
- SYMPTOMATIC / PROGRESSIVE SPLENOMEGALY
- HYDROXYUREA 10 – 20 mg/kg/day VO if (+ Allopurinol 200 – 300mg/day)
ALTERNATIVE
- Refractivity to hydroxyurea, pregnancy, pruritus intractable (alternative: Paroxetine 20mg/d)
- INF 3000000u SC 3X/week (UP TO 3,000,000 U/m 2 /d)
SUBJECTS MUST NOT BE SUBMITTED TO ELECTIVE SURGICAL PROCEDURES BEFORE HAVING
OBTAINED A SUITABLE HEMATOLOGICAL CONTROL. PAY ATTENTION TO THE PROPHYLAXIS OF
DVT.
SPECIAL CARE IN THE PREGNANCY:
Before the delivery:
AAS – 100 mg/day – interrupt 10 days before the delivery
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