Protocols - Hemorio

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TREATMENT – 2nd LINE - Indicated for subjects intolerant to hydroxyurea or those who can not reach a suitable control of platelets counting, even with an excessive hematological toxicity - INF 3000000 U – start 3x/week, with an adjustment in accordance to the tolerance and efficacy, and it can reach up to 3000000U/m 2 /day -> drug to choose (together with AAS), in the pregnancy - Option: Anagrelide, after discussion in the Service meeting TREATMENT – HEMORRHAGIC SETTINGS - Mild: interrupt AAS + local measures + antifibrinolytic (respecting the contraindications) + control of the platelets counting. - Severe (Digestive, intracranial hemorrhage): interrupt AAS + FVIII concentrated rich in vWillebrand multimers (alternative: DDAVP) + Plateletpheresis. SPECIAL CARE IN THE PREGNANCY: the same as Polycythemia vera 108
PRIMARY MYELOFIBROSIS DIAGNOSE CRITERIA: NECESSARY OPTIONAL 1 – Diffuse fibrosis of MO 2 – Absence of crPh and BCR/ABL DIAGNOSIS: 2(N) + 2(O) if splenomegaly present 2(N) + 4(O) if splenomegaly absent LABORATORIAL TESTS - Hemogram, reticulocytes, hematoscopy - Full biochemistry with hepatogram - Abdominal ultrasound + Doppler of portal vein - Chest X-Ray - FAN / anti-DNA - Myelogram + conventional cytogenetics 1 – Splenomegaly 2 – Anisopoikilocytosis + red blood cells in the tear 3 – Immature myeloid cells at the SP 4 – Erythroblasts at the SP 5 – Cluster of anomalous megacaryocytes / megakaryoblasts at the MO 6 – Myeloid Metaplasia - Bone marrow biopsy - Molecular biology of SP for BCR-ABL - Erythropoietin Dosage - HLA Typing subject and brothers if candidate to allogenic TMO - Other tests according to the clinical indication. RISK STRATIFICATION RISK FACTORS RISK GROUPS • Hb < 10 g/dL • LOW RISK: NO FACTOR • Leuko < 4000 or > 30,000/mm 3 • INTERMEDIATE RISK: 1 FACTOR • Blasts SP > 1% • HIGH RISK: 2 FACTORS OR MORE • Constitutional symptoms TREATMENT LOW RISK: quarterly control HIGH RISK: if < 50 years old and with a compatible-HLA donor - alo TMO, otherwise, similar to the intermediate risk INTERMEDIATE RISK: Anemic setting Proliferative setting / Splenomegaly Extramedullar hematopoiesis Constitutional symptoms ANEMIA ERYTHROPOIETIN 4000 – 10000 U SC 3x/week if low serum dosage DANAZOL 400 – 800 mg/day in 2 takes PREDNISONE – 0.5mg/kg/day + THALIDOMIDE 50-100mg/day SPLENOMEGALY - According to the proliferative setting - Splenectomy: giant and painful splenomegaly, refractory cytopenias. Contraindicated if thrombocytosis or hepatic failure. - Splenic radiotherapy: giant and painful splenomegaly in candidates not indicated to the surgery. Contraindicated if important cytopenias FOLLOW-UP - Hemogram every 2 weeks after the introduction or change of any drug dosage and after being stable, every 2 – 3 months. - Biochemistry every 2 – 3 months. - Hepatogram every 2 weeks after the introduction or increase of the dosage of Danazol and, if stable, every 2 – 3 months 109
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PROTOCOLS INSTITUTE OF HAEMATOLOGY
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COORDINATION AND REVISION Clarisse
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SUMMARY: PART I - CLINICAL PROTOCOL
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1.INICIAL CLINICAL EVALUATION SICKL
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TREATMENTO AND IN ADULTS AT ANY AGE
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SPLENECTOMY - INDICATIONS: (1) CHIL
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OUTPATIENT TREATMENT: It is based o
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ASPIRIN AND NSAID PARACETAMOL OPIOI
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CONDUCTION: - Hospitalization - Com
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ONE, TWO-DIMENSIONAL DOPPLER ECHOCA
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Hemianopsia Homonymous deficit of v
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TREATMENT OF CONVULSIVE EPISODES -
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INITIAL ATTENDANCE TO PREGNANT WOME
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- It may occurs acute thoracic synd
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3 Diet with potassium restriction 4
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MICROALBUMINURIA Screening Patients
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RECURRENCE OF PRIAPISM: - Pain Trea
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SPECIAL CARES DEFERASIROX - The use
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TREATAMENT: DRUG Hydroxiurea (hard
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MAJOR AND INTERMIDIATE THALASSEMIA
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HEREDIRATY SPHEROCYTOSIS CLINICAL E
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G6PD DEFICIENCY INITIAL EVALUATION
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LABS EXAMS TO DIAGNOSE APLASTIC ANE
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SELFIMMUNE HEMOLYTIC ANEMIA CONCEPT
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2. Splenectomy: Vaccinate 14 days b
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IMMUNE THROMBOCYTOPENIC PURPURA LAB
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THROMBOTIC THROMBOCYTOPENIC PURPURA
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HEMORRHAGIC SYNDROME INTRODUCTION H
Page 58 and 59: MULTIDISCIPLINARY FOLLOW-UP OF HEMO
Page 60 and 61: LYOPHILIZED CONCENTRATES: They are
Page 62 and 63: TABLE 2: REPLACEMENT THERAPY TO PER
Page 64 and 65: CONDUCTION IN CONFIRMED INTRACRANIA
Page 66 and 67: Severe CET with neurological change
Page 68 and 69: PHARMACOKINETICS OF CLOTTING FACTOR
Page 70 and 71: INHIBITORS CLASSIFICATION The inhib
Page 72 and 73: - Extended surgeries require increa
Page 74 and 75: CLINICAL DIAGNOSIS: According to In
Page 76 and 77: DDAVP TEST The “test dose” must
Page 78 and 79: TREATMENT OF BLEEDING SITUATIONS SI
Page 80 and 81: TABLE 6 - REPLACEMENT THERAPY IN LE
Page 82 and 83: • Primary prophylaxis: controvers
Page 84 and 85: CLINICAL AND LABORATORIAL FOLLOW-UP
Page 86 and 87: MYELODISPLASIC SYNDROME LABORATORIA
Page 88 and 89: If EPO < 500 mU/ml : EPO (8000U 3x/
Page 90 and 91: ACUTE MYELOID LEUKEMIA LABORATORIAL
Page 92 and 93: LMA LMA M3 - non-M3 LMA Protocol LM
Page 94 and 95: Key: Volunteer to aggressive treatm
Page 96 and 97: Acute Promyelocytic Leukemia Transf
Page 98 and 99: BMP LMA IN CHILDREN AND TEENAGERS
Page 100 and 101: Ara-c dose reduction by age: Age in
Page 102 and 103: ATRA RECOMMENDATION: ATRA is starte
Page 104 and 105: - venous hydration - leukapheresis
Page 106 and 107: POLYCYTHEMIA VERA LABORATORIAL TEST
Page 110 and 111: ACUTE LYMPHOID LEUKEMIA LABORATORIA
Page 112 and 113: RE-INDUCTION Phase I (weeks 1-4) -
Page 114 and 115: Cycles 2, 4, 6, 8 - Methotrexate 20
Page 116 and 117: PHASE 2 Infusion CPM in 1 hour 1000
Page 118 and 119: CURATIVE RADIOTHERAPY of CNS < 1 ye
Page 120 and 121: CHRONIC LYMPHOCYTIC LEUKEMIA LABORA
Page 122 and 123: fludarabine 25 mg/m VENOUS 2 D1-D3
Page 124 and 125: TRICHOLEUKEMIA LABORATORIAL TESTS -
Page 126 and 127: - age >45 years old - leukocytosis
Page 128 and 129: - Leukemia / T-Cell Lymphoma in Adu
Page 130 and 131: INDICATIONS FOR THE TREATMENT: Symp
Page 132 and 133: 1 st line Chemotherapy R- CHOP (21
Page 134 and 135: CODOX- M/IVAC Cycles 1 and 3 Cyclop
Page 136 and 137: BLOCK A DEXA VO/IV 10 mg /m2 in 3 d
Page 138 and 139: - Surgical treatment is only indica
Page 140 and 141: LEUKEMIA / T-CELLS LYMPHOMA OF THE
Page 142 and 143: HN2 or PUVA (similar to the located
Page 144 and 145: MULTIPLE MYELOMA LABORATORIAL TESTS
Page 146 and 147: RESPONSE CRITERIA Full Response Abs
Page 148 and 149: WALDENSTRON MACROGLOBULINEMIA LABOR
Page 150 and 151: − If HLA-identical related donor
Page 152 and 153: TREATMENT PROTOCOL - ACUTE MYELOID
Page 154 and 155: TREATMENT PROTOCOL - MULTIPLE MYELO
Page 156 and 157: Post-autologous transplantation pro
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PART II - TRANSFUSIONAL PROTOCOLS A
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PRESERVATION AND CONSERVATION: The
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TRANSFUSION OF RED BLOOD CELLS, PLA
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FORMAL CONTRAINDICATIONS TO THE PLA
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1 - TRANSFUSION OF FROZEN FRESH PLA
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COMMUNICATION FORM OF CRYOPRECIPITA
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Volume to be = changed (*) VOLEMIA
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HEMOTHERAPIC PROTOCOL TO FALCIFORM
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5 - TRANSFUSIONAL CONDUCT AT THE SE
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CML - Subjects with symptoms relate
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- Aplastic anemia bearers - HIV pos
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Severe reaction: anaphylactic shock
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- Heart monitoring - Prescribe Furo
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CARES AT THE PLATELETS CONCENTRATE
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ATTACHMENT I - HEMATOLOGICAL CLINIC
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INFECTIOUS SPLENO MEGALIES IMMUNO L
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INVESTIGATION OF HEMORRHAGIC SYNDRO
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INVESTIGATION OF POLYGLOBULIAS: POL
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ATTACHMENT III - HEMATOLOGY SPECIAL
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IMMUNOPHENOTYPE PROFILE OF THE ACUT
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ATTACHMENT IV - PAIN APPROACH ROUTI
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If it is prescribed for more than 1
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HOW TO PRESCRIBE OPIOID: SPECIAL CA
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SPECIFICITIES OF EACH OPIATE (cont
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METHADONE Intravenous (*) Oral path
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Psychic Dependence or “addiction
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CROSS TOLERANCE - The subject must
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ATTACHMENT V - CHEMOTHERAPY SUBJECT
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ATTACHMENT VII - IRON CHELATION GEN
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10. G N N - DFP DFP-100 mg/kg/day d
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ATTACHMENT VIII - SEDATION IN CHILD
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224 NOTES _________________________
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224 NOTES _________________________
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Expresso Gráfica e Editora Ltda-me
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Protocols - Hemorio

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