Protocols - Hemorio

-
CONDUCTION IN THE HOSPITALIZATION:
Likely to ORAL therapy
Require ENDOVENOUS therapy
- No improvement after 47 h using
ORAL scheme
- History of hospitalization >24 h in
the last 30 days
Up to 12
years
11
Cefuroxime axetil 15 mg/kg VO 12/12 h +
Azitromicine 10 to 12 mg/kg/day VO 1 X/day
> 12 years Cefuroxime axetil 500 mg VO 12/12 h +
Azitromicine 500 mg VO 1 x day
Up to 12
years
Cefuroxime axetil 15 mg/kg EV 12/12 h +
Azitromicine 10 to 12 mg/kg/day EV 1 X/day
> 12 years Cefuroxime axetil 0.75 – 1.5mg/kg EV 8/8 h +
Azitromicine 500 mg EV 1 X/day
Moxifloxacine 400 mg IV 1X/day
(may be performed sequential therapeutic with moxifloxacine 400 mg VO 1
X/day after clinical improvement)
4. SPLENIC SEQUESTRATION:
CLINICAL PICTURE:
- Suspect splenic sequestration in case of: acute anemia with large volume splenomegaly followed or not
of reticulocytosis, as well as in the pictures of hypovolemic shock with splenomegaly.
- Subacute episodes may also occur characterized by moderate increase of the spleen, decrease of
baseline Hb level to 2 and 3 g/dl and reticulocytosis.
- It is important to teach the family spleen palpation and to alert them to a possible occurrence of this
complication and its severity. Tongue depressor is an easy access tool and that might be used by the
assistant doctor during the consultation. Using as axis the gradil costal and directing the depressor to
umbilical region, the tongue depressor is marked and given to the mother so she will have the initial size
of the spleen.
CONDUCTION :
- The first action to be made is patient hydration, once the initial shock is caused by hypovolemia and not
by hypoxia.
- Use, preferably, plasmatic expandor at 10 and 15 ml/kg dose. In this absence, use 40ml/kg of saline
solution to run within 2 hours at quick step. Bed rest using oxigenotherapy with mask .Elevate MMII
- Packed cells transfusion 10 to 15 ml/kg, to reach 6 to 7 g/dL Hb levels. (see transfusional protocol)
- Conduct after
the 1 st episode
of splenic
sequestration
without
infection:
- Children > 2 years: to confirm pneumococcal and Haemophilus vaccine; splenectomy –to
perform hypertransfusion until splenectomy .
- Children < 2 years: must be conduct for follow-up by Hemotherapy Service to
hypertransfusion program to delay a possible splenectomy.
NOTE: Theses measures do not apply to babies that developed sequestration due to an infectious picture,
when splenomegaly is very often. Conduction in theses cases will depend on the frequency of the
occurrence and the corresponding spleen increase. Splenectomy, in these cases, must be discussed at
Multidisciplinary Group.