Protocols - Hemorio

Sources of Zinc in food: Milk ad derivates, eggs, oyster, beef, chicken and fish, cereal, rice, beans, lentil
and nuts.
NOTE: Please conduct the patient to Nutritional and Diet Service for orientation regarding rich food in zinc.
Drugs: Please avoid using zinc sulphate, due to gastric intolerance.
IRON SULPHATE:
The use of iron sulphate constitutes counter-indication, only being justified its using when severe iron
deficiency has been comproved by lab tests.
Due to chronic anemia and the possibility to multiple transfusions over the lifetime, the person that
experiences sickle cell disease tends to present increases stocks of iron in the body system.
Recommendation to avoid iron accumulation:
- To ingest mate-tea, black-tea or coffee, at big meals time (lunch and dinner), because theses beverages
reduce the absorption of these element.
- Avoid ingesting rich food in Vitamin C (orange, lemon, cashew, passion fruit) at big meals time (lunch
and dinner). These foods must be ingested at small meals.
7. PAIN CRISIS
GENERAL ACTIONS:
- See also chapter appendix III (Pain approach)
- Hydration IV with Glucose-Saline 5% (patients experiencing vomits or who are not ingesting liquids)
- O2 determination by pulse oximetry (at least 1 X/d, at emergency room and compare with baseline
saturation).
- - Prophylactic respiratory Physiotherapy
- In case of thoracic pain or abdominal pain in children (referred pain), a chest X-ray must be performed
daily to early diagnose Acute Thoracic Syndrome.
- Pulse oximetry daily
- Chest x-ray in case of O2 decrease greater than 5%, by pulse oximetry
- Sodium bicarbonate 3g/m 2 must be used only in cases of proved metabolic acidosis and/or Nephropathy
- Red cells packed transfusion, only in cases of Ht decrease > 20% regarding baseline value.
- Due to multifactor pain, in severe cases may have an association of: DIAZEPAN - 5 - 10 mg, once a day
and/or AMITRIPTYLINE - 25 mg once or twice a day.
- To conduct to PAIN Outpatient the cases with more than 2 episodes of pain in the last quarter.
13