Protocols - Hemorio

TABLE – SUMMARY OF THE INDICATIONS
Encephalic vascular accident, acute or intermittent episodes caused by infarct.
The best results are obtained when the change is performed up to 6 hours
CVA
after the installation of the table. The purpose is to keep the HbS between 30
and 50%.
Acute Thoracic Syndrome – thoracic or abdominal pain, fever, pulmonary
infiltrate to the radiological test, progressive respiratory failure, dispneia, PaO2
ATS
< 60 mmHg, kept for 6 months. The best results are obtained with the
introduction of the Change Transfusion, as soon as ATS is established.
Pulmonary
In subjects with ECG presenting tricuspid regurgitation speed higher than 2.5
hypertension
or diagnosis of HP by other cardiopulmonary criteria.
Execute the procedure in at most up to 12h, after the installation of the table,
Priapism
mainly if the HCT ≥ 20% of the baseline, in children or ≥ 25% in the adults.
Refractory algic crisis Causing muscular necrosis with no-responsive pain to the drug in the 48h.
Indicated in special cases that must be discussed jointly to the multidisciplinary
Leg ulcer
group. The Change Transfusion or hypertransfusion is indicated in the cases of
concurrent hyperbaric treatment.
History of multiple abortions, complications during the pregnancy and
Pregnant women
gemellary pregnancy.
Surgeries Preparation for elective surgeries, of medium to big size.
* The red blood cells to be transfused in this subjects must be de-leukocytated prophylactically and
compatible for the antigens Rh and Kell (Rh1, Rh2, Rh3, Rh4, K1). Respect, whenever possible, the
phenotype Jka and Jkb of the subject.
* The regimen to be used at the change transfusion is described next:
PROCEDURE OF CHANGE TRANSFUSION:
1st - Check the subject’s weight
- Vital Signs
Step
- Calculation of the total volemia (WEIGHT X 70)
- Dosage of Hb or HCT of the unit(s) to be transfused
2nd Step - Hydration – Fast step of 10 to 15 ml/Kg of SF to 0.9%
3rd Step - Remove from 10 – 20% of the total volemia of the subject by step
4th Step - Infuse around 5ml/Kg or 50% of the volume to be infused between the removals
5th Step - Repeat the previous items until the volume to be removed is reached
From 15% of removal of the total volemia from the subject, if it is necessary to keep the oncotic pressure
of the subject, a human albumin may be used as a replacement liquid, and, in case of absence, plasma
may be used.
REMOVAL / INFUSION CALCULATION
In general, 40 ml/Kg of weight are removed from the subject and transfused 30 ml/Kg. The purpose of the
change is to keep the S hemoglobin between 30-50% until the next change procedure.
If it is not possible, for any reason – particularly lack of a proper venous access – include the subject at the
change regimen, you may choose the chronic simple transfusion regimen, being careful to make an
adjuvant therapy with Iron chelant when the serum ferritin increases to more than 2,000 µg/dL.
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