Protocols - Hemorio

HEMOTHERAPIC PROTOCOL TO FALCIFORM DISEASE AND SURGERY
The subject must be sent by the clinical Hematology, through an opinion, indicating if it is released under
the hematological point of view for the proposed surgery. This opinion must bear the probable date of the
surgical procedure. Do not attend the subject without the medical folder.
SMALL SIZE
(AMBULATORIES)
Local anesthesia:
biopsies in general
MEDIUM AND BIG
SIZE
General anesthesia:
cholecystectomy,
hernias in general,
splenectomy,
orthopedic, cardiac
surgeries,
neurosurgeries, etc.
FLOWCHART TO
BE FOLLOWED
Do not need
hemotherapic
preparation
Medium Size: Let
the subject with
levels of HbS < or =
50%
Big Size: Let the
subject with levels of
HbS < or = 30%,
The subjects must perform Full hemogram tests and dosage of
Hemoglobin A and S at least 47 hours before the hemotherapic
preparation. It must be evaluated if the subject is submitted to the simple
or change transfusion.
Simple transfusion = it will be applied when the subject presents
hemoglobin value ≤ 6.0 g/dl, or presents at the tests a decrease of 20 %
at the hematimetric baseline values.
Change transfusion = it will be applied in all subjects with Hemoglobin >
6.0 g/dl and HbS > 50%.
The preparation must be performed up to 62 hours before the surgery,
being mandatory at the end of the procedure, an order of a new full
hemogram and dosage of HbS. If the subject presents any clinical
intercurrence at the preparation day, tell your assistant physician
through the Clinical Boss.
HEMOTHERAPIC PROTOCOL OF SPLENIC SEQUESTRATION:
HYPERTRANSFUSION PROGRAM:
INDICATION 0- to 2-year old children who have presented splenic sequestration
HCT and baseline Hb (transfusion indicated when there is a decrease of 20 % in
PARAMETERS
VOLUME TO BE
TRANSFUSED
YES
Preparation
conclusion up to
03:00 p.m.?
NO
these parameters)
5ml/Kg, until the hemodynamics stabilization is reached. The subject must attend,
fortnightly, the Hemotherapy Service according to the topical specifications “Splenic
Sequestration”. After 2 years old, splenectomy is automatically indicated.
TRANSFUSIONAL PROTOCOL OF PREGNANT WOMEN WITH FALCIFORM DISEASE:
ASYMPTOMATIC Hb ≥ 7g/dL - Do not transfuse, evaluate every 10 days
SYMPTOMATIC with a decrease of - Perform a simple transfusion.
20 % of baseline hematimetric values - Reevaluate every week.
SYMPTOMATIC with baseline
hematimetric levels (ATS, algic crisis
moderate to intense, toxemia, fetal
distress with risk of abortion).
Ask for hemogram and dosage of
HbS for the same day.
Perform change transfusion – keep HbS ≤ 50 %
- Reevaluate in 24 hours.
- Make a reservation of red blood cells concentrate at the
previous week to the hospitalization for the delivery
TRANSFUSIONAL PROTOCOL OF SUBJECTS WHO HAVE SUFFERED CVA:
TIA and CVA Start the change transfusion immediately after the diagnosis
Hemorrhagic CVA Do not make any change transfusion, if necessary just simple transfusion
Change of D.T.C. Include the subject at the change program, before an opinion of the Hematology and
Neurology.
172
Hb reached the
desired level?
Ask for the hemogram and
dosage of HbS for the next day.
YES
Release the
surgery with the
document of
Hemotherapy
NO Reevaluate the
transfusion