Protocols - Hemorio

5 – TRANSFUSIONAL CONDUCT AT THE SELF-IMMUNE HEMOLYTIC ANEMIA (AHAI)
Transfuse de-leukocytated blood prophylactically
Transfuse only when there are any signs of hemodynamics decompensation and/or hypoxia that may
compromise the immediate vital prognosis, regardless the hematocrit.
Use phenotyped blood for the antigens Rh and Kell (Rh1, Rh2, Rh3, Rh4, K1), and, whenever possible, for
the antigens Jk a , Jk b , Fy a , Fy b , S, s.
Use red blood cells compatible to serum or absorbed plasma (self-absorption or differential absorption)
In case of urgency, or in the impossibility to phenotype the subject, or yet if there is no sample that is
sufficient for the execution of the pre-transfusional tests foreseen for the cases and AHAI, transfuse Onegative
red blood cells.
Fractionate the bag of red blood cells concentrate into two, in a closed system, and transfuse in two steps,
slowly (maximum of 1 ml/Kg/hour), putting the subject’s legs at a pending position and lifting the bed
headboard.
In case of self-immune hemolytic anemia in the cold, cover the subject with a blanket and put wool gloves
and socks in him. The blood heater must be used only if there is any immediate hemolysis after the first
transfusion.
All transfusions made in subjects with AHAI must be monitored by the hemotherapist, who must always
check the transfusional utilization and the eventual appearance of reaction to the transfusion. Those data
must be inserted at the transfusional protocol of the subject.
If there is any reaction to the transfusion, the case must be evaluated again in order to establish the
decision to transfuse again or not.
6 – TRANSFUSIONAL CONDUCT AT THE IMMUNOLOGICAL THROMBOCYTOPENIC PURPURA -
ITP
There is no indication of prophylactic transfusion of platelets at the Immunological Thrombocytopenic
Purpura.
At the preparation for splenectomy, the recommended regimen is not to transfuse prophylactically before
the surgery, but to let separated two dosages of platelets concentrates. The first dose must be transfused
if there is any abnormal bleeding or a figure during the surgery; if this complication occurs, a second dose
must be transfused right after the pinch of splenic pedicle.
If this complication does not occur, transfuse a dosage right after the pinch of the splenic pedicle.
7 – HEMOTHERAPIC CONDUCT AT THE THROMBOTIC THROMBOCYTOPENIC PURPURA - TTP
Coadjuvant at the therapeutic conduct of TTP - PLASMAFERESIS
- deep venous access double lumen
- daily change 40 to 60 ml/kg (may reach 80 ml/kg)
- replacement with cryo-free plasma or frozen fresh plasma
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