Protocols - Hemorio

- keep this procedure until the disappearance of the neurological symptoms and the normalization of the
plateletmetry and LDH for at least 2 to 3 days
- The early suspension of the treatment may bring an early and fatal relapse.
- Attention regarding the toxicity caused by the citrate, which brings hypocalcemia manifested by cramps,
paresthesia and tetany.
- It may have a worsening of plateletpenia due to the change of a great volume of plasma.
- Plasma infusion:
- Indicated whenever it is not possible to perform the plasmapheresis
- Dose: 40 ml/kg/day
- The same response criteria as plasmapheresis
8 – HERITAGE HEMORRHAGIC DISEASES – see “HEMORRHAGIC SYNDROMES”
9 – HEMOTHERAPIC CONDUCT AT THE HEMOGLOBINURIA PAROXYSMAL NOCTURNAL - HPN
- Transfusions if clinically necessary: de-leukocytated and phenotyped red blood cells.
- The transfusion of washed red blood cells is not indicated.
- Phenotyped red blood cells must be transfused for the antigens Rh and Kell (Rh1, Rh2, Rh3, Rh4, K1).
10 – MYELODYSPLASTIC SYNDROMES (MDS)
- Transfuse de-leukocytated blood prophylactically
- Transfuse phenotyped blood for the antigens Rh and Kell (Rh1, Rh2, Rh3, Rh4, K1)
- The serum level of ferritin of each subject must be checked every three months
- Levels of ferritin above 1,000 µg% indicate that the case must be evaluated and discussed jointly by the
Hemotherapy and Hematology Services
11 – ACUTE LEUKEMIA
Adult subjects with age below 45 years old, children or candidates to T.M.O
- Transfuse de-leukocytated blood prophylactically
- Transfuse phenotyped blood for the antigens Rh and Kell (Rh1, Rh2, Rh3, Rh4, K1)
- In case of anti-erythrocytary allo-immunization, transfuse red blood cells lacking antigen(s) against which
the subject has developed antibodies.
Subjects with age above 45 years old
- Transfuse de-leukocytated blood prophylactically
- In case of anti-erythrocitary allo-immunization, transfuse red blood cells lacking antigen(s) against which
the subject has developed antibodies.
12 – MYELOPROLIFERATIVE SYNDROMES: ESSENTIAL THROMBOCYTHEMIA, CHRONIC
MYELOID LEUKEMIA, POLYCYTHEMIA VERA AND MYELOFIBROSIS
Essential Thrombocythemia - Plateletpheresis. For the immediate decrease of platelets counting, the
plateletpheresis is indicated. In cases of severe hemorrhage, thrombosis and before an emergency
surgery. This last procedure, however, is extremely rare.
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