Protocols - Hemorio

18. SURGERY
PRESURGICAL CARES: Clinical Evaluation made by hematologist.
- Complete Red Blood Cell Test - Coagulogram
- Glucose, urea, creatinine, hepatogram -SAE
- ECG – Cardiologic surgical risk
- Chest x-ray - Hb A and S Dosage
- O2 evaluation by pulse oxymeter
- - Transfusion preparation (see item 19)
- Immunohematology Study with erythrocytes of Phenotype for all systems
- Keep plain hydration 12 hours before surgery
PRESURGICAL CARES:
- Pleasant temperature in surgery room
- O2 to 50% in combination with anesthetic agent.
- Clinical monitoring - ECG, blood pressure, pulse, temperature urinary output.
- lab monitoring - serum electrolytes dosage, O2 concentration inspirited pulse oxymeter or arterial
gasometry.
POSTSURGICAL CARES :
- O2 at immediate postsurgical
- pulse oxymeter
- parenteral hydration
- respiratory physiotherapy
SPECIAL SITUATIONS:
Presurgical of falciform disease with recent history of priapism: Start 5 mg finasteride, 15 days before
surgery and continue for more 20 days.
19. IRON CHELATION THERAPY:
See also VI appendix – Iron Chelation
INCLUSION CRITERIA
DEFEROXAMINE
DOSES
- All patients that are in a hypertransfusion program
- All patients that experience ferritine levels > 2000, confirmed by 3 dosage performed
with 1-month interval with the patient at baseline.
- 20-60 mg/kg/day SC every 8 h, by infusion pump (average of 40mg/kg/day), from
Monday to Friday.
- Children below 3 years old, start 10 mg/kg/day to avoid hypodevelopment
INTERRUPTION - Fever, abdominal pain and diarrhea (may be Yersinia infection)
FERRITINE CONTROL - Weekly drug dose may be reduced to 3 or 4 fold, when have therapeutic response .
SIDE EFFECTS
MORE FREQUENT
- cyanosed (extremities, lips and skin)
- Blur vision and other visual problems
- seizures,
- dyspnea or taquipnea,
- tachycardia,
- earring problems,
- pain and/or administration site edema
- rash or pruritus
35
LESS FREQUENT
- diarrhea
- dysuria
- fever
- cramps
- abdominal
discomfort
- bleeding