Protocols - Hemorio

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SELFIMMUNE HEMOLYTIC ANEMIA CONCEPT: Selfimmune hemolytic anemia is defined as pathologies in which occurs premature destruction of red blood cells, mediated by fixes antibodies and antigens of erythrocyte membrane. This immune fixation triggers a number of reactions in cascade that finishes in these cells lysis (INTRAVASCULAR HEMOLYSE), in addition to phagocytose by macrophagolitic system (ETRAVASCULAR HEMOLYSE) ETHIOLOGIC CLASSICATION PRIMARY IDIOPATIC SECONDARY Lynphoproliferative disease LLC, DH, LNH, MM Self-immune disease LES, self-immune hepatitis, rheumatoid AHAI BY WARM arthritis, self-immune thyroiditis, Biermer ANTIBODY anemia IgG, C3b Tumor Ovary Cyst, malignant neoplasm Infections Pneumonias and rhinopharyngitis Immunosuppressive Pregnancy and transplants Drugs Alpha-metildope, cimetidine, Procainamide AHAI BY COLD PRIMARY / IDIOPATIC ANTIBODY (COLD AGGLUTININ) SECONDARY Lynphoproliferative disease Infections Cascade complement formation Intravascular hemolyze Drug absorption in cellular membrane Extra-vascular hemolyze DRUG-INDUCED AHAI Changes in cellular membrane Adsorption non-immunologic PAROXYSM COLD HEMOGLOBINURIA (biphasic hemolysins) Self-antibodies formation Alpha-metildope Fixes complement at low temperatures and promotes intravascular hemolyse > 37o IDIOPATIC C Diagnose by Donath-Landsteiner test SECONDA RY More frequent in children associated to viroses (measles, chickenpox, rubeola, mononucleosis) More rare form of AHAI. DIAGNOSE Clinical Diagnose: clinical signals of anemia, jaundice. In case of extravascular hemolyze, it may occurs splenomegaly and in case of cold antibodies, Raynaud phenomena and intolerance to cold, due to vase spasms, can be noted. 48
Laboratorial Diagnose: Positive direct Coombs test (Negative on 4% of the cases) Positive indirect Coombs test Immunohematologic Study Antibodies elution and fixation [for TCD (-) cases and to identify aloantibodies (irregular agglutinin)] Antibody Identification Panel Erythrocyte phenotype Macrocytic Anemia Reticulocytose Peripheral Blood Study Spherocytte Policromasia RDW elevated Indirect Bilirubinemia Extravascular hemolyze Elevated LDH Biochemistry Study Haptoglobine reduced Hemoglobinuria Intravascular Hemolyze Indirect Bilirubinemia TREATMENT: Opinion to Hemotherapy for combined follow-up – see HEMOTHERAPIC PROTOCOLS Red blood cells reserve for potential transfusion in more serious cases Investigation for preexisting based-disease. Mielogram to rule out the presence of lynphoprliferative disease. Objectives: Reduce antibodies production, reduce viable antibodies quantity, reduce or stop hemolyze mediated by self-antibody. DRUGS-INDUCED AHAI Stop potential drugs-related event. AHAI – cold antibody: Maintain the patient warmed and in case of serious hemolyze, even with poor response to corticoid, we should continue with the immunosuppressive scheme, aiming a potential urgent hemotransfusion. AHAI – warm antibody: Minimal hemolyze: Folic acid and observation Moderate to intense hemolyze: Corticosteroids (prednisone 1-2 mg/kg/day) during 2 to 4 weeks. If there is a response, gradually reduce to 30-90 days until there is no clinical evidence of hemolyze. RESPONSE FAILURE TO CORTICOSTEROID OR RECIDIVE 1. Cytotoxics agents: ciclofosfamide: 60mg/m 2 /day PO or Azatioprine: 80mg/m 2 /day (or 1.5mg/kg/day) PO during 3-6 months. 49
Page 2 and 3: PROTOCOLS INSTITUTE OF HAEMATOLOGY
Page 4 and 5: COORDINATION AND REVISION Clarisse
Page 6 and 7: SUMMARY: PART I - CLINICAL PROTOCOL
Page 8 and 9: 1.INICIAL CLINICAL EVALUATION SICKL
Page 10 and 11: TREATMENTO AND IN ADULTS AT ANY AGE
Page 12 and 13: SPLENECTOMY - INDICATIONS: (1) CHIL
Page 14 and 15: OUTPATIENT TREATMENT: It is based o
Page 16 and 17: ASPIRIN AND NSAID PARACETAMOL OPIOI
Page 18 and 19: CONDUCTION: - Hospitalization - Com
Page 20 and 21: ONE, TWO-DIMENSIONAL DOPPLER ECHOCA
Page 22 and 23: Hemianopsia Homonymous deficit of v
Page 24 and 25: TREATMENT OF CONVULSIVE EPISODES -
Page 26 and 27: INITIAL ATTENDANCE TO PREGNANT WOME
Page 28 and 29: - It may occurs acute thoracic synd
Page 30 and 31: 3 Diet with potassium restriction 4
Page 32 and 33: MICROALBUMINURIA Screening Patients
Page 34 and 35: RECURRENCE OF PRIAPISM: - Pain Trea
Page 36 and 37: SPECIAL CARES DEFERASIROX - The use
Page 38 and 39: TREATAMENT: DRUG Hydroxiurea (hard
Page 40 and 41: MAJOR AND INTERMIDIATE THALASSEMIA
Page 42 and 43: HEREDIRATY SPHEROCYTOSIS CLINICAL E
Page 44 and 45: G6PD DEFICIENCY INITIAL EVALUATION
Page 46 and 47: LABS EXAMS TO DIAGNOSE APLASTIC ANE
Page 50 and 51: 2. Splenectomy: Vaccinate 14 days b
Page 52 and 53: IMMUNE THROMBOCYTOPENIC PURPURA LAB
Page 54 and 55: THROMBOTIC THROMBOCYTOPENIC PURPURA
Page 56 and 57: HEMORRHAGIC SYNDROME INTRODUCTION H
Page 58 and 59: MULTIDISCIPLINARY FOLLOW-UP OF HEMO
Page 60 and 61: LYOPHILIZED CONCENTRATES: They are
Page 62 and 63: TABLE 2: REPLACEMENT THERAPY TO PER
Page 64 and 65: CONDUCTION IN CONFIRMED INTRACRANIA
Page 66 and 67: Severe CET with neurological change
Page 68 and 69: PHARMACOKINETICS OF CLOTTING FACTOR
Page 70 and 71: INHIBITORS CLASSIFICATION The inhib
Page 72 and 73: - Extended surgeries require increa
Page 74 and 75: CLINICAL DIAGNOSIS: According to In
Page 76 and 77: DDAVP TEST The “test dose” must
Page 78 and 79: TREATMENT OF BLEEDING SITUATIONS SI
Page 80 and 81: TABLE 6 - REPLACEMENT THERAPY IN LE
Page 82 and 83: • Primary prophylaxis: controvers
Page 84 and 85: CLINICAL AND LABORATORIAL FOLLOW-UP
Page 86 and 87: MYELODISPLASIC SYNDROME LABORATORIA
Page 88 and 89: If EPO < 500 mU/ml : EPO (8000U 3x/
Page 90 and 91: ACUTE MYELOID LEUKEMIA LABORATORIAL
Page 92 and 93: LMA LMA M3 - non-M3 LMA Protocol LM
Page 94 and 95: Key: Volunteer to aggressive treatm
Page 96 and 97: Acute Promyelocytic Leukemia Transf
Page 98 and 99:
BMP LMA IN CHILDREN AND TEENAGERS
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Ara-c dose reduction by age: Age in
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ATRA RECOMMENDATION: ATRA is starte
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- venous hydration - leukapheresis
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POLYCYTHEMIA VERA LABORATORIAL TEST
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TREATMENT - 2nd LINE - Indicated fo
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ACUTE LYMPHOID LEUKEMIA LABORATORIA
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RE-INDUCTION Phase I (weeks 1-4) -
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Cycles 2, 4, 6, 8 - Methotrexate 20
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PHASE 2 Infusion CPM in 1 hour 1000
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CURATIVE RADIOTHERAPY of CNS < 1 ye
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CHRONIC LYMPHOCYTIC LEUKEMIA LABORA
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fludarabine 25 mg/m VENOUS 2 D1-D3
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TRICHOLEUKEMIA LABORATORIAL TESTS -
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- age >45 years old - leukocytosis
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- Leukemia / T-Cell Lymphoma in Adu
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INDICATIONS FOR THE TREATMENT: Symp
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1 st line Chemotherapy R- CHOP (21
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CODOX- M/IVAC Cycles 1 and 3 Cyclop
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BLOCK A DEXA VO/IV 10 mg /m2 in 3 d
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- Surgical treatment is only indica
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LEUKEMIA / T-CELLS LYMPHOMA OF THE
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HN2 or PUVA (similar to the located
Page 144 and 145:
MULTIPLE MYELOMA LABORATORIAL TESTS
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RESPONSE CRITERIA Full Response Abs
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WALDENSTRON MACROGLOBULINEMIA LABOR
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− If HLA-identical related donor
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TREATMENT PROTOCOL - ACUTE MYELOID
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TREATMENT PROTOCOL - MULTIPLE MYELO
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Post-autologous transplantation pro
Page 158 and 159:
PART II - TRANSFUSIONAL PROTOCOLS A
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PRESERVATION AND CONSERVATION: The
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TRANSFUSION OF RED BLOOD CELLS, PLA
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FORMAL CONTRAINDICATIONS TO THE PLA
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1 - TRANSFUSION OF FROZEN FRESH PLA
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COMMUNICATION FORM OF CRYOPRECIPITA
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Volume to be = changed (*) VOLEMIA
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HEMOTHERAPIC PROTOCOL TO FALCIFORM
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5 - TRANSFUSIONAL CONDUCT AT THE SE
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CML - Subjects with symptoms relate
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- Aplastic anemia bearers - HIV pos
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Severe reaction: anaphylactic shock
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- Heart monitoring - Prescribe Furo
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CARES AT THE PLATELETS CONCENTRATE
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ATTACHMENT I - HEMATOLOGICAL CLINIC
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INFECTIOUS SPLENO MEGALIES IMMUNO L
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INVESTIGATION OF HEMORRHAGIC SYNDRO
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INVESTIGATION OF POLYGLOBULIAS: POL
Page 194 and 195:
ATTACHMENT III - HEMATOLOGY SPECIAL
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IMMUNOPHENOTYPE PROFILE OF THE ACUT
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ATTACHMENT IV - PAIN APPROACH ROUTI
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If it is prescribed for more than 1
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HOW TO PRESCRIBE OPIOID: SPECIAL CA
Page 204 and 205:
SPECIFICITIES OF EACH OPIATE (cont
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METHADONE Intravenous (*) Oral path
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Psychic Dependence or “addiction
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CROSS TOLERANCE - The subject must
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ATTACHMENT V - CHEMOTHERAPY SUBJECT
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ATTACHMENT VII - IRON CHELATION GEN
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10. G N N - DFP DFP-100 mg/kg/day d
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ATTACHMENT VIII - SEDATION IN CHILD
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224 NOTES _________________________
Page 222 and 223:
224 NOTES _________________________
Page 224:
Expresso Gráfica e Editora Ltda-me
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Protocols - Hemorio

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