Protocols - Hemorio

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.
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