Protocols - Hemorio
Protocols - Hemorio
Protocols - Hemorio
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THROMBOTIC THROMBOCYTOPENIC PURPURA<br />
PRIMARY CRITERIA:<br />
- Thrombocytopenia<br />
- Microangiopathic Hemolytic Anemia (defined as negative TCD, fragmented red blood cell and<br />
laboratorial clinical evidence of hemolyze)<br />
- Absence of other causes for thrombocytopenia and anemia<br />
OTHER ALTERATIONS:<br />
- Renal function alterations (proteinuria, hematuria, oliguria and acute renal insufficiency)<br />
- Neurologic alterations (agitation, disorientation, lethargy, coma and focal alterations)<br />
- Abdominal symptoms (pain, nauseas, diarrhea, vomit)<br />
- Asthenia<br />
- Fever<br />
COMPLEMENTARY EXAMS:<br />
- Complete red blood cell with peripheral blood evaluation<br />
- Reticulocytes Count<br />
- Biochemistry<br />
- Hepatogram<br />
- LDH<br />
- SAE<br />
- Coagulogram, PDF and fibrinogen<br />
- Serology: HBV, HCV, HIV, HTLV<br />
- Immunohematologic Study<br />
- Mielogram<br />
TREATMENT:<br />
Plasmapheresis: see HEMOTERAPIC PROTOCOLS<br />
Corticoid:<br />
- It may be used when plasmapheresis or plasma infusion failed. This is recommended when the patient<br />
is submitted to plasmapheresis.<br />
- Metylprednisolone pulse: 20 mg/kg/day for 3 days, with gradual reduction posterior until reach the<br />
equivalent to 1 mg/kg/day of prednisone.<br />
- Maintain PDN for 4 weeks, with gradual reduction<br />
Splenectomy: indicated in PTT refractory cases<br />
Immunosuppressant:<br />
- Vincristine: 2 mg/week for 4 weeks<br />
- Rituximab / Azatioprine / Ciclofosfamide / Ciclosporine<br />
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