Protocols - Hemorio

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MULTIDISCIPLINARY FOLLOW-UP OF HEMOPHILIC PATIENT The newly-diagnosed patient must have a consultation with hematologist, physiatrist, nurse, social worker, psychologist and physiotherapeutic from multidisciplinary group for general orientation about the illness. Deontological evaluation must be periodical. NOTE: All diagnosed cases, like hemophilia, must be notified to the hemostasia alterations group. HEMOPHILIA CLASSIFICATION It is validated both A and B hemophilia and it is considerate that amount of coagulation activity of FVIII (A hemophilia) or FIX (B hemophilia). CLASSIFICATION FACTOR SERIOUS
REPOSITION CALCULATION Reposition therapy depends on patients weight, clinical picture and amount of coagulation activity that patients presents. It follows the formulas below: A Hemophilia: International Units (IU) of factor VIII = weight (Kg) x ∆/2 B Hemophilia: International Units (IU) of factor IX = weight (Kg) x ∆ ∆= % to be elevated less % of factor that the patient has Example for reposition calculation: Serious A Hemophilia (FVIII 0%) with hemarthrosis of the knee and 50Kg weight - (Elevate FVIII at 30%): IU from FVIII = 50 X (30 – 0) = 50 X 15 = 750 IU 2 Notes: 1. Remember that half-life of FVIII is 50% every 8- 12 hours al normal conditions; 2. Half-life of FIX is 50% every12 hours 3. FVIII consume is greater when there is infection or active bleeding; 4. ∆ is depends on the severity of clinical picture. See Table 2. 5. Reposition therapy for each clinical situation is described at tables 2, 3,and 4; however, there is different ways to conduct it. PRODUCTS THAT CONTAIN FVIII: FORZEN AND FRESH PLASMA (PFC): It contains all coagulation factors (approximately 1U/ml). It must avoid PFC, whenever possible, and specially on patients with hemophilia because there is safer products available in Brazil, with less risk of viral transmission. It may be administered at 10 a 20ml/Kg/day dose, divided in two and three administrations, on hemorrhagic episodes of minor importance, because it reaches plasmatic levels between 15 and 20%. Defrosted must be at 37°C and the infusion has to occur right after. Note: The Health Minister FORBIDS the use of frozen and fresh plasma and cryoprecipitated on patients with hemophilia (RDC n° 23, from January, 24, 2002). CRYOPRECIPITATED: This is obtained from Hemotherapy Service through fast frozen method, and plasma centrifugation of a donor. Each bag contains FVIII 80IU, FvW, FXIII and fibrinogen 3 to 4,5g/dl. Mode of application: defrosted at maximum 10 minutes at 37°C. Mixture with the syringe the content of 5 bags in the same recipient. Transfunded with filter. Note.: Use of CRYOPRECIPITATED is indicated on serious liver insufficiency, sepsis and XIII factor deficiency and fibrinogen. The Health Minister FORBIDS the use of frozen and fresh plasma and cryoprecipitated on patients with hemophilia (RDC n° 23, from January, 24, 2002). 59
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PROTOCOLS INSTITUTE OF HAEMATOLOGY
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COORDINATION AND REVISION Clarisse
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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 48 and 49: SELFIMMUNE HEMOLYTIC ANEMIA CONCEPT
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 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
Page 100 and 101: Ara-c dose reduction by age: Age in
Page 102 and 103: ATRA RECOMMENDATION: ATRA is starte
Page 104 and 105: - venous hydration - leukapheresis
Page 106 and 107: 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
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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
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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
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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
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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 _________________________
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224 NOTES _________________________
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Expresso Gráfica e Editora Ltda-me
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Protocols - Hemorio

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