Protocols - Hemorio

CONDUCTION IN CONFIRMED INTRACRANIAL HEMORRHAGE:
1 WITHOUT
NEUROLOGICAL
SIGNS:
2 WITH
NEUROLOGICAL
SIGNS:
Increase FVIII or FIX to 100% in first infusion. Afterwards, 50% every 12 hours (for VIII factor) and
every 24 h for IX factor, during 14 days.
Increase FVIII or FIX to 100% immediately and after, keep 50% every 8 hours (for VIII factor) and
12 h (for IX factor), during 7 days. If there is improvement of TCC image, maintain replacement at
50% every 12 h (for VIII factor) and 24 hours (for IX factor), until 14 th day.
- General care: pain killers and anticonvulsants.
- Get to minimum level of clotting factor every 3 days.
- Do not administer Antifibrinolytics.
CONDUCTION IN SURGICAL PROCEDURES
Every surgical procedure must be preceded by inhibitor research or recovery curve of infused
factor. Minimum level of clotting factor must be performed in post-operatory of medium and major
surgeries.
Patients with mild hemophilia A, responsive to DDAVP (see treatment of Von Willebrand disease with
DDAVP), may use this drug in pre-operatory of minor surgeries, such exodontia.
MINOR SURGERIES
(1) PRE-OPERATORY: increase FVIII or FIX to 50% immediately before surgery.
(2) POST-OPERATORY: if necessary (hematoma or external bleeding) increase FVIII or FIX to 30% every
24 hours, for over than 2 – 3 days.
- Use of Antifibrinolytic whenever possible.
- On exodontias increase the factor to 30% only dose.
- Attention to volume hematomas, they may lead to fibrinolysis.
MEDIUM SURGERIES
(1) PRE-OPERATORY:
Increase FVIII or FIX to 100% 30 to 60 minutes before surgery.
Example 1: Severe Hemophilia A (F VIII = 0%) - Weight 70 Kg
IU = 70 x (100 - 0) = 3.500 IU of F VIII UFVIII = weight (Kg) X
∆/2
2
Example 2: Severe Hemophilia B (FIX = 0%) - Weight 70 Kg UFIX = Weight (Kg) X ∆
IU = 70 x (100 - 0) = 7.000 IU of F IX
(2) POST-OPERATORY:
D1 to D7 - increase FVIII or IX to 50% (every 12 hours)
D8 to D14 - increase FVIII or IX to 50% (every 24 hours) until removal of stitches.
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