0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44
Intravascular, Non-immune Hemolytic Anemia 865■acute renal failure and hematologic abnormalities are the main tar-
gets of therapy
■dialysis
■antihypertensive therapy
■plasma exchange is frequently initiated but is often not efficacious
■transfuse packed red blood cells and platelets as neededSide Effects/Complications/Contraindications
■DIC
■heparin therapy should be avoided in patients with documented
CNS bleed or recent surgery
■TTP
■transfuse platelets only to treat life-threatening bleeding; platelet
transfusions may exacerbate disease process, and reports of death
have consistently occurred in those transfused with plateletsbefore
treatment has been initiated with the first therapeutic plasma
exchange
■anti-platelet drugs may increase the risk of bleeding
■HUS
■plasma exchange, steroids, heparin and anti-platelet drugs have not
been helpful or their role has not been clearly defined
➣Antifibrinolytics, prothrombin complex concentrates, and
recombinant activated factor VII are contraindicated in DIC due
to risk of precipitating disseminated thrombosis.follow-up
■DIC
■the efficacy of therapy can be monitored by following changes in
D-dimers, fibrinogen, and platelets
■the PTT or heparin level should be checked several hours after
heparin administration and dosage adjustments made accordi-
ngly
■TTP
■the efficacy of therapy can be monitored by following changes in
mental status, platelet count, hemoglobin, LDH, schistocyte num-
ber, and renal function; platelet counts can be monitored periodi-
cally with decreasing frequency as duration of remission lengthens
■HUS
■monitor blood pressure, renal function, platelet count, LDH,
hemoglobin levels, schistocyte number