Proposal of treatment algorithm for immune thromocytopenia in adult patients of a hematology service at a referral center in Northeastern Brazil

ABSTRACT Introduction: The management of adult (≥18 years) immune thrombocytopenia patients relies on platelet count, the risk of bleeding and presence of bleeding. Objective: Confirming the diagnosis of immune thrombocytopenia and the start of therapy, our hematology service, a referral center, favors the establishment of this algorithm to treat those patients. Results: Presentation, recently diagnosed or recurrence - group 1: life-threatening bleeding: high-dose intravenous immunoglobulins with methylprednisolone or dexamethasone. Hospitalization and platelet transfusion are considered. Group 2: Platelets <30 × 109/L with bleeding or risk factor for bleeding, or platelets <20 × 109/L: prednisone or dexamethasone. No response, platelets <20 × 109/L: replace corticoid or increase doses. If platelets continue <20 × 109/L: immunization and splenectomy. Investigation of Helicobacter pylori, if positive: treatment for H. pylori. Chronic immune thrombocytopenia with platelets <20 × 109/L we propose two new groups (A and B): Group A: <65 years, no or low surgical risk, patient declines maintenance therapy or patient intends to get pregnant: immunization and splenectomy. Group B: failure of splenectomy (refractory) or no splenectomy indication or history of exposure to malaria or babesiosis and no response to corticoids or corticoid dependence: choose thrombopoietin receptor agonists: eltrombopag or romiplostim. Patient at high risk for arterial or venous thrombosis: recommend rituximab. After rituximab or thrombopoietin receptor agonists, if platelets continue <20 × 109/L: indicate immunosuppressants (azathioprine or cyclophosphamide), dapsone or mycophenolate mofetil or vinca alkaloids. The goals of treatment for chronic or refractory immune thrombocytopenia are to keep platelets >20 × 109/L and stop bleeding.

Perfil das instituições de longa permanência para idosos no estado de Alagoas no período de 2007 a 2008 / Profile of homes for the aged in the state of Alagoas in the period of 2007 to 2008

OBJETIVO: avaliar o funcionamento das ILPI no Estado de Alagoas quanto aos critérios da Agência Nacional de Vigilância Sanitária. METODOLOGIA: estudo de casos, com dados secundários coletados dos roteiros de inspeções sanitárias efetuadas nos anos de 2007 e 2008, pela Vigilância Sanitária Estadual e dos Municípios. RESULTADOS: das 17 ILPI analisadas, a maioria (94,1 por cento) foi considerada de alto ou médio risco para saúde do idoso, ou seja, não alcançaram os padrões mínimos necessários para seu funcionamento e não ofereciam assistência adequada ao idoso institucionalizado. CONCLUSÃO: estes resultados apontam para a necessidade de intervenções que busquem garantir o atendimento adequado e qualificado dos idosos institucionalizados.

OBJECTIVE: to evaluate the operation of the ILPI in the State of Alagoas based on the criteria of the National Health Surveillance Agency. METHODOLOGY: case studies, using data collected from health surveillance inspections, in the years 2007 and 2008, by the State and Municipal Health Surveillance. RESULTS: among the 17 ILPI analyzed, the majority (94.1 per cent) were considered at high or medium risk for health of the elderly, or have not achieved the minimum standards required for their operation and did not provide proper assistance to the institutionalized elderly. CONCLUSION: these results emphasize the need for interventions that seek to guarantee appropriate and qualified care for the institutionalized elderly.