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Treatment of the Chronically Transfused Patient
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Hepatitis/Liver Disease
Hepatic illness causes serious morbidity secondary to viral infection
and iron overload. Progressive liver injury leads to chronic liver failure
and hepatocellular carcinoma. Annual screening for hepatitis should include
hepatitis A antibody, hepatitis B surface antigen, hep B core, hepatitis
C antibody (if positive, hepatitis C PCR and RIBA). For patients who have
hepatitis of unknown etiology, hepatitis G testing should be performed.
All patients who are hepatitis B or C positive and elevated liver enzymes
should be scheduled for liver biopsy to evaluate disease activity and
need for therapy. Patients whose biopsies indicate significant hepatitis
staging criteria undergo consideration for interferon alpha 2B. Therapy
is initiated at 3 x 106 units subcutaneously 3 times a week and continued
for at least one year if a good response is obtained. During this time,
patients' opthalmologic, metabolic, and hematologic status is monitored.
Psychosocial Complications of Thalassemia
The family with a child with thalassemia undergoes psychosocial changes
throughout the care of their child. Anticipatory counseling, therapy,
and at times pharmacologic intervention can have a major impact on quality
of life. In the early years, parents are severely shocked that their child,
previously felt to be normal, has a chronic, fatal disease. This is complicated
by extreme feelings of guilt resulting in overprotective behavior and
damage to the family unit. Early psychological care may prevent such problems.
Adolescence is a particular crisis period and can be complicated by hopelessness,
despair, seclusion, denial and non-compliance. Young adults have to come
to terms with life and death. Peer support groups, mentoring programs
and employment placement programs will be crucial for the psychological
well-being of patients. <back>
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