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Treatment of the Chronically Transfused Patient
Chronically transfused patients have special health care needs. In order to thoroughly assess these needs, an annual comprehensive examination is conducted. Prior to the comprehensive visit, each patient undergoes a series of diagnostic tests, including cardiac assessment (echocardiogram, 24-hour Holter monitor, scans), audiology screen, endocrine evaluation (thyroid, hypogonadism, oral glucose tolerance test, bone density, etc.), hepatitis panel, quantitative iron staging (ferritin, SQUID or liver biopsy), nutritional laboratory screening, as well as growth, opthalmologic, and dental evaluations. During the comprehensive clinic visit, patients and their families meet with the hematologist, pediatrician, endocrinologist, gastroenterologist, nutritionist, nurse practitioner, genetic counselor, psychologist, and social worker. Based on the individual needs of each patient, other specialists (cardiology) may also attend. Input from each provider is solicited at case conference following the comprehensive clinic and used to construct a care plan. Transfused patients also undergo two semi-annual visits each year to monitor overall status. Care for the transfused thalassemia patient focuses on the most frequent complications including transfusion, iron overload and Desferal administration, endocrine failure, cardiac complications, splenomegaly, infectious disease, hepatitis, and psychosocial complications. Our approach to each of these problems is briefly described in the following pages. <next> |
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