In addition, the home health care agency is asked to report on patient compliance. Evaluate compliance, chelation protocol, dose of desferoxamine, annual and semiannual transfusion requirement, hepatitis status, liver function and liver biopsy results. Most common problem is non-compliance and requires assessment by team psychologist and nurse practitioner for intervention. All patients who are documented or suspected of having hepatitis C or B should have a liver biopsy annually as indicated and biannual hepatic ultrasound evaluations for hepatic carcinoma. Cardiac Stress ECHO, Holter monitor, ECG annually.
Abnormalities require cardiac referral and evaluation of hemosiderosis and chelation history.
Documented cardiac findings require assessment of hemosiderosis by liver biopsy and intensification of chelation, surveillance and treatment by a Cardiologist in association with a Hematologist. Coordinated care with a Cardiologist. Consideration of heart transplantation in severe refractory congestive heart failure due to cardiomyopathy. Dental System Annual dental examination. Annual endocrinological consultation.