Standard Treatment Guidelines (STG) and The National Essential Drug List for Tanzania (NEDLIT): Standard Treatment Guidelines (STG): 19. NUTRITIONAL AND HAEMATOLOGIC CONDITIONS: HAEMATOLOGICAL DISEASE CONDITIONS: 19.4 Bleeding Disorders: 19.4.3 Haemophilia B (Factor IX deficiency)

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	Standard Treatment Guidelines (STG) and The National Essential Drug List for Tanzania (NEDLIT) (WHO; 1997; 210 pages)
		FOREWORD
		ACKNOWLEDGMENTS
		INTRODUCTION
		Standard Treatment Guidelines (STG)
			1. GASTROINTESTINAL CONDITIONS
				1.1 Parasitic Diseases
					1.1.1 Amoebiasis
					1.1.2 Ascariasis (Round Worms)
					1.1.3 Ancylostomiasis (Hookworm Disease)
					1.1.4 Cestodiasis (Tapeworms)
					1.1.5 Filariasis
					1.1.6 Giardiasis
					1.1.7 Strongyloidiasis
					1.1.8 Typhoid and paratyphoid
					1.1.9 Schistosomiasis
				1.2 Bacillary Dysentery
				1.3 Diarrhoea
					1.3.1 Management of diarrhoea in children
					1.3.2 Special Notes on Management
				1.4 Cholera
					1.4.1 Moderate Dehydration
					1.4.2 Severe Dehydration
				1.5 Ulcers and related conditions
					1.5.1 Peptic Ulcer-General Measures
					1.5.2 Oesophageal Ulcer
					1.5.3 Gastric Ulcer
					1.5.4 Duodenal Ulcer
					1.5.5 Non-Ulcer Dyspepsia
					1.5.6 Acute Gastritis
					1.5.7 Gastro-Enteritis (Food Poisoning Viral)
					1.5.8 Ulcerative colitis
				1.6 Other gastro-intestinal problems
					1.6.1 Irritable Bowel Syndrome
					1.6.2 Malabsorption Syndrome
					1.6.3 Tropical Sprue
					1.6.4 Pernicious Anaemia
					1.6.5 Chronic Pancreatitis
					1.6.6 Disaccharides Deficiency
					1.6.7 Peritonitis
					1.6.8 Constipation
					1.6.9 Haemorrhoids and other Peri-Anal Conditions
				1.7 Liver Diseases Conditions
					1.7.1 Liver Cirrhosis
					1.7.2 Acute Liver Failure/Hepatic Encephalopathy
			2. RESPIRATORY DISEASES
				2.1 Acute Respiratory Infections (ARI)
					2.1.1 Pneumonia
					2.1.2 ARI in Children
					2.1.3 Wheezing
					2.1.4 Croup
					2.1.5 Laryngeal Diphtheria
					2.1.6 ARI in Adult
						2.1.6.1 Community Acquired Infections
						2.1.6.2 Hospital Acquired Infections
					2.1.7 Chronic Bronchitis
					2.1.8 Other Respiratory Infections
					2.1.9 Asthma
						2.1.9.1 Chronic Asthma in Adults
						2.1.9.2 Moderate Asthma in Adults
						2.1.9.3 Severe Asthma in Adults
						2.1.9.4 Maintenance therapy in children
					2.1.10 Cough
					2.1.11 Whooping Cough
					2.1.12 Allergic rhinitis
			3. OBSTETRIC AND GYNAECOLOGICAL CONDITIONS AND CONTRACEPTION
				3.1 Infection of the Genital Urinary Tact
					3.1.1 Urinary Tract Infection During Pregnancy
					3.1.2 Positive RPR or Syphilis during pregnancy
					3.1.3 Vaginal Discharge During Pregnancy
				3.2 Abortion
				3.3 Prolonged Rupture Of Membrane (PROM)
				3.4 Prophylaxis for Caesarian Section
				3.5 Nausea and Vomiting in Pregnancy
				3.6 Anaemia During Pregnancy
				3.7 Hypertension in Pregnancy
					3.7.1 Essential Hypertension
					3.7.2 Pregnancy Induced hypertension (PIH)
					3.7.3 Mild PIH
					3.7.4 Moderate PIH
					3.7.5 Severe PIH
					3.7.6 Pre-Eclamptic Toxaemia (Proteinuria PIH)
					3.7.7 Imminent Eclampsia
					3.7.8 Eclampsia (Proteinuria PIH with Fits)
				3.8 Diabetes in Pregnancy
				3.9 Anaesthesia, Analgesia, Antacids
				3.10 Steroids in Respiratory Distress Syndrome
				3.11 Myometrial Stimulants (Oxytocics)
				3.12 Uterine Stimulation After Delivery
				3.13 Myometrial Relaxants (Stimulants)
				3.14 Termination of Pregnancy
				3.15 Drugs in Pregnancy and Lactation
				3.16 Pelvic Inflammatory Diseases
				3.17 Hormonal Contraceptives
					3.17.1 Check List Questions
					3.17.2 Oral Contraceptives
					3.17.3 Drugs Reducing Effect of Oral Contraceptives
					3.17.4 Drugs made less Effective by Oral Contraceptives
					3.17.5 Post Coital Contraception (“morning-after pill”)
					3.17.6 Long Term Hormonal Contraceptives
					3.17.7 Implant Contraceptive
				3.18 Antepartum Haemorrhage (APH)
				3.19 Dysmenorrhoea
				3.20 Infertility
			4. CARDIOVASCULAR DISEASES
				4.1 Infections
					4.1.1 Prophylaxis of Bacterial Endocarditis
					4.1.2 Dental and upper Respiratory Tract Procedure
					4.1.3 Parenteral Regimen Required for Genital-Urinary Procedures
					4.1.4 Patient with Prosthetic Valve
				4.2 Rheumatic Heart Disease
					4.2.1 Rheumatic Fever
					4.2.2 Antibiotics Prophylaxis after Rheumatic Fever
				4.3 Treatment of Acute Arthritis and Carditis
				4.4 Hypertension
					4.4.1 Mild Hypertension
					4.4.2 Moderate/Severe Hypertension
				4.5 Cardiac failure
					4.5.1 Mild to Moderate and Severe Cardiac Failure
					4.5.2 Acute Pulmonary Oedema
					4.5.3 Resistant cardiac failure
				4.6 Angina Pectoris
					4.6.1 Stable Angina/Infrequent Attacks
					4.6.2 Frequent Attacks
				4.7 Myocardial Infarction (Ml)
					4.7.1 General Measures
					4.7.2 Left Ventricular (Pump) Failure
					4.7.3 Arrhythmias
					4.7.4 Tachycardia
					4.7.5 Rehabilitation
					4.7.6 Prevention of Re-infarction
			5. MALARIA
				5.1 General Guidelines
				5.2 Uncomplicated Malaria, Chloroquine Sensitive
				5.3 Uncomplicated Malaria, Chloroquine resistant
				5.4 Malaria due to vivax/ovale
				5.5 Complicated Malaria
					5.5.1 General measure
			6. SKIN DISEASES
				6.1 Bacterial Phyzogenic Skin Infections
					6.1.1 Impetigo
					6.1.2 Folliculitis
					6.1.3 Furunculosis
					6.1.4 Erysipelas
					6.1.5 Acute Cellulitis
					6.1.6 Acne
					6.1.7 Paranychia
				6.2 SKIN FUNGAL INFECTIONS
					6.2.1 Dermatophytosis (Ringworm)
					6.2.2 Tinea Corporis (Body Ringworm)
					6.2.3 Tinea Capitis (Scalp Ringworm)
					6.2.4 Tinea Versicolor (Pityrias Versicolor)
					6.2.5 Tinea Pedis (Athlete's Foot)
				6.3 OTHER FUNGAL DISEASES
					6.3.1 Candidiasis
					6.3.2 Deep Fungal Infections
				6.4 Scabies
				6.5 Herpes Simplex
				6.6 Herpes Zoster (Shingles)
				6.7 Chicken Pox
				6.8 OTHER SKIN DISEASES
					6.8.1 Allergic Contact Dermatitis
					6.8.2 Eczema
					6.8.3 Urticaria
					6.8.4 Psoriasis
					6.8.5 Pellagra
					6.8.6 Depigmented Skin
					6.8.7 Brucellosis (Undulant Fever)
					6.8.8 Lichen Planus
			7. SEXUALLY TRANSMITTED INFECTIONS / DISEASES (STD)
				7.1 General Guidelines
				7.2 Reasoning Behind STD Drug Treatment Regimens
				7.3 Gonorrhoea
				7.4 Chancroid
				7.5 Epididymo-Orchitis
				7.6 Chlamydia Infections
				7.7 Syphilis
				7.8 Genital Warts
				7.9 Trichomoniasis
				7.10 The Syndrome Treatment of STD
					7.10.1 In Men
					7.10.2 In Women
			8. DENTAL AND ORAL CONDITIONS
				8.1 Dental Infections
					8.1.1 Periapical Abscess
					8.1.2 Infected (Dry) Socket
					8.1.3 Periodontal Conditions
					8.1.4 Oral/Mucosal Ulcerations
					8.1.5 Infections of the Oral cavity
					8.1.6 Pericoronitis
					8.1.7 Ludwig's Angina
					8.1.8 Dental Abscess
				8.2 Post Extraction Bleeding
				8.3 Tooth Sensitivities
				8.4 Dental Caries
				8.5 Aphthous Ulcerations
					8.5.1 Minor aphthous ulcers
					8.5.2 Major aphthous ulcers
				8.6 Edentulousness
				8.7 Malocclusions
				8.8 Traumatic Injuries to Teeth in Children
				8.9 Tumours of the Oral Cavity
					8.9.1 Benign Odontogenic Tumours
					8.9.2 Malignant Odontogenic Tumours
					8.9.3 Soft Tissue and Bone Tumours (Non-Odontogenic)
					8.9.4 Lymphomas
				8.10 Shedding of Primary (Milk) Teeth
				8.11 Eruption of Teeth
			9. GENITO-URINARY DISEASES: KIDNEY CONDITIONS
				9.1 Glomerulonephritis
				9.2 Pyelonephritis
				9.3 Nephrotic Syndrome
			10. EAR, NOSE AND THROAT CONDITIONS
				10.1 Otitis (External and Media)
					10.1.1 Otitis External
					10.1.2 Otitis Media
				10.2 Acute Rhinitis and Sinusitis
				10.3 Pharyngotonsillitis
				10.4 Laryngitis
				10.5 Acute Epiglotitis (AE)
			11. EYE CONDITIONS
				11.1 Prevention/Management
				11.2 Red Eye
				11.3 Corneal Abrasion
				11.4 Penetrating Injury
				11.5 Chemical Burns
				11.6 Conjunctivitis
					11.6.1 Conjunctivitis of the Newborn
				11.7 Unilateral
				11.8 Trachoma
				11.9 Xerophthalmia/Vitamin A Deficiency
			12. TUBERCULOSIS AND LEPROSY
				12.1 Tuberculosis
					12.1.1 Control of Tuberculosis
					12.1.2 Case Management
					12.1.3 Treatment Categories
						12.1.3.1 Treatment Guidelines Catagory I
						12.1.3.2 Treatment guidelines Category II
					12.1.4 New Cases Other Than Smear Positive (PT)
					12.1.5 Chronic Cases
				12.2 Leprosy
					12.2.1 General Information about Leprosy
						12.2.1.1 When Leprosy Should be Suspected
						12.2.1.2 Diagnosis of Leprosy
					12.2.2 Classification of Leprosy
						12.2.2.1 Tuberculoid Leprosy
						12.2.2.2 Borderline Leprosy
						12.2.2.3 Borderline Tuberculoid (BT) Leprosy
						12.2.2.4 Borderline Lepromatous (BL) Leprosy
						12.2.2.5 Lepromatous (LL) leprosy
				12.3 Treatment of Leprosy
					12.3.1 Categories of Patients
					12.3.2 Where the Patient should be Treated
					12.3.3 Duration of Treatment
					12.3.4 Procedures During and After Treatment
					12.3.5 Responsibilities During Treatment
				12.4 Prevention of Disabilities and rehabilitation
				12.5 Signs and Treatment of Severe Reversal Reaction (RR)
					12.5.1 Signs and Treatment of severe Erythema Nodosum Leprosum (ENL) Reaction
					12.5.2 Treatment of Mild reaction
					12.5.3 Precautions with Prednisolone
				12.6 Responsibilities
				12.7 How to Look After Ulcers
				12.8 Surveillance of Patients After Release from MDT
				12.9 Referral Criteria of Leprosy Patients
			13. MUSCULOSKELETAL CONDITIONS AND JOINT DISEASES
				13.1 Infections
					13.1.1 Osteomyelitis
					13.1.2 Tropical Pyomyositis
				13.2 Inflammatory Conditions
					13.2.1 General Guidelines
					13.2.2 Rheumatoid Arthritis
					13.2.3 Gout
					13.2.4 Osteoarthritis
			14. METABOLIC AND ENDOCRINE SYSTEM CONDITIONS
				14.1 Diabetes Mellitus
				14.2 Thyroid Diseases
					14.2.1 Hyperthyroidism
					14.2.2 Hypothyroidism
			15. CENTRAL NERVOUS SYSTEM DISEASE CONDITIONS
				15.1 Infections
					15.1.1 Meningitis
					15.1.2 Other CNS Infections
					15.1.3 Tetanus
					15.1.4 Rabies
				15.2 Vascular Headaches
				15.3 Anxiety Neurosis
				15.4 Depressive Psychosis
				15.5 Epilepsies
					15.5.1 Status Epilepticus
					15.5.2 Serial Epilepsy
				15.6 Schizophrenia
				15.7 Alcohol Dependence Syndrome
				15.8 Substance Abuse
			16. OTHER DISEASE CONDITIONS
				16.1 Leishmaniasis
				16.2 Trypanosomiasis
				16.3 Anthrax
				16.4 Mastitis (Breast Abscess)
			17. VIRAL INFECTIONS
				17.1 Measles
				17.2 Poliomyelitis
				17.3 Viral Hepatitis
				17.4 HIV
			18. ALLERGIC REACTIONS
				18.1 Anaphylaxis (Acute Hypersensitivity)
			19. NUTRITIONAL AND HAEMATOLOGIC CONDITIONS
				HAEMATOLOGICAL DISEASE CONDITIONS
					19.1 Anaemia
					19.2 Sickle Cell Anaemia
					19.3 Q6PD deficiency
					19.4 Bleeding Disorders
						19.4.1 Hereditary Bleeding Disorders
						19.4.2 Haemophilia A (Factor VIII deficiency)
						19.4.3 Haemophilia B (Factor IX deficiency)
					19.5 Von Willebrand Disease (VWD)
					19.6 Acquired Bleeding Disorders/Platelet Disorders
					19.7 Haemorrhagic Disease of the Newborn
					19.8 Anticoagulation
				NUTRITIONAL DISEASE CONDITIONS
					19.1 Avitaminosis
						19.1.1 Vitamin A Deficiency
						19.1.2 Vitamin D Deficiency
						19.3 Nicotinic Acid Deficiency (Pellagra)
						19.1.4 Thiamine Deficiency (Beriberi)
						19.1.5 Riboflavin Deficiency
						19.1.6 Pyridoxine Deficiency
						19.1.7 Ascorbic Acid Deficiency
						19.1.8 Vitamin K Deficiency
			20. MALIGNANT DISEASE CONDITIONS
				20.1 Hepatoma
				20.2 Cancer of the Cervix
				20.3 Cancer of the Breast
				20.4 Kaposi's Sarcoma
				20.5 Leukemia
				20.6 Burkitt's Tumour
			21. INJURIES AND TRAUMA
				BITES
					21.1 Animal Bites
					21.2 Insect Bites
					21.3 Snake Bites
				BURNS
			22. FOREIGN BODIES
			23. PAIN
			24. POISONING
			25. NORMAL LABORATORY VALUES
		NATIONAL ESSENTIAL DRUG LIST
			1. ANAESTHETICS
			2. MUSCLE RELAXANTS AND CHOLINESTERASE INHIBITORS
			3. ANALGESICS, ANTIPYRETICS
			4. ANTIMIGRAINE DRUGS
			5. ANTI-ALLERGICS AND DRUGS USED IN ANAPHYLAXIS AND SHOCK
			6. ANTIDOTES
			7. ANTIEPILEPTICS AND ANTICONVULSANTS
			8. ANTI-INFECTIVE DRUGS
			9. ANTINEOPLASTIC DRUGS AND IMMUNOSUPPRESSIVE DRUGS
			10. ANTI-PARKINSONISM DRUGS
			11. DRUGS AFFECTING THE BLOOD
			12. PLASMA SUBSTITUTES, BLOOD PRODUCTS
			13. CARDIOVASCULAR DRUGS
			14. DERMATOLOGICAL DRUGS
			15. DIURETICS
			16. GASTROINTESTINAL DRUGS
			17. HORMONES, ANTIDIABETIC AGENTS, ENDOCRINE DRUGS, CONTRACEPTIVES
			18. DIAGNOSTIC AGENTS
			19. IMMUNOLOGICALS
			20. OPHTHALMOLOGICAL PREPARATIONS
			21. DRUGS USED IN EAR, NOSE AND THROAT (ENT)
			22. OXYTOCICS & ANTI-OXYTOCICS
			23. PSYCHOTHERAPEUTIC DRUGS
			24. RESPIRATORY TRACT DRUGS
			25. SOLUTION, CORRECTING WATER ELECTROLYTE AND ACID BASE DISTURBANCES
			26. DISINFECTANTS and ANTISEPTICS
			27. VITAMINS & MINERALS
			28. DENTAL DRUGS/SUPPLIES
			29. VILLAGE HEALTH POSTS
			30. ESSENTIAL LABORATORY DIAGNOSTIC REAGENT
		ABBREVIATIONS AND SYMBOLS

19.4.3 Haemophilia B (Factor IX deficiency)

Mild bleed	factor IX concentrate 2 bottles (500 IU/ bottle) in adults.
	OR
	fresh frozen plasma (FFP) 1 bag/15 kg body weight (4-5 bags for average adult)
Major bleeding	Factor IX concentrate 3-6 bottles (500 IU/bottle) in adults
	OR
	fresh frozen plasma (FFP) 1 bag/7.5 kg body weight (8-10 bags in adults). Repeat in 24 hours if bleeding continues. As adjunct to replacement therapy. Tranexamic acid (O) 500 - 1000 mg three times a day as for Haemophilia A.

• For children use appropriate proportions

• Factor VIII concentrate and cryoprecipitate are not useful for Haemophilia B, so accurate diagnosis is essential.

• Some Haemophilia A and B patients are on recommended dosage but may require assistance from health personnel.

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