Hemochromatosis, blood transfusion and myeloproliferative disorders interfering with driving

Is characterized by the local or generalized deposit of iron higher than normal

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Hemosiderosis is characterized by the local or generalized deposit of iron higher than normal in the tissues. Hemochromatosis occurs if tissue injury is associated.

The symptoms of hemochromatosis are caused by liver cirrhosis, diabetes mellitus, myocardiopathy, heart failure, arrhythmia, and less frequently, abdominal pain and arthritis.

Blood transfusion is a form of transplant of blood cellular components from a donor to a recipient, and sometimes the following complications can arise.

The hemolytic reaction usually has an acute onset and occurs during the transfusion or just after it, with a variable outcome, but it is always a serious condition.

The patient notices discomfort and anxiety, and starts with breathlessness, headache, severe pain in the neck, chest and low-back area, precordial tightening, and vomiting.

  • The febrile reaction is associated with shivering, fever, headache, and dorsolumbar pain.
  • The allergic reaction is usually mild, with urticaria, edema, lightheadedness, and headache during the transfusion or immediately after it, and sometimes bronchospasm and incontinence can occur. Depending on the symptoms and their severity, an antihistamine, corticoid, or epinephrine will be administered.
  • Circulatory overload occurs in patients with anemia and with heart disease, where the transfusion causes congestive heart failure requiring specific treatment.

Advice on Hemosiderosis

  • The ability to drive will depend on the stage of the disease, for the multiple organ involvement frequently occurring.
  • The physician will indicate the added risks caused by hemochromatosis when driving, and the favorable or stable evolution that in each case permits driving.
  • In the necessary cases, the physician will advise against driving.
  • It is advisable to take inside the car, in a visible place, a report including the data on the disease, and the treatment, in case road assistance should be required for the occurrence of complications while driving or in the event of an accident.

Myeloproliferative disorders

Polycythemia vera is characterized by an increased concentration of hemoglobin, volume, blood viscosity, and erythrocytosis. In half of the patients there is also an excessive production of leukocytes and blood platelets.

It occurs as weakness, pruritus, headache, lightheadedness, visual disturbances, asthenia, or dyspnea, and gastrointestinal bleeding and epistaxis are frequent. Hepatomegaly and splenomegaly, that can become massive, are frequent.

Early atherosclerotic and thrombotic disease occurring with stroke, myocardial infarction and peripheral vascular disease are characteristic. Gout and nephrolithiasis occur later.

It can be associated with peptic ulcer, thrombosis and bone pain. Thrombosis is the most common cause of death, followed by the complications of myeloid metaplasia and hemorrhage.

Secondary erythrocytosis occurs due to arterial hypoxemia in chronic pulmonary disease, smoking, some neoplasms or hemoglobin disorders.

Myelofribrosis or myeloid metaplasia causes during its evolution asthenia, anemia, weight loss of weight, splenomegaly, and in half of the cases hepatomegaly.

Thrombosis often occurs, and bleeding is uncommon.

The treatment is aimed at controlling complications, with transfusions in cases of serious anemia, splenectomy, and palliative therapy.

Primary thrombocythemia frequently occurs with weakness, gastrointestinal bleeding, epistaxis, ecchymosis, headache, paresthesia of the hands and feet, digital ischemia and dizziness. Anemia is frequent.

The treatment is aimed at reducing platelet count and hemorrhagic and thrombotic complications.

Chronic myeloid leukemia is characterized by splenomegaly and leukocytosis, and shows first a chronic phase with few symptoms, and then the blastic phase that is similar to acute leukemia of fatal prognosis.

Advice on Blood transfusion

  • The patient cannot drive until the clinical condition has returned completely to normal, and with a report from the specialist that specifies and indicates it.

Advice on The febrile reaction

  • With fever, headache, and lack of concentration, the patient should not drive.

Advice on The allergic reaction

  • The patient cannot drive until the clinical condition returns completely to normal, and the physician will warn the patient of the risk.
  • The patient will be warned of the side effects of some drugs, that can interfere with driving, such as drowsiness.

Advice on Circulatory overload

  • The patient cannot drive until the clinical condition has completely returned to normal and the patient should be warned about it.
  • The specialist will report the complete cardiological recovery without symptoms or handicaps of the patient, of when he can drive.

Advice on Myeloproliferative disorders

  • Polycythemia vera is a disease that interferes with driving for the risk of suffering complications related to hyperviscosity and increased circulatory volume.
  • The specialist will advise the patient against driving in the event of possible or presence of complications of the disease, providing in the recommendations of the report the advice not to drive.
  • Based on the evolution of each patient, the expert will advise on the ability to drive in mild cases.

Advice on Erythrocytosis

  • It does not interfere with driving.
  • The symptoms of the primary disease are those that will limit driving.

Advice on Myelofribrosis or myeloid metaplasia

  • The ability to drive is limited in advanced cases due to the lightheadedness, drowsiness, and lack of attention caused by anemia.
  • Thrombotic episodes are disabling for driving, and the patient should be warned about it.
  • Splenectomy requires a postoperative recovery period without driving, until the specialized physician reports on the complete recovery of the patient, both in hematology and in the healing of wounds.

Advice on Primary thrombocythemia

  • The presence of hemorrhage, symptomatic anemia, and thrombosis prevent from driving.
  • The favorable response to the treatment and its stabilization over time will permit driving, always with a report from the expert physician in this regard.

Advice on Myeloid leukemia

  • Driving is permitted during the symptom-free chronic phase.
  • The unfavorable natural history of the disease prevents from driving at a given time and the patient should be warned about this by their physician.