CPG Management of Transfusion Dependent Thalassaemia

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    5

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Bh Okgkrzbk' ;= }ekgkzzklobk o|}k}bahz jah}sbc|}l }a }el okiasb}r

    af }ekgkzzklobk(30 Glvlg BBB ]el bh}lskj}bahz af }elzl vksba|z o|}k}bahz

    slz|g} bh el}lsanlhlb}r k} pelha}rpbj glvlg( ]el pslmaobhkh} }rpl af

    }ekgkzzklobk koahn Okgkrz ekz k $ pelha}rpl TBVZ ;/< %NJ"_(3;/3= Glvlg BBB Bh jah}skz}' koahn Okgkrzbkh Jebhlzl' }ebz bz fa|hm }a cl 0

    pelha}rpl TFZJ =;/=3%/]J]]"_(;5'3

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    2

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    :( JA\HZLGGBHN KHM ZJSLLHBHN

    :(; NLHL]BJ JA\HZLGGBHN

    :(;(; Bh}sam|j}bah

    E Nlhl}bj ja|hzlggbhn bz }el psajlzz bh ~ebje pk}blh}z as slgk}bvlz

    k} sbzd af k mbzasmls }ek} okr cl elslmb}ksr ksl kmvbzlm af }el

    jahzl{|lhjlz af }el mbzasmls' }el psackcbgb}r af mlvlgapbhn as

    }skhzob}}bhn b}' khm af }el ~krz bh ~ebje }ebz okr cl pslvlh}lm!

    kvabmlm as kolgbask}lm(36 Glvlg BBB

    E Nlhl}bj ja|hzlggbhn bz lzzlh}bkg }a psa}lj} }el k|}ahaor af

    kh bhmbvbm|kg as ja|pgl khm }a f|gg }elbs sbne}z }a okubo|o

    bhfasok}bah kca|} }el mbzasmls khm }a elgp }elo }a |hmlsz}khm

    khm }a jeaazl koahn }el ap}bahz kvkbgkcgl(:0Glvlg BBB

    E Jahmlh}bkgb}r af nlhl}bj bhfasok}bah hllmz }a cl slzplj}lm(:0 Glvlg BBB

    E ]el z|jjlzz af nlhl}bj ja|hzlggbhn mlplhmz js|jbkggr ah b}z

    lm|jk}bahkg' vag|h}ksr khm hahpslzjsbp}bvl!hahmbslj}bvlhk}|sl(32Glvlg BBB

    E Pzrjeaganbjkg z|ppas} khm lopek}bj slgk}bahzebp cl}~llh }el

    ja|hzlggas khm }el ja|hzlgll ksl bopas}kh} lglolh}z af nlhl}bj

    ja|hzlggbhn(:0Glvlg BBB

    :(;(3 ^ea zea|gm psavbml nlhl}bj ja|hzlggbhn1

    E Nlhl}bj ja|hzlggbhn zea|gm cl psavbmlm cr Jgbhbjkg Nlhl}bjbz}z'

    nlhl}bj ja|hzlggasz as kml{|k}lgr }skbhlm olmbjkg!h|szbhn z}kff

    ~ea ksl jahmlh} k} psavbmbhn bhfasok}bah slnksmbhn kgg kzplj}z

    af }ekgkzzklobk(:0/:=Glvlg BB/:

    E Nlhl}bj ja|hzlggbhn af k} sbzd ja|pglz khm fkobgblz ~b}e kfflj}lm

    bhmbvbm|kgz' khm fas plapgl ~b}e |h|z|kg jkssbls z}k}lz as

    pks}bj|gks psacglo!bzz|l' zea|gm cl psavbmlm cr nlhl}bjbz}z!}skbhlm maj}asz(32Glvlg BBB

    E Elkg}e ~asdlsz bhvagvlm bh psavbmbhn bhb}bkg zjsllhbhn }lz}z hllm

    }a cl kcgl }a psavbml zbopgl khm jglks bhfasok}bah kca|} }el

    slkzahz khm acilj}bvlz af }el }lz}z( Gkr ja|hzlggasz zea|gm

    cl kvabmlm(32':=Glvlg BBB

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    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    :(;(: ^elh }a psavbml }el nlhl}bj ja|hzlggbhn1

    E Ja|hzlggbhn zea|gm cl afflslm clfasl jkssbls zjsllhbhn bzjahm|j}lm khm kf}ls }el slz|g} cljaolz kvkbgkcgl(:Glvlg BBB TSlfls }a Kpplhmbu : khm =_

    E Z|b}kcgl bhfasok}bah zea|gm cl okml kvkbgkcgl(:

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    ;;

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    SLJAOOLHMK]BAH

    Nlhl}bj ja|hzlggbhn zea|gm cl psavbmlm cr kh kppsapsbk}lgr }skbhlmpsaflzzbahkg( %Nskml J"

    Nlhl}bj ja|hzlggbhn zea|gm cl jahm|j}lm bh kjjasmkhjl }a }el

    fagga~bhn psbhjbpglz9

    E Psavbzbah af slglvkh} khm acilj}bvl bhfasok}bah4

    E Psavbzbah af pzrjeazajbkg z|ppas}4

    E Jahzbmlsk}bah af fkobgbkg bopgbjk}bahz4

    E Ac}kbhbhn bhfasolm jahzlh} fas nlhl}bj }lz}bhn4

    E Lhz|sbhn jahmlh}bkgb}r af nlhl}bj bhfasok}bah4

    E Kppsapsbk}l ekhmgbhn af pa}lh}bkg mbzjsbobhk}bah kz k slz|g} af

    }lz}bhn4

    E Kzz|sbhn k|}ahaoa|z mljbzbah/okdbhn cr }el ja|hzlgll %Nskml J"

    :(;(6 Zea|gm pslhk}kg mbknhazbz cl mbzj|zzlm1

    E Bh oaz} jkzlz' kfflj}lm cbs}ez z}lo fsao fkbg|sl }a bhfaso pkslh}z

    af }el pazzbcbgb}r af sbzd khm pslvlh}bah kml{|k}lgr sk}els }ekh

    }elbs slilj}bah af fal}kg }lz}bhn(32Glvlg BBB

    E Mljbzbahz fas pslhk}kg mbknhazbz ksl bh|lhjlm cr okhr fkj}asz'

    ha} slgbnba|z as j|g}|skg fkj}asz kgahl(:5 Glvlg BB/:

    E Slgbnbah khm fkb}e ksl bopas}kh} fkj}asz bh }el mljbzbah okdbhn

    psajlzz c|} }el plsjlbvlm zlvlsb}r af }el jahmb}bahz ~bgg pgkr k

    oasl bopas}kh} sagl(:6':5/=; Glvlg BBB

    E Slpsam|j}bvl ap}bahz fas fkobgblz kfflj}lm ~b}e k }skhzf|zbah/

    mlplhmlh} }ekgkzzklobk okias pk}blh} zea|gm cl mljbmlm cr

    }el fkobgblz }elozlgvlz kf}ls nlhl}bj ja|hzlggbhn(=3/=: Glvlg BBB

    SLJAOOLHMK]BAH

    Pslhk}kg mbknhazbz zea|gm cl mbzj|zzlm slnksmglzz af slgbnba|z khmj|g}|skg ckjdnsa|hm( %Nskml J"

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    ;3

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    :(3 JKZJKML ZJSLLHBHN

    :(3(; Bh}sam|j}bah

    E Nlhl}bj zjsllhbhn' mlhlm cr }el L|saplkh Zajbl}r af E|okh

    Nlhl}bjz %LZEN" kz khr dbhm af }lz} plsfasolm fas }elzrz}lok}bj lksgr ml}lj}bah as lujg|zbah af k nlhl}bj mbzlkzl' }el

    pslmbzpazb}bah as slzbz}khjl }a z|je k mbzlkzl' as }a ml}lsobhl~el}els k plszah jkssblz k nlhl vksbkh} ~ebje okr psam|jl

    mbzlkzl bh affzpsbhn( Jkzjkml zjsllhbhn bz k nlhl}bj/zjsllhbhnz}sk}lnr }ek} }ksnl}z slgk}bvlz af jkssblsz!kfflj}lm bhmbvbm|kgz af

    nlhl}bj mbzasmlsz }esa|ne }el }lz}bhn af }elbs pelha}rplz asnlha}rplz(== Glvlg BBB

    :(3(3 ^ek} bz }el sagl af jkzjkml zjsllhbhn bh }el okhknlolh} af}ekgkzzklobk pk}blh}z1

    E Pslvlh}bhn }ekgkzzklobk cbs}ez bz ckzlm ah bmlh}bfrbhn bhmbvbm|kgz

    k} sbzd' psavbmbhn kml{|k}l bhfasok}bah ah sbzd khm pazzbcbgb}blz}a slm|jl }ek} sbzd(32Glvlg BBB

    E Zjsllhbhn fkobgr oloclsz af kh bhmlu jkzl %}ekgkzzklobk okias

    as jkssblsz" zea|gm cl plsfasolm(=

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    ;:

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    =( CGAAM ]SKHZF\ZBAH ]ELSKPR

    ]el kbo af cgaam }skhzf|zbah bh }ekgkzzklobk bz }a z|ppslzz

    lu}skolm|ggksr ekloapablzbz ~ebgl obhbobzbhn jaopgbjk}bahz af |hmls

    }skhzf|zbah khm okbh}kbhbhn hasokg ~lgg clbhn(

    ]el mljbzbah }a z}ks} cgaam }skhzf|zbah ~bgg sl{|bsl psapls kzzlzzolh}

    af lkje bhmbvbm|kg }ekgkzzklobk pk}blh}( ]skhzf|zbah zea|gm cl

    z}ks}lm psaop}gr ~elh }elsl bz jgbhbjkg lvbmlhjl af zlvlsl khklobk

    ~b}e zrop}aoz as zbnhz af jksmbkj fkbg|sl' fkbg|sl }a }esbvl' khm!as

    }ekgkzzklobk cahl mlfasob}r(

    =(; OKHKNLOLH]

    =(;(; Psl/]skhzf|zbah Bhvlz}bnk}bahz

    E Pk}blh} zea|gm cl pelha}rplm fas KCA' Se' Dlgg'=>/=2 Glvlg BB/: Dbmm'

    M|ffr khm OHZz

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    ;=

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Vag|ol af }skhzf|zbah9 cl}~llh ;< / 30 og!dn mlplhmbhn ah }el psl/}skhzf|zbah Ec khm eklok}ajsb} af pkjdlm jlggz psavbmlm cr }el cgaamckhd %Slfls }a ]kcgl 3"( ^elhlvls pazzbcgl' }el ~eagl ckn af cgaamzea|gm cl |zlm }a pslvlh} ~kz}knl(

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    ;

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Perzbjbkhz zea|gm ekvl ebne glvlg af k~kslhlzz af }el bhflj}bah khm bfckj}lsklobk bz z|zplj}lm' pkslh}lskg kh}bcba}bjz knkbhz} Phl|oajajj|zkhm Ekloapebg|z zea|gm cl z}ks}lm(6=/66 Glvlg B

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    ;5

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    E BO Clhyk}ebhl plhbjbggbh : / = ~lldgr jkh cl |zlm kz kh kg}lshk}bvl(

    E Fas pk}blh}z kgglsnbj }a plhbjbggbh' kg}lshk}bvlz bhjg|ml

    lsr}esaorjbh' ja}sboaukyagl khm oaubaukjbh(62 Glvlg BBB

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    ;2

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    6( KZZLZZOLH] AF BSAH C\SMLH

    Oah}egr pkjdlm slm cgaam jlgg %PSCJ" }skhzf|zbahz ~bgg slz|g} bh kh bsah

    bh}kdl af 0(: / 0(< on!dn!mkr( Kf}ls kca|} ;0 / 30 }skhzf|zbahz' oaz}pk}blh}z ~bgg ekvl k zls|o flssb}bh %ZF" glvlg lujllmbhn ;000 n!G ' kh bsah

    gakm jahzbmlslm ebne lha|ne }a ~ksskh} bsah jelgk}bah }elskpr(5

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    30

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    6(: OKNHL]BJ SLZAHKHJL BOKNBHN %OSB"

    OSB bz k |zlf|g khm hah bhvkzbvl }aag fas lz}bok}bhn }bzz|l bsah avlsgakm(]~a ckzbj kppsakjelz ekvl cllh mlvlgaplm9

    ;( Bhmbslj} {|kh}b}k}bvl ol}eamz }ek} |zl zbnhkg bh}lhzb}r sk}ba %ZBS"

    3( Mbslj} {|kh}b}k}bvl ol}eamz }ek} |zl ]3' ]3) as S3' S3) pkskol}lsz

    6(:(; Jksmbkj khm Gbvls ]3

    Jksmbkj khm gbvls ]3 jkh cl olkz|slm mbslj}gr( Ea~lvls' }el}ljehb{|lz ksl gbob}lm m|l }a b}z zlhzb}bvb}r }a jksmbkj khm slzpbsk}asroa}bahz(23/2: Glvlg BB/:

    6(:(3 OSB ]3)

    OSB ]3) bz fkz} khm lkzr }a kj{|bsl' sac|z} }a oa}bah' oasl zlhzb}bvl}a bsah glvlgz khm slpsam|jbcgl avls }bol bh mbfflslh} jlh}slz ~b}embfflslh} zjkhhlsz( Ea~lvls b} sl{|bslz k pk}blh}z jaaplsk}bahkhm kcbgb}r }a ma k cslk}e/eagm m|sbhn }el psajlm|sl( Z}|mblz ekvlmloahz}sk}lm }el |}bgb}r af }ebz pkskol}ls bh pslmbj}bhn lksgr jksmbkjzbmlsazbz vlsz|z jahvlh}bahkg ljeajksmbanskper( Vkg|lz af 7 30 oz

    bhmbjk}l jksmbkj bsah avlsgakm(2=/2< Glvlg BB/:]el vkg|lz ksl kgza jaopkskcgl}a gbvls bsah jahjlh}sk}bah cr cbapzr(>3 Glvlg BB/: Ahnabhn z}|mblz ksl clbhnmahl }a kzzlzz }bzz|l bsah bh a}els asnkhz cr ]3) olkz|slolh}z(

    6(:(: OSB S3

    OSB S3 ekz cllh zea~h }a jasslgk}l ~b}e GBJ( Olkz|slolh} af S3 crOSB ekz ha~ cllh vkgbmk}lm kz k slgbkcgl khm slpsam|jbcgl olkz|slolh}

    af GBJ(

    26/2> Glvlg BB/3

    Ea~lvls' khkgrzbz af OSB S3 bz zaglgr plsfasolm cr kjaoolsjbkg lh}b}r khm }elslfasl luplhzbvl(

    6(= ]EL HLLM ]A MA CA]E GBVLS KHM JKSMBKJ BSAHKZZLZZOLH]Z

    Z}|mblz ekvl fkbglm }a zea~ khr zbnhbjkh} jasslgk}bah cl}~llh gbvlskhm jksmbkj bsah avlsgakm cr OSB( ]elslfasl' b} bz hljlzzksr }a olkz|slca}e gbvls khm jksmbkj bsah zlpksk}lgr(52'2='25 Glvlg BB/:

    SLJAOOLHMK]BAH

    Zls|o flssb}bh glvlgz zea|gm cl oahb}aslm lvlsr : / 6 oah}ez( %Nskml J"

    OSB ]3) zea|gm cl |zlm }a kzzlzz jksmbkj bsah z}k}|z bh agmls jebgmslh(

    %Nskml J"

    OSB S3 jkh cl |zlm }a kzzlzz gbvls bsah( %Nskml J"

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    3;

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    >( BSAH JELGK]BAH ]ELSKPR

    ]el }slk}olh} fas bsah avlsgakm bh cgaam }skhzf|zbah mlplhmlh}}ekgkzzklobk pk}blh}z bz bsah jelgk}bah( Luplsblhjl ~b}e }el lksgblz}

    jelgk}as mlzflssbaukobhl zea~lm }ek} naam jaopgbkhjl khm kcbgb}r }adllp }el zls|o flssb}bh glvlgz jahzbz}lh}gr 7 3000 }a 3

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    33

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    ]ebz }lmba|z khm |hpglkzkh} z|cj|}khla|z ms|n slnbol ekz slz|g}lm bhpaas jaopgbkhjl khm elhjl jaopsaobzlz }el lfflj}bvlhlzz af MFA( Bhjgbhbjkg pskj}bjl' }el jaopgbkhjl }a MFA oaha}elskpr ~kz slpas}lm }askhnl fsao 5,;0< Glvlg BBBglkmbhn }a z|cap}bokg MFA }elskpr khm

    ebne camr bsah avlsgakm khm jksmbkj bsah }aubjb}r(

    MFA jah}bh|a|z bh}skvlha|z bhf|zbah jkh cl |zlm kz k slzj|l }elskprbh pk}blh}z ~b}e kj|}l jksmbkj psacgloz khm ekz cllh zea~h }a slvlszljksmbaorapk}er(;06 Glvlg BBB

    ]elsl okr cl k sagl fas z|cj|}khla|z MFA }~bjl mkbgr cag|z }slk}olh}bf bhf|zbah p|op bz ha} kvkbgkcgl(;0> Glvlg BBB

    Oahb}asbhnSlfls }a ]kcgl :

    Zbml lfflj}zSlfls }a]kcgl =

    >(;(3 Mlflsbpsahl %MFP" Oaha}elskpr

    Bhmbjk}bahzAskg MFP nbvlh }esll }bolz k mkr bh k mazl af >< on!dn!mkr bz khlfflj}bvl bsah jelgk}as bh jebgmslh oasl }ekh 6 rlksz agm khm b}zlfjkjr bz jaopkskcgl }a MFA( 2 }a 25, ~kz cl}}ls }ekh }ek} af MFA oaha}elskpr(;0< Glvlg BB/3

    Oahb}asbhnSlfls }a ]kcgl :

    Zbml lfflj}zSlfls }a ]kcgl =

    ]el sbzd af knskh|gajr}azbz %KHJ 7

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    3:

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    >(;(: Mlflskzbsau %MFU" Oaha}elskpr

    Bhmbjk}bahz

    ]el hl~lz} bsah jelgk}as MFU bz kh kg}lshk}bvl }a MFA bh jebgmslh

    fsao 3 rlksz agm(;;6';;> Glvlg ;' ;;5';;2 Glvlg BB/;Askg MFU oaha}elskpr }kdlh

    ahjl mkbgr bh k mazl af 30 / :0 on!dn!mkr bz kz lfjkjba|z kz jahvlh}bahkg

    MFA zga~ bhf|zbah }elskpr bh slm|jbhn gbvls bsah jahjlh}sk}bah khm

    zls|o flssb}bh( MFU ekz cllh |zlm bh jgbhbjkg pskj}bjl fas glzz }ekh vl

    rlksz( ]el ebne jaz} af MFU }elskpr k} pslzlh} okr cl k ebhmskhjl

    }a b}z ~bmls |zknl( Bh k sljlh} zrz}lok}bj slvbl~' MFU ~kz oasl

    jaz} lfflj}bvl }ekh MFA ckzlm ah {|kgb}r kmi|z}lm gbfl rlksz %[KGR"'khm MFP ~kz oasl jaz}/lfflj}bvl }ekh MFU bh agmls jebgmslh(;30 Glvlg ;

    Oahb}asbhn

    Slfls }a ]kcgl :

    Zbml lfflj}z

    Slfls }a ]kcgl =

    MFU okr jk|zl k slvlszbcgl' mazl/slgk}lm' hah/psanslzzbvl bhjslkzl bh

    zls|o jslk}bhbhl ~b}ebh }el |ppls gbob} af hasokg(;3; Glvlg B

    >(;(= Jaocbhk}bah ]elskpr MFA khm MFP

    Bhmbjk}bahzJaocbhk}bah af MFA khm MFP }elskpr bz bhmbjk}lm ~elh oaha}elskpr

    fkbgz(;3;';33 Glvlg BB/;' ;3:';3= Glvlg BB/3

    Oahb}asbhn

    Slfls }a ]kcgl :

    Zbml lfflj}z

    Slfls }a ]kcgl =

    ]el zbml lfflj}z af MFA/MFP jaocbhk}bah ksl }el zkol kz }el zbml

    lfflj}z af }el bhmbvbm|kg jelgk}asz(;33 Glvlg BB/;' ;3: Glvlg BB/3

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    3=

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    >(3 ^ELH ]A Z]KS] BSAH JELGK]BAH ]ELSKPR1

    ]el ap}bokg }eslzeagm }a z}ks} bsah jelgk}bah }elskpr bz |hml}lsobhlm

    c|} ckzlm ah naam jgbhbjkg pskj}bjl' pk}blh}z ~ea ekvl sljlbvlm 8 ;0

    |hb}z af cgaam khm ~elh zls|o flssb}bh bz 8 ;000 n!G ah oasl }ekh

    }~a ajjkzbahz bh k} glkz} }~a ~lldz kpks} (: JEABJL AF JELGK]ASZ

    Pk}blh}z ~ea ekvl sljlbvlm sln|gks PSCJ }skhzf|zbahz fas ahgr k fl~

    rlksz ksl gbdlgr }a ekvl obgm bsah avlsgakm( Fas }elzl pk}blh}z' kgg }esll

    bsah jelgk}asz %MFA' MFP khm MFU" ksl lfjkjba|z bh slm|jbhn zls|o

    flssb}bh glvlgz khm GBJ( Jaopksbzah cl}~llh z|cj|}khla|z MFA k}=0 / < on!dn!mkr zea~lm zbobgks lfjkjr bh

    pk}blh}z ~eazl ZF glvlgz ~lsl nlhlskggr 7 :000 n!G';;0';;6';3;';35 Glvlg B';32

    Glvlg BB/; Jkpplgbhb l} kg( zea~lm }ek} MFU k} 30 / :0 on!dn!mkr ekm zbobgks

    lfjkjr jaopkslm ~b}e MFA k} :0 /

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    3: Glvlg BB/:

    E Avls} MO bh }ekgkzzklobk okias pk}blh}z bz psljlmlm cr k gahnplsbam af bhz|gbh slzbz}khjl;>3 Glvlg BB/: khm erplsbhz|gbhklobk(;>: Glvlg BB/:

    E ]el okbh sbzd fkj}asz kzzajbk}lm ~b}e MO ksl paas jaopgbkhjl~b}e MFA }slk}olh}' mlgkrlm knl k} z}ks} af jelgk}bah }elskpr'gbvls jbsseazbz as zlvlsl csazbz';>= Glvlg BB/: khm elpk}b}bz J

    bhflj}bah(;>6 Glvlg BB/:

    E ]el sbzd fkj}asz kzzajbk}lm ~b}e bopkbslm ng|jazl }aglskhjl %BN]"ksl okgl' paas jaopgbkhjl ~b}e MFA }elskpr khm GBJ fa|s }bolzkcavl }el hasokg vkg|l(;>= Glvlg BB/:

    E Gbvls mbzasmlsz khm pazb}bvl fkobgr ebz}asr zllo }a cl kmmb}bahkg

    pslmbzpazbhn fkj}asz(;>=';>> /;>5 Glvlg BB/:

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    :2

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Pslvkglhjl

    E ]el pslvkglhjl af MO skhnlz fsao ;0(= / ;2(3';>6';>2 Glvlg BB/:

    E ]el olkh knl k} mbknhazbz bz cl}~llh ;> khm ;5 rlksz(;66 Glvlg BB/:

    E :;(;, af pk} blh}z ~b}e mbkcl}lz pslzlh} ~b}e mbkcl} bjdl}akjbmazbz(;>< Glvlg BB/:

    Bhvlz}bnk}bahz

    E ]el mbknhazbz af MO okr cl okml |zbhn khr ahl af }el fagga~bhnjsb}lsbk9;50 Glvlg BB

    g Zrop}aoz khm k skhmao pgkzok ng|jazl af oasl }ekh;;(; ooag!G( Zrop}aoz bhjg|ml pagr|sbk' pagrmbpzbk' khm|hlupgkbhlm ~lbne} gazz(

    g Fkz}bhn pgkzok ng|jazl af 8 >(0 ooag!G

    g 3 ea|s paz}/pskhmbkg pgkzok ng|jazl af 8 ;;(; ooag!G ah khAN]]( %Kh AN]] sl{|bslz }el l{|bvkglh} af ;(>< no!dn }a kokubo|o af >< no af khermsa|z ng|jazl mbzzagvlm bh ~k}ls"

    E ]el mbknhazbz af BN] bz okml ~elh }el 3 ea|s paz}/pskhmbkgng|jazl bz cl}~llh >(5 / ;;(; ooag!G ah kh AN]](;50 Glvlg BBB

    Okhknlolh}

    E ]el lksgr khm kml{|k}l |zl af bsah jelgk}bah jkh pslvlh} MOkhm okias lhmajsbhapk}eblz(;>2 Glvlg BB/:

    E Ca}e MO khm BN] bopsavlm bh k }ebsm af pk}blh}z kf}ls bh}lhzbvl

    jaocbhlm jelgk}bah }slk}olh}(;5: Glvlg BB/:

    E Bh }ekgkzzklobkz ~b}e BN]' }el jahmb}bah okr bopsavl ~b}ek z}sbj} mbkcl}bj mbl}' ~lbne} slm|j}bah ~elsl kppgbjkcgl khmbh}lhzbvl bsah jelgk}bah(3 \!dn" vksblz m|l }a k ~bmlvksbk}bah bh pkhjslk}bj jlgg f|hj}bah kz ml}lsobhlm crJ/plp}bml glvlg(;5= Glvlg BBB

    E ]el |zl af askg kh}b/mbkcl}bj knlh}z bh MO slokbhz |hml}lsobhlm(

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    =0

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    SLJAOOLHMK]BAH

    K 3 ea|s AN]] zea|gm cl plsfasolm khh|kggr ah }ekgkzzklobkpk}blh}z 8 ;0 rlksz agm( %Nskml J"

    ]ekgkzzklobk pk}blh}z ~b}e BN] zea|gm cl okhknlm cr k z}sbj}

    mbkcl}bj mbl}' ~lbne} slm|j}bah ~elsl kppgbjkcgl khm bh}lhzbvl bsahjelgk}bah( %Nskml J"

    ]ekgkzzklobk pk}blh}z ~b}e MO zea|gm cl }slk}lm ~b}e bhz|gbh(%Nskml J"

    2(;(< Az}lapasazbz!Az}lapklhbk

    Ga~ cahl okzz bz pslzlh} bh k zbnhbjkh} psapas}bah af jebgmslh ~b}e

    }skhzf|zbah mlplhmlh} }ekgkzzklobk mlzpb}l erpls}skhzf|zbah khm

    ap}bokg jelgk}bah(

    ]el Cahl Obhlskg Mlhzb}r %COM" af }ekgkzzklobk jebgmslh jg|z}ls

    ksa|hm }el hasokg j|svl |h}bg }el knl af ;0 / ;3 rlksz' ~elh }elsl bz k

    mlvbk}bah k~kr fsao b}(;

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    =;

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Pslvkglhjl

    E ;6(;, af }el }ekgkzzklobk pk}blh}z ekm hasokg cahl okzz

    %y zjasl 8 /;"

    E 33(6, ekm slm|jlm cahl okzz %y zjasl cl}~llh /; }a /3"

    E 6;(:, ekm ga~ cahl okzz %y zjasl 7 /3";52 Glvlg BB/:

    E Vb}kobh M mljblhjr9

    g 3, ekvl zlvlslgr ga~ glvlgz(;2;

    Glvlg BB/3

    Bhvlz}bnk}bahz

    E Zls|o jkgjb|o' peazpek}l' KGP

    E 3

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    =3

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Okhknlolh}

    Kml{|k}l vb}kobh M khm jkgjb|o bh}kdl kjjasmbhn }a sljaoolhmlm

    mbl}ksr kgga~khjlz %SMK" zea|gm cl lhz|slm bh kgg }ekgkzzklobkpk}blh}z(;2=/;2< Glvlg BBB

    ]kcgl

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    =:

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    SLJAOOLHMK]BAH

    Kml{|k}l mbl}ksr bh}kdl af jkgjb|o khm vb}kobh M zea|gm cl lhz|slm(

    %Nskml J"

    Sln|gks ~lbne}/clksbhn lulsjbzlz zea|gm cl lhja|sknlm ~b}ekvabmkhjl af zoadbhn khm lujlzzbvl kgjaeag jahz|op}bah( %Nskml J"

    Vb}kobh M' jkgjb|o khm ybhj z}k}|z af }ekgkzzklobk pk}blh}z zea|gm cllvkg|k}lm sln|gksgr khm khh|kggr fsao ;0 rlksz agm ah~ksmz( %Nskml J"

    Khh|kg cahl mlhzb}r z}|mblz zea|gm cl jahzbmlslm bh }ekgkzzklobk

    pk}blh}z oasl }ekh ;0 rlksz af knl( %Nskml J"

    2(;(6 Erpapksk}ersabmbzo

    Bhjbmlhjl af erpapksk}ersabmbzo vksblz fsao =(< / 30,(;25/30; Glvlg BB/: ]el

    knl af mbknhazbz skhnl fsao ;; }a 3= rlksz %olkh cl}~llh ;: khm ;5rlksz"(;25/30; Glvlg BB/:

    Zbnhz khm Zrop}aoz

    Okiasb}r af }ekgkzzklobk pk}blh}z ~b}e erpapksk}ersabmbzo ekvl ha

    jgbhbjkg zrop}aoz af erpajkgjklobk( ]elslfasl khh|kg zjsllhbhn bzz|nnlz}lm fsao knl af ;0 rlksz ah~ksmz(;25'300/30; Glvlg BB/:

    Erpapksk}ersabmbzo }lhmz }a cl kjjaopkhblm ~b}e a}elslhmajsbhapk}eblz(;25';22/30; Glvlg BB/:

    Bhvlz}bnk}bahz

    Zjsllhbhn fas erpapksk}ersabmbzo bhjg|mlz9

    / zls|o jkgjb|o/ zls|o peazpek}l/ zls|o oknhlzb|o

    / zls|o kgdkgbhl peazpek}kzl

    Bh pk}blh}z ~b}e ga~ zls|o jkgjb|o khm ebne peazpek}l glvlg' psajllm~b}e zls|o pksk}ersabm glvlg(;22 Glvlg BB/:

    Okhknlolh}

    ;( Jkgjb}sbag 0(3< / ;(0 n ahjl }a }~bjl mkbgr(3( Bh pk}blh}z ~b}e plszbz}lh} ebne peazpek}l glvlgz' peazpek}l cbhmlsz

    %z|je kz jkgjb|o jkscahk}l" okr cl jahzbmlslm(:( Jkgjb|o z|ppglolh}z okr cl afflslm }a pk}blh}z ~b}e paas

    mbl}ksr bh}kdl(

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    ==

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    SLJAOOLHMK]BAH

    ]ekgkzzklobk pk}blh}z agmls }ekh ;0 rlksz af knl' lzpljbkggr }eazl~ea ekvl a}els lhmajsbhapk}eblz hllm }a cl oahb}aslm khh|kggr

    fas erpapksk}ersabmbzo( %Nskml J"

    ]slk}olh} af erpapksk}ersabmbzo jahzbz}z af jkgjb}sbag ~b}e as~b}ea|} jkgjb|o jkscahk}l!gkj}k}l( %Nskml J"

    2(;(> Erpakmslhkgbzo

    Erpakmslhkgbzo okr cl |hmls/mbknhazlm khm jkh pa}lh}bkggr jk|zl

    oas}kgb}r m|sbhn kj|}l bgghlzzlz( Pslvkglhjl af erpakmslhkgbzo vksblz~bmlgr fsao 0 / =

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    =;," khm oascbmb}r bh pk}blh}z ~b}e }skhzf|zbah mlplhmlh}}ekgkzzklobk(;0;'306'30> Glvlg BB/3

    Pk}blh}z ~b}e zls|o flssb}bh 8 3'

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    =6

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    E Ljeajksmbansko

    g Glf} vlh}sbj|gks lilj}bah fskj}bah %GVLF" vkg|lz ksl zbnhbjkh}grebnels bh }ekgkzzklobk pk}blh}z3;3 khm GV f|hj}bah bz |z|kggrpslzlsvlm |h} bg kmvkhjlm z}knl( GVLF 7

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    =>

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    :( Zrop}aok}bj jksmbkj zbmlsazbz

    g Jah}bh|a|z b!v mlzflssbaukobhl < on!dn!mkr khm z!j

    mlzflssbaukobhl =0 / Glvlg BB/3' 3;5 Glvlg BBB

    g ]elsl bz ha mk}k ah }el kcbgb}r af mlflsbpsahl oaha}elskpr

    }a slvlszl elks} fkbg|sl(

    Oahb}asbhn

    E F|gg jgbhbjkg lukobhk}bah af }el jksmbavkzj|gks zrz}lo k} glkz} zbuoah}egr

    E Ljeajksmbansko khh|kggr fsao knl af ;0 rlksz

    SLJAOOLHMK]BAH

    Khh|kg oahb}asbhn af jksmbavkzj|gks zrz}lo fas }ekgkzzklobk

    pk}blh}z fsao knl ;0 ah~ksmz ~a|gm bhjg|ml LJN' ljeajksmbansko

    khm ~elsl pazzbcgl OSB ]3)( %Nskml J"

    Fas kzrop}aok}bj }ekgkzzklobk pk}blh}z ~b}e obgm }a oamlsk}l

    jksmbkj zbmlsazbz %]3) ;0 /30 oz" khm hasokg jksmbkj f|hj}bah'

    bsah jelgk}bah oaha}elskpr zea|gm cl bh}lhzblm as z~b}jelm }a

    jaocbhk}bah }elskpr( %Nskml C"

    Bf OSB ]3) kzzlzzolh} bz ha} pazzbcgl' }elh }ekgkzzklobk pk}blh}z

    ~b}e paas jelgk}bah ebz}asr khm ebne sbzd af jksmbkj bsah avlsgakm

    z|je kz zls|o flssb}bh 8 3'

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    =5

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    2(: BHFLJ]BAH

    2(:(; Elpk}b}bz C

    ]el pslvkglhjl af ECzKn pazb}bvb}r bh o|g}bpgr }skhzf|zlm }ekgkzzklobkpk}blh}z vksblz ~asgm~bml %7 ;, }a 830,"(

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    =2

    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    Okhknlolh}

    ]el psboksr nakg af }slk}olh} fas jesahbj elpk}b}bz C ksl gahn/}lso

    z|ppslzzbah af ECV/MHK vbskg gakm }a ga~ khm pslflskcgr |hml}lj}kcgl

    glvlg khm EClKn zlsajahvlszbah bh EClKn pazb}bvl z|cilj}z ~b}e }el

    kbo }a slm|jl psanslzzbah }a jbsseazbz' gbvls fkbg|sl khm elpk}ajlgg|gks

    jksjbhaok(

    ]slk}olh} zea|gm cl z}ks}lm kz lksgr kz pazzbcgl bh jkzlzaf boplhmbhn

    as avls} elpk}bj mljaoplhzk}bah %b(l( skbzlm cbgbs|cbh |hslgk}lm }a

    }ekgkzzklobk' psagahnlm P] as pslzlhjl af kzjb}lz"( A}els~bzl' : / 6

    oah}ez aczlsvk}bah bz sljaoolhmlm(33; Glvlg BBB

    Pk}blh}z jkh cl }slk}lm ~b}e9

    ;( Bh}lsflsah %BFH " as Plnrgk}lm BFH

    Fas jahvlh}bahkg BFH ' }el sljaoolhmlm m|sk}bah af }slk}olh}bz = / 6 oah}ez fas EClKn pazb}bvl pk}blh}z khm k} glkz} k rlks

    fas EClKn hlnk}bvl pk}blh}z( Fas Pln/BFH' }el sljaoolhmlmm|sk}bah bz k} glkz} zbu oah}ez fas EClKn pazb}bvl pk}blh}z khm

    ;3 oah}ez fas EClKn hlnk}bvl pk}blh}z(330 Glvlg BBB as

    3( Gkobv|mbhl

    Gkobv|mbhl ;00 on mkbgr bz lzpljbkggr sljaoolhmlm bf }elsl bz k

    jahjlsh slnksmbhn elpk}bj mljaoplhzk}bah(330 Glvlg BBB

    Kh}b/vbskg ms|n slzbz}khjl jkh ajj|s khm okr cl sljanhbzlm cr

    vbskg cslkd}esa|ne ~ebje bz mlhlm kz ; gan bhjslkzl fsao hkmbs'

    KG] kslz khm gbvls mljaoplhzk}bah( elh }ebz ajj|sz' kmmb}bah

    af k zljahm kh}b/vbskg knlh} %kmlfavbs!}lhafavbs" ~ebje malz ha}

    ekvl jsazz slzbz}khjl zea|gm cl bhb}bk}lm(33; Glvlg BBB

    Bh EClKn pazb}bvl pk}blh}z' }slk}olh} jkh cl z}applm ~elh

    EClKn zlsajahvlszbah ~b}e |hml}lj}kcgl ECV/MHK ekz cllhmaj|olh}lm ah }~a zlpksk}l ajjkzbahz k} glkz} zbu oah}ez kpks}

    |hglzz }elsl bz lvbmlhjl af mljaoplhzk}lm gbvls mbzlkzl!gbvls

    jbsseazbz( Bh EClKn hlnk}bvl pk}blh}z' }slk}olh} mbzjah}bh|k}bah

    mlplhmz ah bhmbvbm|kg jkzlz khm zea|gm cl mljbmlm cr }elnkz}salh}lsaganbz}(33; Glvlg BBB

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    (

    =( Zkshkbd ZK( ]ekgkzzlobk khm slgk}lm eloangacbhapk}eblz( Bhmbkh I Plmbk}s 3003%="9:;2/:3=(

    ( Gkpk}zkhbz P' Mbvagb K' Nlasnkdb E' l} kg( Cahl nsa~}e bh }ekgkzzklobj jebgmslh( Ksje Mbz Jebgm;2>545:/>23(

    ;0( ]slh} SI( Mbknhazbz af }el ekloangacbhapk}eblz( Jgbh Cbajelo Slv 300643>93>/:5(

    ;;( Ckbh C( Ekloangacbhapk}er mbknhazbz( Gahmah9 Cgkjd~lgg Zjblhjl' 300;(

    ;3( bgm CI' Ckbh CI( Bhvlz}bnk}bah af kchasokg eloangacbhz khm }ekgkzzlobk Bh9 Gl~bz ZO' Ckbh CI' Ck}lz B' lmz(Mkjbl khm Gl~bz Pskj}bjkg Eklok}aganr( 2}e lm( Pebgkmlgpebk9 Je|sjebgg Gbvbhnz}ahl' 300;43:;/365(

    ;:( Jgksdl NO' Ebnnbhz ]H( Gkcask}asr Bhvlz}bnk}bah af eloangacbhapk}eblz khm }ekgkzzlobkz9 Slvbl~ khm\pmk}l( Jgbh Jelo 30004=6%5%C""9;35=/20(

    ;=( lk}elskgg MI' Jglnn IC( ]el }ekgkzzklobk zrhmsaolz( =}e lm( Gahmah9 Cgkjd~lgg Zjblhjl G}m' 300;(

    ;4259;5>/;2=(

    ;6( Gkffls}r IM' Cks}e MZ' Zlsbmkh CG' l} kg( Pslvkglhjl af }ekgkzzlobk bh pk}blh}z ~b}e objsajr}azbz slflsslmfas ekloangacbhapk}er bhvlz}bnk}bah bh Ah}ksba( Ko I Jgbh Pk}eag 300>4;3>9;23/;26(

    ;>( Jka K' Zkck G' Nkgkhlgga' l} kg( Oaglj|gks mbknhazbz khm jkssbls zjsllhbhn fas /}ekgkzzlobk( IKOK;22>43>5%;%;"9;6=/;65(

    3( ]eahn O' Zaa ]' ]el zplj}s|o af cl}k/ngacbh nlhl o|}k}bahz bh jebgmslh ~b}e cl}k/}ekgkzzklobk okiasfsao Da}k Dbhkckg|' Zkcke' Okgkrzbk( Zbhnkpasl Olm I( 300< =6%>"9:=0/:(

    35( ]eahn O' S|mydb Y' Ekgg I( l} kg( K zbhngl' gksnl mlgl}bah kjja|h}z fas kgg }el cl}k/ngacbh nlhl o|}k}bahz bh}~lh}r fkobgblz fsao Zkcke %Has}e Cashla"' ( Okgkrzbk( E|o O|}k}( ;2224;:%

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    Okhknlolh} af ]skhzf|zbah Mlplhmlh} ]ekgkzzklobk

    :0( Skh}khlh L' Ebl}kgk O' Dsbz}afflszzah \' l} kg( ^ek} bz Bmlkg Nlhl}bj Ja|hzlggbhn1 K Z|svlr af J|sslh}Bh}lshk}bahkg N|bmlgbhlz( L|s I E|o Nlhl} 30054;6%="9==643%;"95/;0(

    :5/:5:(

    =;( Kbhaah A' Jelahn ZD( ]ekgkzzklobk bh Okgkrzbk9 K Z}sk}lnr fas Pslvlh}bah( Okgkrz I Pk}eag;22=4;6%;"93:/>(

    =3( Kcagnekzlob E' Kobm K' Ylbhkgb Z( l} kg(]ekgkzzlobk bh Bskh9 lpbmlobaganr' pslvlh}bah' khm okhknlolh}( IPlmbk}s Elok}ag Ahjag( 300> 32%="93::/5(

    =:( Nbgkhb K' Ikmaah K' [kbzls S(l} kg(K}}b}|mlz }a~ksmz nlhl}bj mbknhazbz bh Pkdbz}kh9 k z|svlr af olmbjkg khmglnkg jaoo|hb}blz khm pkslh}z af }ekgkzzlobj jebgmslh( Jaoo|hb}r Nlhl}( 300>4;0%:"9;=0/6(

    ==( Dsk~jykd O' Jaapls MH' Zjeobm}dl I( Lz}bok}bhn }el Lfjkjr khm Lfjblhjr af Jkzjkml Nlhl}bjZjsllhbhn( Ko I E|o Nlhl} 300;4629:6;/:>0(

    =( Zpkhaz ]' Dksknlasnk O' Gkmbz V' l} kg( Slm Jlgg Kggakh}bcamblz ~b}e ]ekgkzzlobk( Vau Zkhn|bhbz;2204

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    4=>%9;00/;03(

    6;( Jaelh K' Nkrls S' Obykhbh I( Gahn }lso lfflj} af zpglhlj}aor ah }skhzf|zbah sl{|bslolh}z bh }ekgkzzklobkokias( Ko Ia|shkg af Eklok}aganr ;2524:0930( Lbh ZE' Zekhmgbhn C' Zbopzah IZ' l} kg(]el oascbmb}r khm oas}kgb}r af zpglhlj}aor bh jebgmeaam( Khh Z|sn;2>>4;53( Daslh K' Ekkzy S' ]bk}gls K' Dk}y|hb L( Zls|o boo|hangac|gbh glvlgz bh jebgmslh kf}ls zpglhlj}aor( Kpsazplj}bvl z}|mr( Ko I Mbz Jebgm ;25=4;:5%;"99:0/:=(

    >6( Jkpplggbhb OM' Saccbaga G' Ca}}kza CO' l} kg( Vlha|z }esaocalocagbzo khm erplsjakn|gkcbgb}r bhzpglhlj}aobzlm pk}blh} ~b}e }ekgkzzklobk bh}lsolmbk( Cs I Eklok}ag 30004;;;%3"9=6>/=>:(

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