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A clinical guide to stem cell and bone marrow transplantation - part 4

Tất cả các sản phẩm máu phải được chiếu xạ để ngăn chặn GVHD. (2) bộ lọc bạch cầu, giảm được sử dụng cho các PRBCs cầu và tiểu cầu để giảm tiếp xúc với HLAs và CMV. (3) sản phẩm CMV-âm tính với bệnh nhân âm tính CMV, kể từ khi vi-rút được thực hiện trên cầu hạt và có thể làm tăng nguy cơ nhiễm CMV | Page 134 7. Management a See Table 5.1 for blood component therapy. 2 --------------b Avoid invasive procedures that could result in additional blood loss unless absolutely necessary. c Transfuse packed red blood cells if HCT is less than 25 or Hgb is less than 8 g dL if active bleeding occurs or prior to general anesthesia or invasive procedures where blood loss is anticipated as clinically indicated . 1 All blood products must be irradiated to prevent GVHD. --------------------- 2 Leukocyte-reduction filters are used for PRBCs and platelets to reduce exposure to HLAs and CMV. --------------------- 3 Give CMV-negative products to CMV-negative patients since the virus is carried on granulocytes and may increase the risk of CMV infection. --------------------- 4 Premedicate with acetaminophen diphenhydramine or hydrocortisone alone or in combination if the patient has a history of transfusion reaction. d Transfuse children more than 1 year of age with 10 to 15 mL kg transfusion. D. Graft failure -------1. Definition a complete absence of engraftment or a seemingly initial hematopoiesis posttransplant with later decreasing blood counts and absence of normal hematopoiesis 2. Etiology --------------a Thought to be a sensitization of the recipient to minor histocompatibility antigens shared by the transfusion and the marrow blood cell donor. --------------b May also be related to the persistence of host-derived cytotoxic T lymphocytes or natural killer cells. Page 135 --------------c Graft rejection in the allogeneic matched sibling donor recipient is thought to result from marrow rejection by host T cells not eliminated during conditioning. 9 --------------d T-cell depletion of donor marrow to prevent GVHD also contributes to graft rejection. e In the autologous BMT setting graft failure is thought to be due to infusion of inadequate numbers of stem cells ex vivo manipulation of marrow purging and cryopreservation.3 3. Risk factors a Recipient of HLA-incompatible .