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Management of the bone marrow transplant recipient in ICU 

Management of the bone marrow transplant recipient in ICU
Chapter:
Management of the bone marrow transplant recipient in ICU
Author(s):

Andrew Retter

DOI:
10.1093/med/9780199600830.003.0375
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date: 29 November 2020

Bone marrow transplants are an exciting and rapidly evolving area of haematology providing life-saving therapy to many patients and the number performed annually is increasing. Transplants are generally not considered as first line therapy due to their inherent toxicity and high rate of complications. The patients tend to have more heavily pre-treated disease with it attendant toxicities and a decreased physiological reserve. Admission rates vary between series from 15 to 30%. It is increasingly important that intensivists are aware of the basic principles of bone marrow transplantation and its’ possible morbidities. There are two types of transplant autologous transplants, where the patient’s own stem cells are returned to them and transplants from a donor. Only allogeneic transplants are associated with graft-versus-host disease. Allograft recipients also require immunosuppression to prevent transplant rejection. It is essential that this immunosuppression is continued when patients are admitted to intensive care. Transplant patients are always severely immunocompromised and prone to prolonged periods of neutropenia. They routinely receive antiviral, antifungal, and antibacterial prophylaxis, which must be continued on their admission. They remain vulnerable to unusual infections presenting in an atypical fashion. It is essential to have both a very low clinical threshold of suspicion for infection and detailed local protocols established to guide empirical antimicrobial therapy. Although traditionally poor, the prognosis is slowly improving.

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