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HEMA/
ONCO
■ Administer analgesic and antipyretics; provide comfort measures as needed.
■ Provide emotional support to patient and family members.
Bone Marrow Transplantation

Bone marrow transplantation is the aspiration of marrow from the posterior
iliac crest of a marrow donor with the use of regional or general anesthesia and
the IV transfusion of the marrow into a donor-matched recipient. The three
kinds of bone marrow transplants are autologous bone marrow transplant
(patient’s own), allogeneic bone marrow transplant (from a donor), and umbilical
cord blood transplant (stem cells from a newborn baby’s umbilical cord imme-
diately after birth).
Procedure
Before being ready to receive the transplant, the patient must:
■ Undergo high-dose chemotherapy, radiation, or both (myeloablative treat-
ment) or lower doses of chemotherapy and radiation (nonmyeloablative) in
an effort to treat the underlying disease and overcome rejection.
■ Be treated with immunosuppressive drugs to decrease the risk of rejection.
T factors influencing the outcome of bone marrow transplantation include:
■ Disease status at transplantation
■ Type of donor
■ Recipient’s age
■ Comorbid medical conditions
Early-Stage Complications
The time of greatest risk is between 0 and 100 days.
■ Rejection
■ Mucositis, pain issues secondary to oral ulcerations and reactive herpes
virus; oral nutritional deficits secondary to oral pain
■ Hemorrhage, caused by chronic thrombocytopenia and tissue injury; can be
life threatening, but rare
■ Common minor bleeding, such as petechiae, epistaxis, or GI or GU bleeding
(not life-threatening, but worrisome to patients)
■ Infections
■ Bacterial; usually gram-positive, but can be gram-negative
■ Fungal
■ Viral; can be life-threatening to these patients
■ Acute graft-versus-host disease: One of the most serious and challenging
complications; caused by immunologically competent donor-derived T cells
that react with recipient tissue antigens
■ Veno-occlusive disease of the liver: One of the most feared complications;
signs and symptoms include unexplained weight gain, jaundice, abdominal
pain, and ascites
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