Chapter 16: hematopoietic cell transplantation

Question 1

adjusted body wt

Answer 1

(actualy wt - ideal )x .25

Question 2

why increase kcal needs in hematopoietic cell transplantation

Answer 2

immediately post transplant metabolic stress induced by the preparative regimen, fevers, infection

Question 3

what renal help might be needed with HCT

Answer 3

CRRT

Question 4

vitamin info for HCT

Answer 4

discontinue vit C - if elevated serum ferritin >1000 mc/L to decrease oxidative damage from release of free iron

renal multi may be appropriate

add calcium for corticosteroid therapy

add zinc for large volume diarrhea 1mg/100 mL stool output

if hepatic dysfunction eliminate copper and manganese from PN

Question 5

Indication for PN in HCT

Answer 5

myeloablative conditioning regimesn with high GI toxicity profiel or those with refractory gut GVHD

Rec discontinue PN once stem cells have engrafted and regimen related toxicities have resolved to avoid morbidity from bacteremia

Question 6

EN considerations in HCT

Answer 6

before tube placement adequate neutrophil and platelet counts are necessary

Question 7

glutamine in HCT

Answer 7

not supported with evidence but may decrease hospital stay