Nutrition Therapy For Hematopoietic Cell Transplantation-Chapter 16 Flashcards
What are the calorie needs for adults adolescents and young children under HCT?
ADULTS basil needs X 1.3 to 1.5
ADOLESCENTS basil needs X 1.4 to 1.6
YOUNG CHILDREN basil needs X 1.6 to 1.8
What are the PROTEIN needs for adults, adolescents and children undergoing HCT?
Adults 1.5 grams /kg/day 15 to 18 years. 1.8 g /kg/day 11 to 14 years. 2.0 grams /kg/day 7 to 10 years. 2.4 grams /kg/day Birth to 6 years. 2.5 to 3 grams /kg/day
What are the carbohydrates of someone undergoing H CT?
50 to 60% carbohydrate
What are the calculations to determine fluid needs in patients with HCT?
1-10 kg. ….100mL x kg
11-20 kg…1000mL for 1st 10kg+50mL per kg for each additional11-20kg
21-40 kg…1500mL for 1st 20kg+20mL per kg for each additional kg over 20
> 40kg:. 1500mL/m2 body surface area
Can patients receiving HCT when should enteral nutrition be considered?
Nonmyeloablative conditioning regimens with a functioning GI tract
Low-risk HCT (autologous or matched related donor)
Long-term eating problems after engraftment
Resolution of conditioning related mucositis and esophagitis
Adequate platelet recovery
Which type of patients receiving HCT should be considered candidates for parenteral nutrition?
Patients receiving Myeloablative conditioning regimens with a high GI toxicity profile
Those with refractory gut GVHD
Malnourished patients that can’t obtain adequate Nutrition By enteral nutrition alone
Note : PN should be discontinued once still sends have engrafted and toxicities have resolved
Which types of HCT patients should follow a food restricted diet ? And for how long?
Autologous transplant patients should follow the diet during the first 3 months after HCT
Allogenic transplant patients should follow the diet until immunosuppressive therapy is discontinued
What are the food restrictions on the diet for immunosuppressed patients on HCT?
- raw and undercooked meat ,eggs ,sausage and bacon
- raw tofu, unless pasteurized or packaged
- all luncheon meats, unless cooked to steaming
- smoked Seafood, such as lox, kippered, fish jerky , Nova- Style, or pickled fish
- unpasteurized milk , unpasteurized cheese or yogurt
- , blue cheese, gorgonzola, Roquefort or Stilton cheese
- Brie, Camembert, feta, farmer’s cheese
- Queso blanco, queso Fresco cheese
- cheese with chili peppers or other vegetables
- Fresh, refrigerated salad dressings
- unwashed Raw frozen fruit and vegetables and sprouts(such as alfalfa and mung beans)
- raw or unpasteurized honey
- Unpasteurized fruit and vegetable juices
- Boil well water for 15 to 20 minutes and consume within 48 hours
What are the calcium requirements of patients on HTC also on corticosteroid therapy or having osteoporosis?
Age 7 to 12 months. 600 mg of calcium
1 - 3 years. 1000 mg of calcium per day
4 to 8 years. 1200 mg
>9 years. 1500 mg
What additional nutrients may be needed during HTC when parenteral nutrition is administered and why?
Extra VITAMIN C may be needed to promote tissue recovery after cytoreductive therapy
<31kg: additional 250 mg/day
>31 kg: additional 500 mg/
Increase CALCIUM during corticosteroid therapy/osteoporosis , 1,500 mg in adults per day
Increase ZINC if large volume diarrhea 1mg/100mL stool
What is sinusoidal obstructive syndrome (SOS)
It occurs to the patient receiving HCT. It occurs in 0- 50% of patients.
It generally occurs about 10 to 20 days after cytoreduction therapy
Is characterized by toxic injury to the sinusoidal and venular epithelium.
Symptoms include weight gain, ascites, right upper quadrant tenderness, painful hepatomegaly, hyperbilirubinemia and renal dysfunction
What Medical Nutrition Therapy is needed to deal with Sinusoidal obstructive syndrome or SOS?
Parenteral nutrition fluids should be administered as well as medical volumes
A reduction of both oral and intravenous SODIUM is needed to minimize fluid retention
If serum BILIRUBIN increases to > 10 mg /dL, monitor serum TRIGLYCERIDE levels
If bilirubin is > 10 mg/dL, remove COPPER and MANGANESE from parenteral nutrition fluid
A side effect of HCT could be renal impairment. What nutrition interventions can be done to correct or improve the situation?
Maximize nutrition support with in fluid allowance
Correct electrolyte imbalances
Provide continuous renal replacement therapy
Eliminate copper and manganese from parenteral nutrition if there is renal dysfunction
Decrease protein if there is renal or hepatic dysfunction
Graft-versus-host disease is a side effect HCT and is a immunological reaction against the host tissue. What major organs are affected by this reaction?
The major organs targeted are the skin liver and GI tract
What are side effects of graft-versus-host disease( GVHD)
Nausea, vomiting, anorexia, diarrhea, abdominal pain, intestinal protein losses and fat malabsorption
What type of diet changes can be helpful in graft-versus-host disease (GVHD)?
Emphasizing foods low in lactose, fiber, acid and in fat.
Patients with fat malabsorption may also benefit from pancreatic enzyme replacement therapy
What are the long-term (80-100 days post transplant) nutrition related complications of graft-versus-host diseas
Weight gain (due to corticosteroid therapy), weight loss, sensitivity to spicy or acidic Foods, dry mouth, stomatitis, anorexia, reflux and diarrhea.
Osteoporosis is another complication of HTC and is seen in as many as____percent as early as 1 year post transplant. What can be done to help reverse bone loss in these?
As many as 50% of these patients see osteoporosis one year after transplant
Chemo and steroid therapy can cause bone loss
Calcium and vitamin D supplementation May benefit when serum 25-OH VITAMIN D levels are<30ng/mL in those treated with steroid therapy
Can benefit from suppln of 1000-1500 IU/D day
Bio phosphate therapy along with calcium and D can help to reverse bone loss
Regular weight bearing and muscle strengthening exercises are also recommended
It is common to see ENDOCRINE problems in HTC patients particularly long-term transplant survivors. What complications are common?
Metabolic syndrome, hyperlipidemia, insulin resistance, diabetes, obesity, and hypertension
Both in Adult & pediatric transplant patients
Pediatric HCT survivors are more likely to develop DIABETES and HYPERTENSION than the general population
What mineral supplementation should be avoided during and after HCT transplantation as well as a multiple vitamin containing this mineral.
Iron overload Is frequent and iron supplementation should be avoided
What are the late effects of HCT?
Secondary malignancies, ocular complications, avascular necrosis, chronic pulmonary effects, thyroid dysfunction, gonadal hormone insufficiency
What diet should one with Graft versus host disease follow when they are experiencing GI cramping, large volume watery diarrhea, depressed serum albumin, reduced GI Transit time, small bowel obstruction or diminished bowel sounds or nausea and vomiting
This patient should be on BOWEL REST and on an NPO diet
What diet should a patient with graft vs host disease follow if they are experiencing minimal GI cramping, diarrhea<500 mL /day, improved GI Transit time, and infrequent nausea and vomiting
They could be introduced to oral feeding including a PHASE 2 isotonic, low-residue, low lactose diet
A treatment used for prophylaxis and treatment of gvhd called
anti thymocyte globulin
What is its nutritional side effects
Nausea and vomiting, diarrhea and stomatitis
A z a t h i o p r i n e
side effects
nausea and vomiting, Anna rexia, diarrhea, mucosal ulceration, esophagitis, steatorrhea
Betlomethasone Diproionate
Side effects
Xerostomia, dysgeusia, nausea
Budesonide
Side effects
None known
Corticosteroids
Side effects
Sodium and fluid retention resulting in weight gain or hypertension, hyperphagia, hyperkalemia, skeletal muscle catabolism and atrophy, gastric irritation and peptic ulceration, osteoporosis, growth retardation in children, decreased insulin sensitivity and impaired glucose tolerance, resulting in hyperglycemia or steroid-induced diabetes, hyperlipidemia
Cyclosporine
Side effects
Nausea and vomiting, nephrotoxicity, hypo magnesia, hyperkalemia
Extra Corporeal photophesis
Intravenous fluid may be necessary to maintain adequate hydration status, monitor calcium status as the citrate anticoagulant can bind calcium and induce hypocalcemia
Methotrexate side effects
Nausea and vomiting, and I rexia, mucositis and esophagitis, diarrhea, renal and hepatic changes
Monoclonal antibodies side effects
Nausea, liver toxicity
Sirolimus side effects
Hypertriglyceridemia
Thalidomide
Constipation, nausea, xerostomia
