October 13, 2015 - Clinical Bone Marrow Transplant Flashcards
Mucositis
Inflammation of the mucous membranes, often caused by chemotherapy or radiation therapy. The rapidly-dividing cells are killed here.
Gilbert’s Syndrome
A relatively common (5%) genetic liver disorder which produces elevated levels of unconjugated bilirubin, but has no serious consequences, although mild jaundice may appear under conditions of exertion or stress.
This is caused by reduced activity of glucoronyltransferase, which conjugates bilirubin.
Tests to Look for Hemolysis
Unconjugated bilirubin
LDH
DAT
Haptoglobin
PBS
HUS
Characterized by hemolytic anemia, acute kidney failure, and a low platelet count.
It can be caused by drugs, particularly cyclosporin.
Maculopapular Rash
May be seen after a bone marrow transplant.
COULD be caused by CMV infection.
Colon Biopsy in GVHD
You will see inflammation and apoptosis.
Target of GVHD
Epithelium.
This can be seen by ulcers in the mouth, in the GI tract, in the cholangiocytes etc
Liver Biopsy in GVHD
Too many lymphocytes (T-cells).
Inflammation at the site.
CMV PCR Test
Tests for the presence of CMV.
Has a very high negative predictive value, but has a poor positive predictive value because 75% of people are infected with CMV.
Epigastric Pain after BMT
Could be ulcers.
Again, mucus cells are often killed and the ulcers that appear in the mouth can appear anywhere along the epithelium in the digestive tract.
Cytomegalovirus
Causes very large cells.
It is a Beta Herpes Virus.
Most people (75%) are infected, but the virus remains dormant unless the patient is in an immunocompromised state.
CMV Diagnosis
Intra-nuclear and or cytoplasmic inclusions surrounded by inflammation.
When suspicious for CMV, but inclusions are not present, more sensitive tests include…
Immunohistochemistry
In situ hybridization
Viral culture, PCR
CMV Treatment
Antiviral Drugs
Eg. gancyclovir, valgancyclovir, foscarnet.
