stem cell transplant Flashcards
Bone marrow
organ in the body that makes blood cells, WBC RBC and platelets
autologous
from yourself, allogenic from some one else, BMT is not a solid organ transplant, no surgery
The BMT cycle
Donor T cells recognizes the host cells (graft vs host disease)
host recognizes donor cells (Rejection- conditioning removes T cells)
more chemotherapy to make room, now the immune system can finish off the cancer/underlying disease
conditioning with chemotherapy
depends on disease and donor
reduced intensity has less collateral damage
infusion of the HPC product with GVHD prevention: bone marrow, cord blood, peripheral blood progenitor cells
children with bone marrow failure
aplastic anemia or hemoglobin should get a bone marrow transplant
Thalessemia
SCA
Children with primary immune deficiecy (SCID)
children with inborn errors of metabolsm
blood is a drug from human (an organ), theres a risk vs benefit
blood donation and testing, recruite, screen, collect and prepare, infectious disease test
16 yo, you give whole blood 500 ccs
usually white cells are taken out
blood types
Abo- most important red cell blood group system, Ab naturally occuring, very potent and can activate complement- responsible for many acute/fatal hemlytic transcfusion reactions
Rh: most important is antigen D (highly immunogenic 80% sensitization risk) antibodies develop through pregnancy or transfusion, implicated in hemolytic disease fo the newborn and hemolytic transfusion reaction.
pre transfusion testing
Type and screen (ABO and Rh) antibody screem, low likelyhood for transfusion (preop for cholecystectomy)
Type and cross (ABO and Rh) antibody screen CROSS MATCH, moderate to high likelyhodd for transfuion (preop heart surgery)
ABO
a person with B blood has anti A,
Inderect antiglobulin test
tests plasma instead of direct red cells
cross matching
final test- plasma of recipient is shaken up with RBCs of donor to see if theres reactio/gluttination
direct antiglobin test
REd cell with red cells with coumbs reagent to see autoimmune
RBCs
cells separated by cetrifuge, plasma is removed, stored at 4C for 42 days
Contains 300 ml, Hct 55%, no viable platelets or WBCs
Transfuse of 3-4 hours, raise Hgb 1g/dl in normal size adult
Patients should get RBC: acute rapid blood loss to increase O2 delivery, anemic pts with hemodynamic instbility, 35% and up need RBC
hemoglobin less than 7
fresh frozen plasma
just the plasma, 250 mls, 10 20 ml/kg, raises clotting factors,
universal donor for plasma is AB because they have no antibodies in it
cryoprecipitate
give a really small amount, fibrinogen not indicated for heamophilia A or B
