The Basics Flashcards
Stem cells
Cells found in bone marrow that can turn into 3 main types of blood cells: RBCs, WBCs, platelets
Hematopoeitic stem cells are precursors to all blood cells
Red blood cells
Carry oxygen around the body
White blood cells
fight infection
Platelets
stop bleeding by clotting
Pluriopotent stem cells (and renewal and differentiation)
most primitive form of cells, they can lead to renewal and differentiation
Renewal- reproduce another cell identical to itself
Differentiation- generate one or more subsets of mature cells
Bone marrow transplant RESCUE
replace bone marrow and restore its normal function after high doses of chemotherapy or radiation are given to treat a malignancy
Plasma cells
plasma B cells, are white blood cells that originate in the lymphoid organs as B lymphocytes
plays a role in adaptive immunity and secreting antibodies
Aphresis
a centrifuge separates blood into it’s components: RBC, WBC, platelets and plasma
Bone marrow harvest
collects stem cells w/ a needle placed in the bone marrow (soft tissue of bones); usually from hip or sternum
Cytokines
any of a number of substances, such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells.
Play a roll in immunity including maturation, defense, inflammatory responses
Graft vs Host Disease
Donor marrow or stem cells attack the recipient, can occur at any time but more common after marrow has started to make healthy cells
Usually occurs in skin, GI tract, liver
Symptoms include rash, jaundice, n/v/d, abdominal pain
Cytokine Release Storm
an acute systemic inflammatory syndrome characterized by fever and multiple organ dysfunction;Immune system activation leads to endothelial activation leading to systemic inflammation
When does CRS commonly occur (ex: with CAR T cell therapy)
3-14 days after infusion (possibility of late CRS is why we keep patients nearby for first 2 weeks)
Symptoms of CRS
Fever, flu-like symptoms, n/v/d/a, rash, tachypnea, hypoxia, pulmonary edema, cardiovascular (tachycardia, hypotension, capillary leak), hepatic dysfunction (transaminitis, increased bili), renal dysfunction
Markers to check if concerns for CRS
inflammatory markers, interleukins
IL-6, IFNy, IL-10, GM-CSF
Risk factors for CRS
- High disease burden in bone marrow
- Rapidly increasing blast count following lymphodepletion
- Active infections
- Other inflammatory processes
CRS Grading system (5)
- Fever
- Fever and hypotension
- Fever and hypotension requiring I pressor, hypoxia
- Fever, requires ventilatory support, requires multiple pressors
- Death
Vasopressors
a group of medications that contract (tighten) blood vessels and raise blood pressure
Graft rejection or relapse
Recipient’s immune system attacks the donor graft and destroys transplanted tissue organ, usually due to donor’s HLA proteins)
Average time to engraftment with peripheral blood (aphresis) & risk for GVHD
10-14 days, higher risk for GVHD
Average time to engraftment with bone marrow harvest & risk for GVHD
14-21 days, intermediate GVHD risk
Average time to engraftment with cord blood & risk for GVHD
21-28 days, low GVHD risk
Neutrophil engraftment
ANC > 500 for 3 consecutive days
anti-diuretic hormone
helps regulate the amount of water in your body.
It works to control the amount of water your kidneys reabsorb as they filter out waste from your blood.
Immunotherapy
directed against recipient’s circulating T-lymphs to decrease risk of graft rejection, it is also directed against donor T-lymphs infused @ the time of transplant to decrease risk of GVHD
Corticosteroids in the setting of BMT
prevent IL-1 and IL-6 production by macrophages and inhibit all stages of T cell activation
Prep for DAY 0 BMT (4)
- TPN should be stopped at midnight (may restart TPN four hours after)
- Cardiac monitor and pulse oximeter 30 min before
- Pre meds administered 3 hours before (Tylenol, Benadryl, Hydrocortisone ) * no hydrocort if CAR T or haplo
- Do not give blood the night before
Infusion rate for autologous transplants
5-30 minutes (fastest)
Infusion rate for allogenic BMT/PBSC transplants
60-120 minutes
Infusion rate for allogenic cord blood transplants
30-60 minutes
Infusion rate for allogenic donor lymphocyte transplants
30-60 minutes
Oral care for BMT patients
Chlorhexidine 4x/day and Nystatin 4x/day
Discontinue CHX if patient gets mucositis - will be painful
Lactate dehydrogenase
Enzyme that helps convert glucose/sugar into energy for cells - levels can help to assess tissue damage in body
LDH is highest in muscles, liver, kidneys and red blood cells
If your LDH blood or fluid levels are elevated, it may indicate that certain tissues in your body have been damaged
Refractory illness
a disease or condition that does not respond to treatment
When to not give steroids
- CAR T cell
- Haplo transplant
- If getting post-transfusion Cytoxan
DMSO
A preservative in transplant cells that can cause hypersensitivity reaction, so be cautions on day 0 and 24h post-transplant
Fibrinogen
a protein produced by the liver. This protein helps stop bleeding by helping blood clots to form.
High levels = increased risk of clot formation
High vs Low INR
INR= international normalized ratio
High INR: Increased risk of bleeding (b/c blood is clotting more slowly)
Low INR: Increased risk of clotting (b/c blood clots more quickly)
Prothrombin time (PT)
How long it takes for blood to clot
Prothrombin is a protein made by the liver
Low vs high clotting factors
Clotting factor levels that are too low can cause you to bleed too much after an injury.
Levels that are too high can cause dangerous clots to form in your arteries or veins.
High vs low platelets
Platelets react to bleeding by initiating blood clot
High platelets: increased risk of clotting
Low platelets: increased risk of bleeding
Platelet engraftment
Plt >20 w/o plt infusion for 10 days, then engraftment date is day #7
