Book contents
- Frontmatter
- Contents
- Acknowledgments
- Contributor
- 1 Rationale for transplantation
- 2 Types of transplantation
- 3 Human leukocyte antigen matching in allogeneic transplantation
- 4 Stem cell source
- 5 Pretransplant evaluation and counseling of patient and donor
- 6 Conditioning regimens
- 7 Stem cell infusion
- 8 ABO compatibility
- 9 Engraftment
- 10 Preventative care
- 11 Transplant-related complications
- 12 Overview of acute and chronic graft-versus-host disease
- 13 Acute graft-versus-host disease and staging
- 14 Graft-versus-host disease prophylactic regimens
- 15 Treatment guidelines for acute graft-versus-host disease
- 16 Chronic graft-versus-host disease
- 17 Engraftment syndrome
- 18 Infectious disease
- 19 Graft rejection and failure
- 20 Gastrointestinal complications
- 21 Oral health in stem cell transplantation
- 22 Pulmonary complications
- 23 Veno-occlusive disease
- 24 Special transfusion-related situations
- 25 Cardiovascular complications
- 26 Neurologic complications
- 27 Cystitis
- 28 Donor lymphocyte infusion
- 29 Transplantation: regulation and accreditation
- Index
7 - Stem cell infusion
Published online by Cambridge University Press: 05 November 2013
- Frontmatter
- Contents
- Acknowledgments
- Contributor
- 1 Rationale for transplantation
- 2 Types of transplantation
- 3 Human leukocyte antigen matching in allogeneic transplantation
- 4 Stem cell source
- 5 Pretransplant evaluation and counseling of patient and donor
- 6 Conditioning regimens
- 7 Stem cell infusion
- 8 ABO compatibility
- 9 Engraftment
- 10 Preventative care
- 11 Transplant-related complications
- 12 Overview of acute and chronic graft-versus-host disease
- 13 Acute graft-versus-host disease and staging
- 14 Graft-versus-host disease prophylactic regimens
- 15 Treatment guidelines for acute graft-versus-host disease
- 16 Chronic graft-versus-host disease
- 17 Engraftment syndrome
- 18 Infectious disease
- 19 Graft rejection and failure
- 20 Gastrointestinal complications
- 21 Oral health in stem cell transplantation
- 22 Pulmonary complications
- 23 Veno-occlusive disease
- 24 Special transfusion-related situations
- 25 Cardiovascular complications
- 26 Neurologic complications
- 27 Cystitis
- 28 Donor lymphocyte infusion
- 29 Transplantation: regulation and accreditation
- Index
Summary
Autologous
Stem cells are routinelycryopreserved with dimethyl sulfoxide (DMSO). These products are red bloodcell (RBC) depleted before cryopreservation and thawed at 37°C in a waterbath before infusion. They should be infused through standard 170-micron redblood cell filters.
General reactions and response to infusion toxicity
The infusion of hematopoieticstem cells may be associated with toxicities that are either specific tohematopoietic products or general to all blood product infusions. Thefollowing text provides a minimal guideline to the workup and management ofinfusional toxicities. Each anticipated toxicity is defined and a plan ofaction is outlined.
Bleeding
Unprocessed marrow contains approximately 20 000 units of heparin, which is infused over 1 to 4 hours. h is will result in anticoagulation to a degree sui cient to result in clinical bleeding. Patients at risk are those with a history of recent surgery (e.g., recent line placement or revision), hemorrhagic cystitis, severe thrombocytopenia. However, bleeding can occur in any individual.
For a patient with a known hemorrhagic risk, the marrow should be concentrated and washed to remove heparin. If the risk factor is known before a harvest takes place, acid citrate dextrose (ACD) can be used in place of heparin as a cryopreservative, if allowed by protocol.
Infused heparin can be reversed with protamine. One mg of protamine will neutralize approximately 100 units of heparin. Maximum dose is 50 mg and the infusion rate should not exceed 5 mg/min .
- Type
- Chapter
- Information
- Manual of Stem Cell and Bone Marrow Transplantation , pp. 31 - 33Publisher: Cambridge University PressPrint publication year: 2013