Transfusion Support During Hematopoietic Cell Transplantation

The stem cell transplantation process poses a myriad of challenges. Beginning at its inception over 50 years ago management strategies have been implemented to improve morbidity and mortality allowing patients with difficult to treat malignancies and inherited genetic disorders the ability and opportunity to be cured of their disease. The central venous catheter ha become an essential tool in the management of patients with hematologic malignancies, particularly in the peri-transplant setting, since they facilitate the process of leukapheresis, the infusion of the graft itself, infusion of the conditioning chemotherapy, antibiotics, electrolytes, parenteral nutrition, blood products, and allow recurrent blood sample collection. Blood products are another essential during the peri-transplant period. Patients receiving hematopoietic stem cell transplantation require extensive transfusion support until appropriate platelet and red blood cell engraftment ensures. Malnutrition in the transplant setting is often between 10 - 50% of patients prior to their preparative chemotherapy regimen for stem cell transplant. While a typical pre-SCT patient has a near normal nutritional status, over 20% of patients have unintentional weight loss of 5-10% in the prior six months to transplant. Strategies to screen for and intervene upon this issue play an important role in the transplant process. Herein we will discuss these key features in the management of stem cell transplant recipients.