Discharge and followup

Criteria for discharge

Blood counts should ideally be: Hb >10.0g/dL (but may require transfusion), neutrophils >1.0 x l09/L, platelets >25 x 109/L, and patients should be able to maintain a fluid intake of 2-3L/d, tolerating diet and oral medications particularly in allografts on cyclosporin. Should be apyrexial and no longer losing weight.

Counsel patients

1. Possible need for blood/platelets.

2. Adherence to neutropenic diet.

3. Check temperature bd and report immediately if febrile.

4. Fatigue post-transplant in irradiated patients due to the late TBI effect usually 6-10 weeks post transplant.

5. Risk of HZV (explain the early symptoms).

6. To continue with mouth care.

7. To report any new symptoms.

Blood tests—initially twice weekly

340 * FBC, reticulocytes and blood film.

• Biochemistry including LFTs.

• CyA levels pre-dose (EDTA sample)—allografts only.

Initially once a week

• Coagulation screen.

• CMV screening test e.g DEAFF—allografts and seropositive autograft recipients only.

• Stool culture—allografts only unless relevant symptoms.

Drugs

1. Cyclosporin capsules—allografts only.

2. Acyclovir prophylaxis against HZV 400mg qds PO for minimum of 3 months in non-TBI patients and 6 months in TBI autografts and all allografts. Allografts may be on 800mg tds if acyclovir chosen for CMV prophylaxis. Consider low dose 200mg bd maintenance until 1-2 years post-transplant.

3. Penicillin V 250mg bd PO should be given to all patients. Erythromycin 250mg od PO if penicillin allergic.

4. Ciprofloxacin 250mg bd PO if neutrophils <1.0 x 109/L.

5. Cotrimoxazole 480mg bd PO Monday, Wednesday, Friday for 1 year minimum and until CD4 count >500. Cotrimoxazole should be started when neutrophils >1.5 x 109/L and platelets >60 x 109/L. Until then, use nebulised pentamidine 300mg every 3 weeks.

6. Itraconazole—allografts only.

7. Nystatin mouth care.

8. Folic acid 5mg bd until full engraftment.

9. Sanatogen Gold™ multivitamins 1/d may be advisable while gaining weight.

10. Antiemetics PRN.

Healthy Weight Loss For Teens

Healthy Weight Loss For Teens

Help your Teen Lose Weight Easily And In A Healthy Way. You Are About to Discover What psychological issues overweight teens are facing and how do you go about parenting an overweight teen without creating more problems?

Get My Free Ebook


Post a comment