Hematopoietic Stem Cell Transplantation in the PICU

摘要: Hematopoietic stem cell transplantation (SCT) is a therapeutic option for patients with bone marrow failure, certain malignancies and inborn errors of metabolism. Complications requiring intensive care are frequent, intensivists need to be familiar the process disorders that unique these patients. The transplant involves use high dose chemotherapy or radiation, followed by intravenous infusion cells matched recipient at human leukocyte antigen (HLA) loci. Full recovery normal immune system can take year more, so following transplantation, exquisitely susceptible infections. Moreover, complications such as graft versus host disease, idiopathic pneumonia syndrome, sinusoidal obstruction syndrome associated thrombotic microangiopathy common in first hundred days after infusion. Respiratory failure presentation necessitating admission may due infectious non-infectious causes. Mechanical ventilation needed along broad spectrum anti-microbial coverage; corticosteroids commonly used if disease present. Acute most frequent children receiving grafts from unrelated donors results significant morbidity. Increased immunosuppression cornerstone therapy protection infection essential survival. Sinusoidal lead multiple organ limited options, but both resolve good supportive during period failure. Outcomes who develop SCT remain poor despite aggressive care, however, single do well. Integrated multi-disciplinary between physicians, other specialists nephrologists pulmonologists leads improved outcomes.