For finals

• ALLOGENEIC TRANSPLANTATION


  Cells, tissues, or organs are transferred from a genetically different donor to a recipient
• SYNGENEIC TRANSPLANTATION


  Involves donor and recipient who is a donor and identical (twin)
• Identical twins


  • Develop from a single fertilized egg and share the same genetic makeup
• Fraternal twins


  • Develop from separate eggs fertilized by separate sperm cells and are genetically no more similar than any other siblings
• AUTOLOGOUS TRANSPLANTATION


  Own bone marrow of a child that is given to the child. Harvest bone marrow, once the treatment is done, ibalik ang bone marrow
• HLA (Human Leukocyte Antigen)


  It must be matched with the donor. Siblings usually have a 25% compatibility rate. If HLA is not compatible, the doctor will prevent T lymphocytes from reacting to the transplanted tissue, as they typically react to foreign tissue. The doctor may need to destroy the bone marrow if it is ineffective and not suitable for transplantation
• Bone marrow transplantation


  1. Immunocompromised drugs such as cyclosporine are administered intravenously before the procedure, which can cause extreme nausea. One of the side effects is vomiting, so antiemetic therapy is provided. The donor should be admitted to the hospital one day before the procedure. To prevent clotting during bone marrow donation, the doctor will administer anticoagulants

  2. Since bone marrow is thick, the infusion time will take 60-90 min

  3. Monitor the child's cardiac rate to check for any circulatory overload or pulmonary embolism

  4. Common effects: fever and chill

  5. Give acetaminophen, dicycloverine chloride

  6. Limit the child's diet to fully cooked foods, as we do not allow raw foods due to the presence of bacteria on their surfaces
• New RBC can be detected after 3 weeks after infusion. In WBC and platelets, it takes up to 1 year after transplant
• GRAFT VS. HOST DISEASE (GFHD)


  • Immunologic response of the donor T-cells which usually takes days (7-14 days)
  • Donor T-cells try to attract the host
  • S/s- mild-severe: rashes, malaise, high fever, diarrhea, liver and spleen enlargement
  • No known cure. Cross-matching is most probable procedure
  • Give IV steroids since it would suppress the T- cells
  • Methotrexate and cyclosporine (anti cancer drugs) which kills the rapidly growing cells which causes alopecia
  • Administer intravenous immunoglobulin (IVIG) and prophylactic treatment to reduce the risk of infection; these should be given consistently
• SPLENECTOMY


  • Removing the spleen which leads to less immunity
  • Expect the patient to receive oral penicillin for approximately 1-2 years, during which resistance may develop
• ACUTE BLOOD LOSS ANEMIA


  Can occur from trauma, internal bleeding, acute nephritis, placenta previa, or intestinal parasites
• Twin-twin transfusion


  • Complication that can occur in pregnancies where identical twins share a placenta (monochorionic twins)
  • In TTTS, there is an imbalance in the blood flow between the twins through blood vessel connections in the placenta. This can lead to one twin (the recipient) receiving too much blood and the other twin (the donor) receiving too little blood
• Erythropoietin


  Protein that produces RBC in the kidneys
• • If there's anemia, there's pallor. Expect that tachycardia will occur. Rapid breathing is observed
  • In newborns who lack RBC, gasping and intercostal retractions are observed
• Treatment for acute blood loss anemia

  1. Give oxygen, stimulate the release of erythropoietin

  2. Transfuse additional red blood cells (RBCs) if the level is extremely low. Lay the patient flat on the bed to facilitate better blood flow

  3. For infants, place them in an incubator or under a radiant heat warmer

  4. If blood is not available yet, the doctor will order blood expanders like plasma or IV fluids like normal saline
• ANEMIA OF ACUTE INFECTION


  Inflammation of infants which leads to decrease production of RBC
• ANEMIA OF RENAL DISEASE


  • Anything that causes the kidney to become inflamed or infected can lead to non production of erythropoietin which leads to anemia
  • Synthetic form of erythropoietin which is the recombinant human erythropoietin: increases RBC production but doesn't correct renal disease
• ANEMIA OF NEOPLASTIC DISEASE


  • Patient is suffering from malignant cancer. For example, leukemia, lymphoma
  • The neoplastic cells will proliferate, leading to rapid metastasis
  • Decrease in platelet formation. Patient is at risk for infection
• Hypersplenism


  Refers to the overactivity of the spleen, which can lead to rapid splenomegaly
• Pancytopenia


  Characterized by a lower-than-normal number of red and white blood cells, as well as platelets, in the blood
• APLASTIC ANEMIA


  • Bone marrow doesn't produce enough RBC which causes anemia
  • Formation and development of WBC and Platelet are also affected
• Types of aplastic anemia

  • Congenital- Fanconi syndrome: an autosomal recessive trait characterized by hypogenitalism. These patients are prone to developing bone failure within 10 years
  • Acquired- Excessive exposure to toxic agents such as radiation, drugs, and chemicals can lead to bone marrow depression. Chloramphenicol, for example, can cause bone marrow suppression
• Assessment of anemia: pale, fatigue, anorexia, hypoxia, bruise easily, petechiae, Epistaxis, GI bleeding: hematochezia (lower GI tract), melena(upper GI tract), hematemesis (stomach), Irritability
• Therapeutic for acquired anemia


  1. Avoid exposure

  2. Child needs stem cell transplantation. If donor

  3. ATG- antithymocyte globulin