10 ways to kill a patient - Page 3

The increased use of granulocyte colony-stimulating factor (G-CSF) ' mobilized peripheral blood stem cells (PBSCs) for allogeneic transplantation has led to guidelines for donor evaluation procedures to protect the safety of the PBSC donor (Joint Accreditation Committee of International Society for Haematotherapy and Graft Engineering (ISHAGE)-Europe and European Group For Blood and Marrow Transplantation (EBMT), 2000). Pregnancy is a contraindication for G-CSF-induced allogeneic PBSC donation, although current information is insufficient to establish definitive exclusion criteria. Here we report an allogeneic donor with unrecognized early pregnancy at the time she underwent G-CSF induced PBSC donation.

A 29 year-old woman was selected for G-CSF-induced allogeneic PBSC donation for her 23 year-old brother suffering from non-Hodgkin's lymphoma. After informed consent was obtained, 3 weeks before PBSC donation she underwent a standardized medical examination including a detailed questionnaire regarding the possibility of a pregnancy. The donor denied any pregnancy and the physical examination and all laboratory tests were normal. For PBSC mobilization, she received a 4 day course of recombinant human G-CSF subcutaneously at a dose of 10 g/kg body weight (b.w.)/d (Filgrastim; Amgen, Thousand Oaks, USA). PBSC donation was initiated on d +5 via peripheral vein access. She tolerated PBSC apheresis without remarkable events and, after two aphereses, 205 10⁶ CD34⁺ cells/kg recipients' b.w. (110 kg) were collected. After completion of stem cell apheresis, the donor was included in our institutional PBSC donor follow-up programme. At a control examination 3 months after PBSC donation she reported her pregnancy. The gynaecological examination revealed a singleton intrauterine pregnancy; gestation was calculated to have occurred 8 weeks before the start of G-CSF administration. Repeat ultrasound scans throughout pregnancy showed no malformations or intrauterine abnormalities in fetal development. Pregnancy progressed uneventfully and, after 40 weeks of gestation, the donor delivered a male baby at term. APGAR index at birth was 9, 10, 10; birth weight (342 kg) and birth length (50 cm) were within the normal percentile. Parturition and post-natal growth was unremarkable. Repeat paediatric examinations until the age of 18 months showed no evidence of haematological or immunological alterations.

Our report illustrates that in females scheduled for G-CSF-induced allogeneic PBSC donation an early pregnancy may be unrecognized, despite a careful medical examination. Considerations against the administration of G-CSF during pregnancy include an unknown risk of spontaneous abortion or the risk of embryonic or fetal malformations (Boxer et al, 1995), as well as concerns about potential long-term effects such as teratogenicity or leukaemogenity. In our donor, however, pregnancy resulted in the successful delivery of a healthy baby, which is in agreement with other case reports demonstrating no serious effect of G-CSF administration on fetal development (Fujiwaki et al, 1995; Kaufmann et al, 1998; Abe et al, 2000; Cavallaro et al, 2000). The data from these few patients, however, are inconclusive to assess the safety of G-CSF administration on gestation. Therefore, we recommend that a pregnancy test should be included in the evaluation procedure for female PBSC donors of child-bearing age as well as obtaining detailed donor information. It should be considered that informed consent from the donor is required for the pregnancy test. Ideally, after consent has been obtained, the pregnancy test should be performed on the days before the recipient's high-dose therapy has begun. Using this approach, we believe that the uncertain risks of G-CSF administration on gestation can be reduced.

Recommended Donor Work-Up

1. Complete physical examination, including evaluation for safety risks of the collection procedure in the possible need for central venous access and/or mobilization therapy for collection of blood cells and anesthesia for the collection of marrow.
2. Complete history and physical examination including history of the following: recreational drug use, alcohol, hypertension, cigarette smoking, blood transfusion, pregnancies, abortions, recent travel, vaccinations, and malignant disease. To identify persons at risk for transmission of communication disease (as defined by the FDA), inherited conditions, and/or hematological or immunological disease, the donor must also complete an Allogeneic Donor Health History Questionnaire (HHQ) form per the FDA. Completion of this form along with a series of studies can be used to determine medical eligibility and suitability.
3. Blood workup: CBC, differential counts, complete panel, LDH, PT/PTT, blood type, and screen (at blood bank), HLA testing, and ?-hCG assessment should be obtained for female donors of childbearing potential.
4. Infectious disease testing (serologies): labs must be drawn within 30 days before stem cell or marrow collection. Labs includeCMV Ab IgG, EBV, and an infectious disease marker (IDM) panel (HIV-1 and -2 antibody, HIV antigen NAT, HTLV-1 and -2 antibody, WNV NAT, HbsAg, HBcAb, HCV NAT, RPR, CMV and type and screen). IDM panel must be tested according to FDA standards.
5. Additional recommended testing if clinically indicated, urinalysis, chest X-ray, and/or EKG. EKG required for marrow donors males >40 years, females >50 years. PPD for all donors with appropriate risk factors (valid for 6 months before donation).
6. Repeat donors: repeat donors should be evaluated according to FDA and institutional standards.

HLA matching

Many factors play a role in how the immune system knows the difference between "self" and "non-self," but the most important for transplants is the human leukocyte antigen (HLA) system. Human leukocyte antigens are proteins found on the surface of most cells. They make up a person's tissue type, which is different from a person's blood type.

Each person has a number of pairs of HLA antigens (the best-known ones being A, B, C, DR, DQ, and DP). We inherit one of each of these antigens from each of our parents (and pass one of each pair on to each of our children). Doctors try to match these antigens when finding a donor for a person getting a stem cell transplant.

How well the donor's and recipient's HLA tissue types match plays a large part in whether the transplant will work. A match is better when all of the major HLA antigens are the same ' a 6 out of 6 match. These have a lower chance of graft-versus-host disease, a common complication of donor transplants. For bone marrow and peripheral blood stem cell transplants, sometimes a donor with a single mismatched antigen is used ' a 5 out of 6 match. For cord blood transplants a perfect HLA match doesn't seem to be as crucial for success, and even a sample with a couple of mismatched proteins may be OK.

science.. n then i see viren's same W*F look as mine.. like dude who gave you that med degree and the licence to practice you retard lmaooo and i crack up even more.. and add to it tandon looks really really sick, like he will pass out any minute.. he looks more than cancer patient than manvi..all taken together this is major unintended comedy.. and I continue being a bad bad viewer roflll

I kept on laughing and my friends joined in the digs on mera baby strong hain😆 or for tht matter the supernova Manvi who in marrow sucked mode sits amidst a bag of infections (aka vadera / tarun/ u name it she's socialized them) and mouth big time devi/ vishwaas dialogues.. n LMFAOOO at science crying its mediocre existence in a corner as the credit is taken by devi maa's signs or something😆 oh whattt unintended comedy

anyhow I digress.. even yesterday i cldnt connect the dots to the deformities but if donation requires registering amounts of growth factors that could cause teratomic effects on a growing foetus too I would imagine..