d. Renal failure from hemoglobinuria. Urine output must be 
carefully monitored. 
12.0 CONCURRENT TREATMENT AND SUPPORTIVE CARE 
a. Irradiate all blood products (except the bone marrow) with 1500-3500 cGy. 
b. Leukocyte poor RBCs and platelet components will be used to minimize 
transmission of CMV. 
c. Allergic reactions (especially to platelet concentrates) can usually be 
controlled with oral or IV benadryl. 
d. Platelets: Irradiated leukocyte poor platelet concentrates are transfused to 
prevent bleeding and in an attempt to keep the circulating platelet count at 
or greater than 20,000/mm 3 for the first 3-4 weeks post-BMT. 
e. Red cells: PRBCs (irradiated, leukocyte poor) 10-15 cc,kg/dose will be 
administered to keep the hemoglobin level _>10g/dl. Higher hemoglobin 
concentrations might be considered for patients with pulmonary insufficiency. 
12.1 Hyperalimentation 
Adequate alimentation appears to be an essential for successful 
transplantation. Parenteral hyperalimentation is maintained until normal 
enteral alimentation can be resumed as judged by the clinical situation. 
Patients may be enrolled on the active SJCRH hyperalimentation protocols 
and will be monitored by the SJCRH Metabolic Support Service. 
12.2 Management of infections 
a. Cultures are obtained as clinically indicated. 
b. Once antibiotic treatment has been initiated, it will not be routinely 
discontinued until marrow function has been restored, even if clinical 
evidence of infection, i.e., fever, has resolved. 
c. Special emphasis will be placed on evaluation of infection at sanctuary 
sites such as the sinuses. 
d. Antifungal treatment will be considered in febrile patients who have 
had 4 days of broad spectrum IV antimicrobials. Patients may be 
enrolled on open SJCRH infectious disease protocol for treatment. 
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Recombinant DNA Research, Volume- 17 
