c. Allergic reactions 
Chills, fever and hives occasionally occur. These reactions are 
never severe and respond to parenteral diphenhydramine 
(benadiyl). 
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^ 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 ^10 g/dl. Higher 
hemoglobin concentrations might be considered for patients with 
pulmonary insufficiency. 
2. 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. 
3. Management of infections 
a. Cultures are obtained as clinically indicated. 
Recombinant DNA Research, Volume 14 
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