screen undertaken for cytotoxic antibodies to help plan transfusion 
therapy. 
12.1.5 Patients with cytomegalovirus negative titers pre-treatment will receive 
only CMV negative, or leukocyte poor blood products for the first 100 
days post ABMT. 
12.2 Nutritional Management 
12.2.1 Silastic semipermanent lumen central venous catheters shall be placed 
in all patients prior to or at the time of their bone marrow harvest. 
12.2.2 The effectiveness of total parenteral nutrition in maintaining body 
weight is well established, and appears to be essential for successful 
AMBR and patient management. Patients may be enrolled on the 
active SJCRH hyperalimentation protocols and will be monitored by 
the Metabolic Support Service. 
12.3 Infectious Disease Management 
12.3.1 Routine microbiologic surveillance cultures from the stool, throat, urine 
tmd blood will be obtained pre-AMBR and then twice weekly for the 
first month post- ABMT. Additional cultures are obtained as clinically 
indicated. 
12.3.2 Patients are to be kept in a protective environment in a single room 
under positive air pressure. Visitors and staff must observe good 
handwashing practice as determined by Infectious Disease staff. 
12.3.3 Complete eradication of pathogens by antibiotics is difficult in the 
agranulocytopenic host. Once antibiotic treatment has been initiated, 
discontinuation prior to marrow recovery (^500 granulocytes/mm^) 
should not be routinely considered. 
12.3.4 Antifungal treatment will be considered in patients who have had at 
least 5-7 days of broad spectrum IV antibiotics in the face of persistent 
fevers and the documented fungal colonization or CT evidence of 
systemic fungus. 
12.3.5 High index of suspicion is necessary for evaluation and treatment of 
interstitial pneumonitis in the post-ABMT patient. Patients with low- 
grade fever and chronic cough should have prompt chest x-rays and 
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