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7 - Stem cell infusion

Published online by Cambridge University Press:  05 November 2013

Joseph H. Antin
Affiliation:
Dana-Farber Cancer Institute, Boston
Deborah Yolin Raley
Affiliation:
Dana-Farber Cancer Institute, Boston
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Summary

Autologous

Stem cells are routinelycryopreserved with dimethyl sulfoxide (DMSO). These products are red bloodcell (RBC) depleted before cryopreservation and thawed at 37°C in a waterbath before infusion. They should be infused through standard 170-micron redblood cell filters.

General reactions and response to infusion toxicity

The infusion of hematopoieticstem cells may be associated with toxicities that are either specific tohematopoietic products or general to all blood product infusions. Thefollowing text provides a minimal guideline to the workup and management ofinfusional toxicities. Each anticipated toxicity is defined and a plan ofaction is outlined.

Bleeding

  • Unprocessed marrow contains approximately 20 000 units of heparin, which is infused over 1 to 4 hours. h is will result in anticoagulation to a degree sui cient to result in clinical bleeding. Patients at risk are those with a history of recent surgery (e.g., recent line placement or revision), hemorrhagic cystitis, severe thrombocytopenia. However, bleeding can occur in any individual.

  • For a patient with a known hemorrhagic risk, the marrow should be concentrated and washed to remove heparin. If the risk factor is known before a harvest takes place, acid citrate dextrose (ACD) can be used in place of heparin as a cryopreservative, if allowed by protocol.

  • Infused heparin can be reversed with protamine. One mg of protamine will neutralize approximately 100 units of heparin. Maximum dose is 50 mg and the infusion rate should not exceed 5 mg/min .

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    Publisher: Cambridge University Press
    Print publication year: 2013

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