Early and acute complications and the principles of haemopoietic stem cell transplantation nursing care

Haematopoietic stem cell transplantation (HSCT) generally includes preparative or conditioning regimes containing chemotherapy and/or radiotherapy in high doses. These regimens, as well as other treatments beforeand after HSCT such as immunosuppressive drugs to prevent graft versushost disease (GvHD) (see Chap. 11), may affect the patient’s organs andtissues and may cause both acute and long-term complications. In theevolving field of stem cell therapies, some complications that traditionallyhave been regarded as early complications are now, due to changes in preparative regimens and choice of stem cell source, sometimes seen later inthe post-transplant out-patient setting. The complications covered in thischapter generally occur within 100 days post HSCT and are thus classifiedas early complications. Two of the most common early complications areoral complications/mucositis and sepsis. Some other relatively rare complications are also covered here: haemorrhagic cystitis (HC), endothelialdamage (ED) syndromes including engraftment syndrome (ES), idiopathicpneumonia syndrome (IPS), diffuse alveolar haemorrhage (DAH),transplant-associated microangiopathy (TAM) and sinusoidal obstructionsyndrome/veno-occlusive disease (SOS/VOD). For all complications, recommendations for prevention and principles for nursing care are presentedsince careful nursing monitoring, prompt intervention and care may havean influence on patients’ morbidity and mortality