Some complications are possible after your transplant. Infection, bleeding, and anemia are some of the major ones that can occur while you are waiting for your blood counts to return to normal. In most cases there are steps that you and your care team can take to prevent, manage, and treat them.
Infection
You will be at risk for bacterial, fungal, and viral infections for several months after transplant. They are a major risk in the early recovery period until your new marrow grows and makes white blood cells to fight infection. Some infections will still be a risk while your immune system recovers during the first two years after your transplant.
Fever is one important sign of infection. If you develop a fever, a chest x-ray will be obtained and urine and blood cultures will be done. You will be given IV antibiotics to help your body fight the infection. Nearly all patients develop fever during the first two weeks after transplantation. Most infections are treated successfully with antibiotics.
Your doctors and nurses will try to prevent you from getting infections. You will likely be given drugs that are used to treat infections. For the transplant patient, they are also used to prevent them. You will receive anti-viral medicines.
These help prevent any viral infection you had in the past from coming back after the transplant.
Viral infections can include:
- Cold sores
- Recurrence of genital herpes
- Shingles
- Cytomegalovirus
- Other infections affecting the lungs or gut
Bleeding
Your platelet count will be low. Since platelets form blood clots, you will be at risk for bleeding. The mucous membranes of the nose, mouth, skin, and gastrointestinal tract are most commonly infected. *You will have platelet transfusions if your count falls below 10,000 or if you have any bleeding.
Anemia
When your red blood cell count is low, you may experience weakness and fatigue. Your nurse will assist you with your daily activities if you need help. You will be given red blood cell transfusion as necessary. These and all other blood products will be irradiated to prevent harmful side effects.
Organ Complication
You may have complications in your kidneys, liver, lungs, or heart. These are not common, but they can be serious. You are at higher risk if you already have a medical condition in any of these organs. This is why we carefully evaluate your organ functions before the transplant.
Kidneys
Your kidneys filter your blood and make urine to send waste products out of the body. The chemotherapy you get before transplant can affect how well your kidneys work. This is temporary, but waste products may remain in your blood until your kidney function improves. It also means that your kidney will have more trouble getting rid of any drugs you are given. Your nurses will keep records of the amount of fluid you get. This includes what you drink and what you are given through your IV line. They will also write down how much urine you make. This will help the doctors know if
you are beginning to have problems with your kidneys. You will also have blood tests every day to tell your doctors how your kidneys are working. If necessary, the doctors will adjust the doses of any drugs you are getting to decrease the risk to your kidneys.
Liver
Your liver removes harmful substances from your body fluids, absorb nutrients, and produces bile. Bile helps you digest your food. Side effects on your liver include problems with digestion. A more serious problem is that the liver may no longer remove breakdown products of your body and you will become jaundiced. In some patients small blood vessels in the liver are injured. This is called Veno-occlusive disease or VOD. These vessels can then become blocked so that blood cannot flow. This can cause the liver to become enlarged and may damage liver cells. Fluid may fill the abdomen. Liver problems of this sort usually begin within the first three weeks after transplant. With rare exception, all patients receive a drug that helps to prevent clot formation in the liver. This drug is called heparin, and it is given through your venous catheter. If you have side effects in your liver, your doctor will discuss the treatment options with you in more detail.
Lungs
Your lungs control breathing. Infections that affect the lungs may cause problems with breathing. Two problems that can occur during transplant are:
- An infection causing pneumonia and
- Damage of your lungs from chemo and radiation
This most commonly occurs in the first few weeks after transplant and can be serious. You will have regular chest x-rays while you are in the hospital. Your doctors and nurses will watch you closely for any signs of pneumonia. Tell them if you notice any change in your breathing. Do not ignore a cough or shortness of breath. Treatment depends on what causes the pneumonia.
Exercise your lungs. This may help to keep them clear. Your nurse will show you how to do deep breathing. You may also use an incentive spirometer. For this, you inhale deeply through a small tube to force a tiny ball to rise. You will receive different kinds of medicines to prevent or treat lung infections. Your nurse will review your routine with you.
Heart
Your heart pumps blood throughout your body. Certain chemotherapy drugs may have side effects that damage the heart. Your doctors will watch your heart function carefully while you are in the hospital.
Relapse
A risk for many patients is that their disease can comeback. This can happen if the treatments you had before the transplant did not kill all of your cancer cells. Your risk is higher if you have your transplant when you are in an advanced stage of disease or are already in relapse. Your doctor will follow you closely to watch for any sign of a return of your disease.