1. Nursing Instruction
  2. Overview
  3. Hematology and Oncology
【Major points】
  1. The patient’s immune system will gradually recover, taking at least six months or longer.
  2. Common post-transplant symptoms include fever, diarrhea, skin reactions, or bleeding. 
  3. Self-care and infection prevention remain crucial after discharge.
  4. Medications should be taken as prescribed without stopping or adjusting the dose without medical advice.

What is Hematopoietic Stem Cell Transplantation (HSCT)?
Hematopoietic Stem Cell Transplantation (HSCT) is a treatment method used for certain blood disorders by transplanting healthy stem cells into the patient to restore the function of the blood system. These disorders are usually caused by abnormal or impaired bone marrow function, such as: Acute Myeloid Leukemia (AML), Lymphoma, Aplastic Anemia.

What Should I Pay Attention To After Transplantation?
After transplantation, your immune system will recover very slowly, typically taking over six months. You should pay special attention to the following:
  1. Maintaining a clean-living environment.
  2. Practicing personal hygiene such as frequent hand washing.
  3. Avoiding contact with individuals who have colds, flu, or other infectious diseases.

Especially for allogeneic transplant recipients, there is a risk of Graft-versus-Host Disease (GVHD)，a rejection response where the donor's lymphocytes attack the recipient's tissue. Even if discharged, patients must be vigilant for symptoms like fever, diarrhea, skin rashes, or bleeding.

Symptom Management:

  1. Fever: Because the immune system has not yet recovered, patients are more susceptible to bacterial, viral or fungal infections. If you experience chilliness or fever >38°C, you should return to hospital as soon as possible.
  2. Diarrhea: It may be an infection or a GVHD reaction of allograft. If the diarrhea is severe, you must return to the clinic to ask the doctor for confirmation as soon as possible.
  3. Skin symptoms: For example, if the skin and sclera turn yellow, skin rashes increase, blisters or pain occur, etc., it is necessary to return to the Hematology Oncology Clinic for further confirmation.
  4. Others: If you have oral ulcers, persistent vomiting, tarry stools, or many petechiae on the skin, you need to return to the clinic for treatment.

Home Care Instructions:
  1. Personal hygiene:
    1. Rinse your mouth with salt water or boiled water, brush your teeth after three meals and before going to bed to keep your mouth clean, and check your oral mucosa every day.
    2. Wash your hands frequently, especially before eating, after going to the toilet, or after going home.
    3. Take a bath and change clothes every day, choose cotton clothes to reduce skin irritation, and apply moisturizing lotion to reduce skin dryness or scaling.
    4. Keep the anus and perineum clean and dry after defecation. If there is abnormal
      redness, swelling, heat and pain around the anus, return to the clinic for evaluation.
  2. Diets:
    1. It is best to take high-calorie and high-protein foods, and avoid too hard and irritating foods.
    2. Have frequent small meals, avoid raw food (such as lettuce salad, sashimi).
    3. Eat fresh fruits that can be peeled instead of overnight food.
    4. Be sure to have personal tableware, and the cutting board must be kept dry to prevent mold growth.
  3. Clothing and living environment:
    1. Wash bed sheets, quilt covers, pillowcases, and underwear frequently, and ensure that they are dried.
    2. The house should be ventilated, dry, and sunny. It is recommended to use an air cleaner (please change the filter regularly).
    3. Do not place potted plants, fresh flowers, dried flowers or fake flowers indoors to
      avoid infection caused by the spread of mold and hyphae in the soil or on flowers and leaves.
    4. Avoid contact with people with colds or infectious diseases.
    5. Do not touch plants, soil, pets' feces directly.
  4. Activities:
    1. You can engage in lower-intensity activities, such as walking. In addition, you should slow down when changing positions to prevent dizziness and falls.
    2. Be sure to wear a mask when going out. If the mask is wet, replace it immediately.
    3. Wear long-sleeved clothes, hats or umbrellas to avoid direct sunlight.
  5. Leisure & Social Activities:
    1. Avoid crowded public transportation and enclosed or crowded public spaces (e.g., temples, markets, department stores).
    2. As immune recovery takes time, consult your doctor before returning to school, work, or traveling abroad.
  6. Other Care Instructions:
    1. Central line care: Use waterproof/breathable dressing and change it every 7 days; every 2 days if using gauze. If the dressing is wet or contaminated, replace it immediately. Watch for redness, swelling, warmth, or pain at the site and return to the clinic as needed. Flush the catheter as instructed based on type.
    2. Medication: Take all prescribed medications on time, exactly as directed. Do not stop or adjust dosage without your doctor’s guidance. If you take cyclosporine, do not drink grapefruit juice due to drug interaction risk.
    3. Sexual activity: It is normal to have sexual needs. Maintain hygiene, use lubricants if needed, and avoid activities that may cause bleeding or infection.
    4. Vaccinations: If vaccines are required, discuss with your doctor first.
    5. Follow-up: Continue regular follow-up appointments at the Hematology and Oncology Clinic post-discharge.

Reference
  1. Khera, N. (2023). Managing survivorship after hematopoietic cell transplantation. Current Hematologic Malignancy Reports, 18(3), 75–82. https://doi.org/10.1007/s11899-023-00694-8
  2. Nascimento, A. A. A., Melo, J. C. A., Soares, K. D., Marinho, A. C. L., Ribeiro, S. E. A., & Azevedo, I. C. (2023). Self-care guidelines for patients in the post-hematopoietic stem cell transplantation period: A scoping review. Revista Brasileira de Enfermagem, 76(4), e20220383. https://doi.org/10.1590/0034-7167-2022-0383
  3. Olivieri, A., & Mancini, G. (2024). Current approaches for the prevention and treatment of acute and chronic GVHD. Cells, 13(18), 1524. https://doi.org/10.3390/cells13181524 
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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