Pediatric emergency medicine trisk 2746 2746
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Complication
Clinical findings
Management
Acute graft versus
host disease
(GVHD)
Skin
Erythematous rash
Classic involvement of
palms and soles
GI tract
Colitis, sometimes bloody
diarrhea
Abdominal pain
Liver
Elevated bilirubin, alkaline
phosphatase,
transaminases
Hepatomegaly
Right upper quadrant
tenderness
Immunosuppressive
medications chosen only in
consultation with experts
in stem cell transplant
Aggressive management of
infections and fevers given
immunosuppression
intrinsic to GVHD
Hydration as needed for
dehydration from colitis
Assessment of anemia
secondary to bloody
diarrhea
Caution using drugs
metabolized in the liver if
hepatic GVHD present
Chronic GVHD
Pulmonary
Hypoxia
Shortness of breath
Liver (as above)
Eye dryness
Mouth dryness
Skin
Sclerodermatous changes
Contractures
Infection
Bacterial
Gram positive
Gram negative
Viral
Endogenous
Varicella zoster
Herpes simplex
Epstein–Barr virus
Cytomegalovirus
Adenovirus
Exogenous
Empiric broad-spectrum
antibiotics for fever
All patients to be considered
functionally neutropenic
and immunocompromised
until they have been off all
immunosuppressive
medications for at least 6
mo
Aggressive imaging to
follow-up and localizing
