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Dear Dr XXXXXXX Thanks For Your Earlier Advice In Https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397428
Question: Dear Dr XXXXXXX
Thanks for your earlier advice in
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397428
We are worried. My niece, has fever again, after it has subsided for a short period. She was re-admitted to hospital four days ago due to fever and pneumonia. Dr said her heart is enlarged a bit based on chest x ray image. My niece has been on antibiotics for 4 days, and was given IVIG treatment 3 days ago, but her fever still persists, ranging from 37.5 to 38.2 degree celcius. Dr said no bacteria detected from blood culture. Her fever seems not under control.
She is very tired these two weeks, with high blood pressure (systolic, 130 – 140, diagstolci 90+ to 1oo+ (but she is already on medication but still so high). Her pulse is high (90+ to 120+ per minute) and she feels her heart beat very fast (palpitation) with shortness of breath.
What worries us more is her platelets keeps dropping after an encouraging rise initiailly. Her platelet engraftment was on day 26 and then reached 95k on day 33, then started to drop to 68k on day 40, then to 42k on day 47, then to 25k today (day 60). The dropping trend make us very worried and nervous. Her hgb is also low since transplant and still need RBC transfusion weekly.
Her neutrophil fluctuates between 2+ to 5+ in past week, mostly around 3.
We are so worried, Dr XXXXXXX Really scared that it is secondary engraftment failure.
1. Is what happening to my niece common problems post transplant? What are the signs of secondary engraftment failure?
2. Prior to transplant, she has received over 150 bags RBC and over 150 bags platelets. Does this affect the success of engraftment? Does this increase the risk of secondary engraftment failure?
3. Is my niece’s conditions like GVHD? Is her conditions not optimistic?
Dr XXXXXXX we are so so scared. What can we do now? What can we ask our doctors? Any advice from you?..............
Eager to receive your reply. We are so worried
Thanks for your earlier advice in
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397428
We are worried. My niece, has fever again, after it has subsided for a short period. She was re-admitted to hospital four days ago due to fever and pneumonia. Dr said her heart is enlarged a bit based on chest x ray image. My niece has been on antibiotics for 4 days, and was given IVIG treatment 3 days ago, but her fever still persists, ranging from 37.5 to 38.2 degree celcius. Dr said no bacteria detected from blood culture. Her fever seems not under control.
She is very tired these two weeks, with high blood pressure (systolic, 130 – 140, diagstolci 90+ to 1oo+ (but she is already on medication but still so high). Her pulse is high (90+ to 120+ per minute) and she feels her heart beat very fast (palpitation) with shortness of breath.
What worries us more is her platelets keeps dropping after an encouraging rise initiailly. Her platelet engraftment was on day 26 and then reached 95k on day 33, then started to drop to 68k on day 40, then to 42k on day 47, then to 25k today (day 60). The dropping trend make us very worried and nervous. Her hgb is also low since transplant and still need RBC transfusion weekly.
Her neutrophil fluctuates between 2+ to 5+ in past week, mostly around 3.
We are so worried, Dr XXXXXXX Really scared that it is secondary engraftment failure.
1. Is what happening to my niece common problems post transplant? What are the signs of secondary engraftment failure?
2. Prior to transplant, she has received over 150 bags RBC and over 150 bags platelets. Does this affect the success of engraftment? Does this increase the risk of secondary engraftment failure?
3. Is my niece’s conditions like GVHD? Is her conditions not optimistic?
Dr XXXXXXX we are so so scared. What can we do now? What can we ask our doctors? Any advice from you?..............
Eager to receive your reply. We are so worried
Dear Dr XXXXXXX
Thanks for your earlier advice in
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397428
We are worried. My niece, has fever again, after it has subsided for a short period. She was re-admitted to hospital four days ago due to fever and pneumonia. Dr said her heart is enlarged a bit based on chest x ray image. My niece has been on antibiotics for 4 days, and was given IVIG treatment 3 days ago, but her fever still persists, ranging from 37.5 to 38.2 degree celcius. Dr said no bacteria detected from blood culture. Her fever seems not under control.
She is very tired these two weeks, with high blood pressure (systolic, 130 – 140, diagstolci 90+ to 1oo+ (but she is already on medication but still so high). Her pulse is high (90+ to 120+ per minute) and she feels her heart beat very fast (palpitation) with shortness of breath.
What worries us more is her platelets keeps dropping after an encouraging rise initiailly. Her platelet engraftment was on day 26 and then reached 95k on day 33, then started to drop to 68k on day 40, then to 42k on day 47, then to 25k today (day 60). The dropping trend make us very worried and nervous. Her hgb is also low since transplant and still need RBC transfusion weekly.
Her neutrophil fluctuates between 2+ to 5+ in past week, mostly around 3.
We are so worried, Dr XXXXXXX Really scared that it is secondary engraftment failure.
1. Is what happening to my niece common problems post transplant? What are the signs of secondary engraftment failure?
2. Prior to transplant, she has received over 150 bags RBC and over 150 bags platelets. Does this affect the success of engraftment? Does this increase the risk of secondary engraftment failure?
3. Is my niece’s conditions like GVHD? Is her conditions not optimistic?
Dr XXXXXXX we are so so scared. What can we do now? What can we ask our doctors? Any advice from you?..............
Eager to receive your reply. We are so worried
Thanks for your earlier advice in
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397428
We are worried. My niece, has fever again, after it has subsided for a short period. She was re-admitted to hospital four days ago due to fever and pneumonia. Dr said her heart is enlarged a bit based on chest x ray image. My niece has been on antibiotics for 4 days, and was given IVIG treatment 3 days ago, but her fever still persists, ranging from 37.5 to 38.2 degree celcius. Dr said no bacteria detected from blood culture. Her fever seems not under control.
She is very tired these two weeks, with high blood pressure (systolic, 130 – 140, diagstolci 90+ to 1oo+ (but she is already on medication but still so high). Her pulse is high (90+ to 120+ per minute) and she feels her heart beat very fast (palpitation) with shortness of breath.
What worries us more is her platelets keeps dropping after an encouraging rise initiailly. Her platelet engraftment was on day 26 and then reached 95k on day 33, then started to drop to 68k on day 40, then to 42k on day 47, then to 25k today (day 60). The dropping trend make us very worried and nervous. Her hgb is also low since transplant and still need RBC transfusion weekly.
Her neutrophil fluctuates between 2+ to 5+ in past week, mostly around 3.
We are so worried, Dr XXXXXXX Really scared that it is secondary engraftment failure.
1. Is what happening to my niece common problems post transplant? What are the signs of secondary engraftment failure?
2. Prior to transplant, she has received over 150 bags RBC and over 150 bags platelets. Does this affect the success of engraftment? Does this increase the risk of secondary engraftment failure?
3. Is my niece’s conditions like GVHD? Is her conditions not optimistic?
Dr XXXXXXX we are so so scared. What can we do now? What can we ask our doctors? Any advice from you?..............
Eager to receive your reply. We are so worried
Brief Answer:
It's not secondary engraftment failure yet
Detailed Answer:
Hi
I do understand your worries.
Secondary engraftment failure requires neutrophil counts to fall below 500/uL, so we can't call it that yet. Neutrophil count is well above that limit. Anemia and low platelets accompany low neutrophils in secondary engraftment failure but not defining by themselves.
Prior transfusions impact GVHD and transplant related mortality so that definitely is a risk. They don't cause secondary engraftment failure usually.
We need to exclude other viruses like parvo and HHV6, bacterial, fungal infections, hypersplenism and also GVHD as causes for these problems.
I would not say that condition is not optimistic but definitely it is concerning.
You can discuss above points with her docs.
Hope this helps.
regards
It's not secondary engraftment failure yet
Detailed Answer:
Hi
I do understand your worries.
Secondary engraftment failure requires neutrophil counts to fall below 500/uL, so we can't call it that yet. Neutrophil count is well above that limit. Anemia and low platelets accompany low neutrophils in secondary engraftment failure but not defining by themselves.
Prior transfusions impact GVHD and transplant related mortality so that definitely is a risk. They don't cause secondary engraftment failure usually.
We need to exclude other viruses like parvo and HHV6, bacterial, fungal infections, hypersplenism and also GVHD as causes for these problems.
I would not say that condition is not optimistic but definitely it is concerning.
You can discuss above points with her docs.
Hope this helps.
regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
It's not secondary engraftment failure yet
Detailed Answer:
Hi
I do understand your worries.
Secondary engraftment failure requires neutrophil counts to fall below 500/uL, so we can't call it that yet. Neutrophil count is well above that limit. Anemia and low platelets accompany low neutrophils in secondary engraftment failure but not defining by themselves.
Prior transfusions impact GVHD and transplant related mortality so that definitely is a risk. They don't cause secondary engraftment failure usually.
We need to exclude other viruses like parvo and HHV6, bacterial, fungal infections, hypersplenism and also GVHD as causes for these problems.
I would not say that condition is not optimistic but definitely it is concerning.
You can discuss above points with her docs.
Hope this helps.
regards
It's not secondary engraftment failure yet
Detailed Answer:
Hi
I do understand your worries.
Secondary engraftment failure requires neutrophil counts to fall below 500/uL, so we can't call it that yet. Neutrophil count is well above that limit. Anemia and low platelets accompany low neutrophils in secondary engraftment failure but not defining by themselves.
Prior transfusions impact GVHD and transplant related mortality so that definitely is a risk. They don't cause secondary engraftment failure usually.
We need to exclude other viruses like parvo and HHV6, bacterial, fungal infections, hypersplenism and also GVHD as causes for these problems.
I would not say that condition is not optimistic but definitely it is concerning.
You can discuss above points with her docs.
Hope this helps.
regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks Dr XXXXXXX for your advice.
My niece's platelet count dropped to below 20k 3 days ago and need transfusion, after being platelet transfusion free for 40 days. Any sign of secondary platelet engraftment failure?
Her hgb, after transfusion for 4 days suddenly dropped from 8.1 to 6.9 within just one day. Could it be hemolysis?
My niece is still on antibiotics but fever seems not under control, fluctuating between 37.5 38.5 degrees celcius. Dr said there is pericardial effusion (seems mild). Could it be due to infection? or GVHD?
What tests can be done to find out whether my nece's current conditions is due to GVHD or not?
We are lost. The cause of her fever seems not found. Any further advice from you Dr Ghosh? We are so worried.
My niece's platelet count dropped to below 20k 3 days ago and need transfusion, after being platelet transfusion free for 40 days. Any sign of secondary platelet engraftment failure?
Her hgb, after transfusion for 4 days suddenly dropped from 8.1 to 6.9 within just one day. Could it be hemolysis?
My niece is still on antibiotics but fever seems not under control, fluctuating between 37.5 38.5 degrees celcius. Dr said there is pericardial effusion (seems mild). Could it be due to infection? or GVHD?
What tests can be done to find out whether my nece's current conditions is due to GVHD or not?
We are lost. The cause of her fever seems not found. Any further advice from you Dr Ghosh? We are so worried.
Thanks Dr XXXXXXX for your advice.
My niece's platelet count dropped to below 20k 3 days ago and need transfusion, after being platelet transfusion free for 40 days. Any sign of secondary platelet engraftment failure?
Her hgb, after transfusion for 4 days suddenly dropped from 8.1 to 6.9 within just one day. Could it be hemolysis?
My niece is still on antibiotics but fever seems not under control, fluctuating between 37.5 38.5 degrees celcius. Dr said there is pericardial effusion (seems mild). Could it be due to infection? or GVHD?
What tests can be done to find out whether my nece's current conditions is due to GVHD or not?
We are lost. The cause of her fever seems not found. Any further advice from you Dr Ghosh? We are so worried.
My niece's platelet count dropped to below 20k 3 days ago and need transfusion, after being platelet transfusion free for 40 days. Any sign of secondary platelet engraftment failure?
Her hgb, after transfusion for 4 days suddenly dropped from 8.1 to 6.9 within just one day. Could it be hemolysis?
My niece is still on antibiotics but fever seems not under control, fluctuating between 37.5 38.5 degrees celcius. Dr said there is pericardial effusion (seems mild). Could it be due to infection? or GVHD?
What tests can be done to find out whether my nece's current conditions is due to GVHD or not?
We are lost. The cause of her fever seems not found. Any further advice from you Dr Ghosh? We are so worried.
Brief Answer:
Yes platelets are showing secondary failure
Detailed Answer:
As I said earlier, this is not secondary engraftment failure but platelets dropping below 20000 qualify for secondary platelet failure.
Mild pericardial effusion is usually not of much concern. Infection is definitely one cause.
Common causes are any infection, GVHD, drug induced. I am sure they are ruling out infective causes one by one. For GVHD, no great test is available and mostly it's a clinical diagnosis. We need to look for GVHD in other organs too.
Hemolysis can play a role in hemoglobin drop. A peripheral blood smear examination with reticulocyte count can exclude that. Rarely hemolytic uremic syndrome can develop which can explain both anemia and thrombocytopenia.
I am really sorry I can't give more specific answers as that's impossible without being on the ground.
I sincerely wish the best for her.
Regards
Yes platelets are showing secondary failure
Detailed Answer:
As I said earlier, this is not secondary engraftment failure but platelets dropping below 20000 qualify for secondary platelet failure.
Mild pericardial effusion is usually not of much concern. Infection is definitely one cause.
Common causes are any infection, GVHD, drug induced. I am sure they are ruling out infective causes one by one. For GVHD, no great test is available and mostly it's a clinical diagnosis. We need to look for GVHD in other organs too.
Hemolysis can play a role in hemoglobin drop. A peripheral blood smear examination with reticulocyte count can exclude that. Rarely hemolytic uremic syndrome can develop which can explain both anemia and thrombocytopenia.
I am really sorry I can't give more specific answers as that's impossible without being on the ground.
I sincerely wish the best for her.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Yes platelets are showing secondary failure
Detailed Answer:
As I said earlier, this is not secondary engraftment failure but platelets dropping below 20000 qualify for secondary platelet failure.
Mild pericardial effusion is usually not of much concern. Infection is definitely one cause.
Common causes are any infection, GVHD, drug induced. I am sure they are ruling out infective causes one by one. For GVHD, no great test is available and mostly it's a clinical diagnosis. We need to look for GVHD in other organs too.
Hemolysis can play a role in hemoglobin drop. A peripheral blood smear examination with reticulocyte count can exclude that. Rarely hemolytic uremic syndrome can develop which can explain both anemia and thrombocytopenia.
I am really sorry I can't give more specific answers as that's impossible without being on the ground.
I sincerely wish the best for her.
Regards
Yes platelets are showing secondary failure
Detailed Answer:
As I said earlier, this is not secondary engraftment failure but platelets dropping below 20000 qualify for secondary platelet failure.
Mild pericardial effusion is usually not of much concern. Infection is definitely one cause.
Common causes are any infection, GVHD, drug induced. I am sure they are ruling out infective causes one by one. For GVHD, no great test is available and mostly it's a clinical diagnosis. We need to look for GVHD in other organs too.
Hemolysis can play a role in hemoglobin drop. A peripheral blood smear examination with reticulocyte count can exclude that. Rarely hemolytic uremic syndrome can develop which can explain both anemia and thrombocytopenia.
I am really sorry I can't give more specific answers as that's impossible without being on the ground.
I sincerely wish the best for her.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks much Dr XXXXXXX for your advice. We are really worried.
Is secondary platelet failure difficult to manage? What can we expect? Fatal consequence?
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, with 600 cc fluide
Thanks much Dr XXXXXXX for your advice. We are really worried.
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, two days ago, with 600 cc fluid drained during procedures, followed by another 400 cc. on the day after. Is her conditions serious? Why her pericardial effusion get worse so quickly within just a few days?(1st echo only showed mild pericardial effusion, but four days later echo showed much more pericardial effusion. The fluid has been sent for tests, results not yet known.
Dr said CMV is detected again from her blood test earlier (she had CMV detected after transplant and got treated and subsided). Can CMV be a cause of her her pericardial effusion? She is now treated for CMV again. Is CMV difficult to treat and easily recurs?
Any further advice?We are frustrated.Thanks much
Is secondary platelet failure difficult to manage? What can we expect? Fatal consequence?
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, with 600 cc fluide
Thanks much Dr XXXXXXX for your advice. We are really worried.
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, two days ago, with 600 cc fluid drained during procedures, followed by another 400 cc. on the day after. Is her conditions serious? Why her pericardial effusion get worse so quickly within just a few days?(1st echo only showed mild pericardial effusion, but four days later echo showed much more pericardial effusion. The fluid has been sent for tests, results not yet known.
Dr said CMV is detected again from her blood test earlier (she had CMV detected after transplant and got treated and subsided). Can CMV be a cause of her her pericardial effusion? She is now treated for CMV again. Is CMV difficult to treat and easily recurs?
Any further advice?We are frustrated.Thanks much
Thanks much Dr XXXXXXX for your advice. We are really worried.
Is secondary platelet failure difficult to manage? What can we expect? Fatal consequence?
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, with 600 cc fluide
Thanks much Dr XXXXXXX for your advice. We are really worried.
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, two days ago, with 600 cc fluid drained during procedures, followed by another 400 cc. on the day after. Is her conditions serious? Why her pericardial effusion get worse so quickly within just a few days?(1st echo only showed mild pericardial effusion, but four days later echo showed much more pericardial effusion. The fluid has been sent for tests, results not yet known.
Dr said CMV is detected again from her blood test earlier (she had CMV detected after transplant and got treated and subsided). Can CMV be a cause of her her pericardial effusion? She is now treated for CMV again. Is CMV difficult to treat and easily recurs?
Any further advice?We are frustrated.Thanks much
Is secondary platelet failure difficult to manage? What can we expect? Fatal consequence?
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, with 600 cc fluide
Thanks much Dr XXXXXXX for your advice. We are really worried.
Her pericardial effusion has worsened sharply within just few days, and has done Pericardiocentesis, two days ago, with 600 cc fluid drained during procedures, followed by another 400 cc. on the day after. Is her conditions serious? Why her pericardial effusion get worse so quickly within just a few days?(1st echo only showed mild pericardial effusion, but four days later echo showed much more pericardial effusion. The fluid has been sent for tests, results not yet known.
Dr said CMV is detected again from her blood test earlier (she had CMV detected after transplant and got treated and subsided). Can CMV be a cause of her her pericardial effusion? She is now treated for CMV again. Is CMV difficult to treat and easily recurs?
Any further advice?We are frustrated.Thanks much
Brief Answer:
Not necessarily fatal
Detailed Answer:
Secondary platelet failure is difficult to manage but not necessarily fatal. It may improve again over time. CMV itself is a cause for low platelets. CMV can relapse and is difficult to treat. It can cause pericardial effusion too. Lot depends upon the fluid testing.
If ganciclovir for CMV doesn't work, we need to consider foscarnet or CMV immune globulin.
Not necessarily fatal
Detailed Answer:
Secondary platelet failure is difficult to manage but not necessarily fatal. It may improve again over time. CMV itself is a cause for low platelets. CMV can relapse and is difficult to treat. It can cause pericardial effusion too. Lot depends upon the fluid testing.
If ganciclovir for CMV doesn't work, we need to consider foscarnet or CMV immune globulin.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Not necessarily fatal
Detailed Answer:
Secondary platelet failure is difficult to manage but not necessarily fatal. It may improve again over time. CMV itself is a cause for low platelets. CMV can relapse and is difficult to treat. It can cause pericardial effusion too. Lot depends upon the fluid testing.
If ganciclovir for CMV doesn't work, we need to consider foscarnet or CMV immune globulin.
Not necessarily fatal
Detailed Answer:
Secondary platelet failure is difficult to manage but not necessarily fatal. It may improve again over time. CMV itself is a cause for low platelets. CMV can relapse and is difficult to treat. It can cause pericardial effusion too. Lot depends upon the fluid testing.
If ganciclovir for CMV doesn't work, we need to consider foscarnet or CMV immune globulin.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks Dr XXXXXXX My become ‘ neutrophil has hmsharply dropped to below 1. just 0.7. Platelet drops to 6k, hemoglobin also decline quickly. need platelet and rbc transfusion twice a week. Dr said may be engraftment failure, mentioned 2nd transplant lightly We are so sacred. My niece is so terrified by 1st transplant experience, because her conditions are even worse than before transplant, more frequent transfusion and with complications like heart issue and hypertension, very tired, Dr XXXXXXX what else can be done to help? We are so so so desparate.
thanks Dr XXXXXXX My become ‘ neutrophil has hmsharply dropped to below 1. just 0.7. Platelet drops to 6k, hemoglobin also decline quickly. need platelet and rbc transfusion twice a week. Dr said may be engraftment failure, mentioned 2nd transplant lightly We are so sacred. My niece is so terrified by 1st transplant experience, because her conditions are even worse than before transplant, more frequent transfusion and with complications like heart issue and hypertension, very tired, Dr XXXXXXX what else can be done to help? We are so so so desparate.
Brief Answer:
Probably seocnd transplant is teh answer
Detailed Answer:
I understand your concerns.
This definitely looks like secondary engraftment failure which is challenging to manage.
Second transplant helps in few cases but not all. Not all patients survive the second transplant as well.
But I don't think any other option is left.
Regards
Probably seocnd transplant is teh answer
Detailed Answer:
I understand your concerns.
This definitely looks like secondary engraftment failure which is challenging to manage.
Second transplant helps in few cases but not all. Not all patients survive the second transplant as well.
But I don't think any other option is left.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Probably seocnd transplant is teh answer
Detailed Answer:
I understand your concerns.
This definitely looks like secondary engraftment failure which is challenging to manage.
Second transplant helps in few cases but not all. Not all patients survive the second transplant as well.
But I don't think any other option is left.
Regards
Probably seocnd transplant is teh answer
Detailed Answer:
I understand your concerns.
This definitely looks like secondary engraftment failure which is challenging to manage.
Second transplant helps in few cases but not all. Not all patients survive the second transplant as well.
But I don't think any other option is left.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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