Case of the Month #24 - respiratory failure

Published 01/02/2022

What are the complications after Bone Marrow Transplant?

Immediate complications:
Transfusion reaction, drug error, complications associated with intravenous access

Early complications2:
Infections: In the 30 days following BMT, bacterial infections secondary to neutropenia and intravenous catheters are common. 30-100 days after transplant, cell mediated immunity and viral and fungal infections such as CMF, pneumocystis pneumonia, and aspergillus can occur. >100 days after transplant, viral infections and mycobacterium infection can occur due to an impaired cell mediated and humoral immunity. Other early complications include acute graft versus host disease (GVHD), haemorrhage, graft failure, haemorrhagic cystitis, interstitial pneumonitis, among others.

Late complications: 2
Infections, chronic GVHD, chronic pulmonary disease, autoimmune disorders, cataract, infertility, and second malignancies can occur.

On assessment on the ward, the patient has a respiratory rate of 42 breaths per minute, heart rate of 103, blood pressure of 108/52, saturations of 92% on 15L/min oxygen via non-rebreathe mask, and a temperature of 38.2°C. He has deteriorated steadily over the last 7 days, but his oxygen requirement has rapidly deteriorated in the last 24 hours. He is orientated, alert, but struggling to speak in full sentences. On examination, he is warm peripherally with a capillary refill time of less than <2 seconds. CXR is awaited. Blood results are unremarkable; white cell count and CRP are normal. The patient is not neutropenic.