Your child will be discharged from the hospital when he or she has the following:
- An adequate absolute neutrophil count (ANC)
- No infection or fever
- Infrequent requirement for blood and platelet transfusions
Your child will need to have his or her nutritional needs met, either through intravenous fluids (TPN), nasogastric tube feeding and/or eating and drinking without supplementation.
The primary caregivers — usually the parents — will need to receive complete discharge teaching by the nursing, dietary and pharmacy team. This includes learning the following:
- How to care for the catheter
- Special isolation precautions
- Medication distribution
- Schedule of follow-up doctor visits
- How to meet the child's diet requirement
- Housekeeping precautions
- Other issues about care at home
Your child will not be discharged from the hospital until everyone is comfortable with the care at home.
Continued Monitoring for Infection
The risk of developing infections lasts for as long as six to 18 months following a bone marrow stem cell transplant. Your child will be followed closely by the transplant team along with his or her own doctor. Initially, blood will be drawn one to two times a week to monitor the recovering marrow and nutritional state, and the patient will be seen weekly by his or her doctor.
As your child's condition stabilizes, the visits will be extended to monthly for the first six months after transplant, then changed to every three months until two years after transplant, and eventually every six to 12 months thereafter. The exact schedule for each patient varies depending on the type of transplant and the patient's clinical situation. At regular intervals, blood will be drawn to evaluate the function of the new immune system and the degree of engraftment, or the percent of donor cells.
Monthly doses of gammaglobulin delivered through an IV and daily antibiotics to help prevent infections will be needed until the new marrow fully recovers. The special precautions at home, including the daily antibiotics, generally are necessary for the first three to six months after transplant. The monthly gammaglobulin is required for six to nine months and sometimes longer depending upon the type of transplant. Patients who develop graft-versus-host disease (GvHD) may require antibiotics and gammaglobulin for a longer period.
Each family will be given a detailed discharge handbook that will help with the teaching and serve as a reference at home.