Bone marrow transplant follow up protocol
| BMD, bone marrow density; BMI, body mass index; DEXA, dual energy x ray absorptiometry; ECG, electrocardiogram; FS, fractional shortening; FSH, follicle stimulating hormone; GTT, glucose tolerance test; LH, luteinising hormone; LV, left ventricle; MRI, magnetic resonance imaging; PTH, parathyroid hormone; TSH, thyroid stimulating hormone; USS, ultrasound scanning. | |
| Auxology including sitting height | 3–6 monthly |
| Plot BMI | |
| Bone age | Annually |
| Discussion points | Schooling/employment—statementing? |
| Psychology assessment | |
| Weight | |
| Diarrhoea? | |
| Eyes and mouth—?Sicca syndrome | |
| (Consider faecal elastase/trial of Creon if loose stools/poor weight gain) | |
| Hip pain/knee pain: consider MRI—?osteonecrosis | |
| Fertility—if relevant/appropriate age | |
| Special points on examination | Pubertal assessment at each visit (testicular volume not a useful indicator of pubertal progression) |
| Palpation of thyroid | |
| Check moles | |
| Neurological examination | |
| Fundoscopy (cataracts) | |
| Blood pressure | |
| Echocardiogram | All patients who have had anthracyclines |
| Echocardiogram at end of treatment | |
| (Request FS, LV function, septal motility) | |
| ECG annually (QT interval) | |
| 3 yearly if FS ⩾30%, annually if <30% | |
| Growth hormone status | Evaluate if persistent poor growth |
| Glucose:insulin ratio | Annually—as increased risk of metabolic syndrome |
| GTT if abnormal | |
| Lipids | Fasting lipids annually |
| Thyroid function | T4 and TSH annually |
| Replace thyroxine if TSH persistently elevated | |
| Gonadotrophins | LH, FSH, oestradiol/testosterone annually after 10 years of age |
| Consider pelvic USS in females; uterine size, endometrial thickness, Doppler studies | |
| Semen studies in males as requested by patient | |
| Ovarian failure may be reversible—trial off oestrogen for 6–8 weeks every 2 years recommended | |
| Evaluation of BMD | Annual PTH and vitamin D |
| DEXA at 2 years, then 3 yearly if concern (must correct for size) | |