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) | |