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Dear Dr XXXXXXX Thanks For Your Earlier Advice Vide The
Question: Dear Dr XXXXXXX
Thanks for your earlier advice vide the thread. https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397658
Some update on my niece case who has done allogenic BMT in Oct.
Blood counts : -
After experiencing initial rise in neutrophils and platelets, she had sharp drop in neutrophils (to below 1) and platelets (to below 10k) in late Dec and early XXXXXXX
Our doctor reduce her medication then (Cellcept is stopped and clyclosporine is being tapered, now only 20 mg twice a day). Her neutrophils then improved a few days later and is now hovering around 3+ to 4+, platelets slightly risen to 20k+. She is now also experiencing hemolysis and require transfusion once every two to three days.
BMB in end Dec showed 100 % donor bone marrow.
She has on and off low grade fever for long, now still on antibiotics
Heart complication – non stop and large amount of pericardial effusion :-
But she is experiencing a severe and non-stop pericardial effusion. She has done pericardiocentesis twice and then pericardial window, but the fluid keeps coming out at a fast rate (around 400 – 500 ml each day), and so a tank is being connected to my niece’s chest for draining out the fluid. This complication made my niece have shortness of breath and is now on oxygen.
Already tested for virus/bacteria but no virus/bacteria detected. Also examined pericardium but no abnormality detected. Our team of doctors all have not seen such non-stop pericardial effusion before and said this is a very rare complication. They do not think it is GVHD, as they said it is not typical GVHD. They have consulted other specialist doctors like cardiologist and medicine but the doctors also have no idea and have not seen such conditions before. The doctors admit that they do not know how to treat since the cause is not known. They once suspected inflammation due to immune disorder and so prescribed steroid (daily 40 mg) for more than two weeks now, but no sign of improvement.
Dr said her hear complication is the imminent concern at the moment, but they do not have any good ideas on how to resolve it. Dr said he intended to give rituxan to treat hemolysis and hope (just can hope) that it could help her pericardial effusion. We are very very desperate. Dr XXXXXXX could you offer some advice /views ‘
Have you ever come across such (non stop cardiac effusion) post BMT complication before? Any reported cases worldwide?
Any idea on the possible causes and how to treat?
Could it be GVHD in your expert opinion? Although our team of doctors said GVHD of the heart is very rare, but given that no causes have been found, could GVHD be a possibility ? Any such reported case in your country of globally?
Any other advice/views do you have on my niece’s case? Hope your views can give some clues or inspire our doctors on how to take forward. My niece is facing an imminent risk to her life. We are so so devastated. Dr XXXXXXX please help. Many many thanks.
Thanks for your earlier advice vide the thread. https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397658
Some update on my niece case who has done allogenic BMT in Oct.
Blood counts : -
After experiencing initial rise in neutrophils and platelets, she had sharp drop in neutrophils (to below 1) and platelets (to below 10k) in late Dec and early XXXXXXX
Our doctor reduce her medication then (Cellcept is stopped and clyclosporine is being tapered, now only 20 mg twice a day). Her neutrophils then improved a few days later and is now hovering around 3+ to 4+, platelets slightly risen to 20k+. She is now also experiencing hemolysis and require transfusion once every two to three days.
BMB in end Dec showed 100 % donor bone marrow.
She has on and off low grade fever for long, now still on antibiotics
Heart complication – non stop and large amount of pericardial effusion :-
But she is experiencing a severe and non-stop pericardial effusion. She has done pericardiocentesis twice and then pericardial window, but the fluid keeps coming out at a fast rate (around 400 – 500 ml each day), and so a tank is being connected to my niece’s chest for draining out the fluid. This complication made my niece have shortness of breath and is now on oxygen.
Already tested for virus/bacteria but no virus/bacteria detected. Also examined pericardium but no abnormality detected. Our team of doctors all have not seen such non-stop pericardial effusion before and said this is a very rare complication. They do not think it is GVHD, as they said it is not typical GVHD. They have consulted other specialist doctors like cardiologist and medicine but the doctors also have no idea and have not seen such conditions before. The doctors admit that they do not know how to treat since the cause is not known. They once suspected inflammation due to immune disorder and so prescribed steroid (daily 40 mg) for more than two weeks now, but no sign of improvement.
Dr said her hear complication is the imminent concern at the moment, but they do not have any good ideas on how to resolve it. Dr said he intended to give rituxan to treat hemolysis and hope (just can hope) that it could help her pericardial effusion. We are very very desperate. Dr XXXXXXX could you offer some advice /views ‘
Have you ever come across such (non stop cardiac effusion) post BMT complication before? Any reported cases worldwide?
Any idea on the possible causes and how to treat?
Could it be GVHD in your expert opinion? Although our team of doctors said GVHD of the heart is very rare, but given that no causes have been found, could GVHD be a possibility ? Any such reported case in your country of globally?
Any other advice/views do you have on my niece’s case? Hope your views can give some clues or inspire our doctors on how to take forward. My niece is facing an imminent risk to her life. We are so so devastated. Dr XXXXXXX please help. Many many thanks.
Brief Answer:
pericardial effusion post BMT is often of obscure cause
Detailed Answer:
Hi
Thanks for following up.
Pericardial effusion in this setting, once the infective markers have come back negative, is very difficult to treat. Causes may be toxicity of conditioning regime, toxicity of cyclosporin, or GVHD.
Treatment includes diuretics (to increase urine flow), increasing immunosuppression (if GVHD likely) or decreasing immunosuppression (if cyclosporin is thought to be the cause). If patient is having GVHD at other sites, then GVHD becomes more likely.
As you can understand, it often depends upon clinical intuition of the the treating physician.
I don't think rituxan can control the effusion. But as we don't have anything else to offer, it can be tried.
I hope she gets better with it.
Regards
pericardial effusion post BMT is often of obscure cause
Detailed Answer:
Hi
Thanks for following up.
Pericardial effusion in this setting, once the infective markers have come back negative, is very difficult to treat. Causes may be toxicity of conditioning regime, toxicity of cyclosporin, or GVHD.
Treatment includes diuretics (to increase urine flow), increasing immunosuppression (if GVHD likely) or decreasing immunosuppression (if cyclosporin is thought to be the cause). If patient is having GVHD at other sites, then GVHD becomes more likely.
As you can understand, it often depends upon clinical intuition of the the treating physician.
I don't think rituxan can control the effusion. But as we don't have anything else to offer, it can be tried.
I hope she gets better with it.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX
Thanks for your advice. Have you come across or heard of such cases of pericardial effusion post BMT? Any cases of successful treatmet?
My niece's cyclosporine dosage has been tapering, but there is no sign of improvement. On the other hand, there seems no sign of GVHD at other sites. If its cause is toxicity of conditioning regime, how to treat?
We are indeed very worried.
Thanks for your advice. Have you come across or heard of such cases of pericardial effusion post BMT? Any cases of successful treatmet?
My niece's cyclosporine dosage has been tapering, but there is no sign of improvement. On the other hand, there seems no sign of GVHD at other sites. If its cause is toxicity of conditioning regime, how to treat?
We are indeed very worried.
Brief Answer:
Yes rarely
Detailed Answer:
This is a rare complication and difficult to treat. No clear guideline.
Conditioning toxicity doesn't have specific treatment. Steroids work sometimes.
In her case probably steroids failed, so not much options.
Rituxan can be tried.
Yes rarely
Detailed Answer:
This is a rare complication and difficult to treat. No clear guideline.
Conditioning toxicity doesn't have specific treatment. Steroids work sometimes.
In her case probably steroids failed, so not much options.
Rituxan can be tried.
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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