Transcript Pre-HSCT counseling of patients, related donors and their families Jay Suriar Hospital Ampang.

Pre-HSCT counseling of patients,
related donors and their families
Jay Suriar
Hospital Ampang
Outline
• Patient counseling
• Donor counseling
• Family counseling
Patient counseling
• Information gathering – clinical, education,
resources
• Assessment of acceptance of transplant
option
• Information giving
• Checking understanding
Information giving
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What is a transplant?
What are the types of transplant?
Which type is required for you?
What is the transplant procedure?
What happens in the immediate and late
post transplant period?
• What are the problems that arise during
each period?
Information giving
• What are the long term problems that may
arise?
• What are the chances of : curing the
disease? Controlling the disease for a
period of time? Serious complications
during and after the transplant?
• What are you options if you do not choose
to have a transplant? How effective are
they?
TRM and Survival
(Hospital Ampang; 1999 – 2009)
• Autologous
1.5% TRM
• Allogeneic
10% TRM
Ong TC, unpublished data, 2009
Information giving
• Lifestyle adjustments in the post transplant
period
• Fertility and fertility preservation options
• Sexual function
• Financial considerations, employment
Counseling the related donor
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Information gathering
Assessment of acceptance
Information giving
Checking understanding
Information giving
• Cytokine administration is safe with minor
side effects and extremely uncommon
serious side effects
• Serious SE 0.01% - splenic rupture
• Vascular events – MI, CVA – uncertain
relationship to donation procedure
Information giving – other issues
• vascular access complications
• post apheresis thrombocytopenia
• Avoidance of contact sports and air travel
for 1 week
• Future collection of other cell fractions
• Follow up
Counseling the family
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Caregiver issues
Dietary advice
Unconventional therapies
Financial considerations
Survivorship
Conflict of interest where donor is
underaged