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PATIENT FLOW

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by

Terri Tallmadge

on 11 October 2011

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Transcript of PATIENT FLOW

STEM CELL TRANSPLANT TRANSPLANT PATIENT PATHWAY HPC PRODUCT PROCESSING Patient diagnosis Consultation Candidate? Treatment Plan Team approach
Weekly review Minimize disease Chemotherapy
Radiation
Surgery
All or any Collect auto's Partial ablation-'Rescue'
Myeloablation Collect Allo's Normal donor
Fresh-24 hrs Matched unrelated (50%) Fresh-72 hours *
Frozen-Cord Blood match Transplant Cell dose by protocol
Global coordination
Fresh vs. Frozen
Counts down then up Engraftment
Growth hormone day 8
Trilineage
White cells-WBC *
Red cells-RBC
Platelets-PLTs *
Stem cells CD34+ Discharge
Oral meds
Mobility Continued care Outpatient
Inpatient
Less Frequent
Molecular -VNTR TRANSPLANT PATIENT
PATHWAY STEM CELL
TRANSPLANT HPC PRODUCT
PROCESSING YOUR ROLE IN SUPPORTING THE
CELL THERAPY LABORATORY AUTOLOGOUS ALLOGENEIC APHERESIS PROCEDURES UNIT PATIENT FLOORS Donor Highly skilled RN and Patient Care staff
Prepare donor
Ensure ability to donate
Obtain veinous access *
Hook up to Cobe Spectra
Adjust collection
Monitor symptoms
Deliver patient samples
-WBC, CD34, Infectious Disease,
other labs as needed for patient
care
Sometimes wait for counts
-WBC 5 k/mm3
-hope for 10 CD34/ul Verify ID
Connect set up
Measure volume
Pull off WBC,
and Culture <70ml
>70 ml
Centrifuge
Express plasma
Pull off WBC, CD34
(WBC will be HIGH**)
QC check

Verify ID
Connect set up
Measure volume
Pull off WBC, CD34,
Culture and Gram Stain
**MUD Determine cell dose
WBCxCD34+% /kg wt.
Split by protocol
Spin and freeze extra
Pull off culture
if add freezing solution
Patient waiting for transplant Apheresis collection Fresh - for Allogeneic
-hangs like blood
Frozen thawed - for Autologous
(or allo's that weren't ready)
Cell therapy staff thaws at bedside
Educate patient families APHERESIS
COLLECTION OBJECTIVE
SUMMARY Symptoms
Primary care Diagnose
Refer for treatment Local Heme/Onc specialist Diagnose
Traditional treatments
Referal to U of M Hematopoetic Progenitor Cell Therapy Apheresis -collected peripherally *
Cord Blood -frozen after birth
Bone Marrow- aspiration Lymphoma, Multiple Myeloma, Leukemia, Hodgkins, Non-Hodgkins, Myelodysplastic Syndrome (MDS), Aplastic Anemia Also non-malignant Sickle Cell, BThalasemia, Scleroderma Able to minimize disease?
Able to handle treatment?
Educate Stronger therapy
Replace marrow afterward Consent RN Coordinators
Team Doctors, NP's, PA's
HPC Supervisor/Level III Tech
Social Workers Determine Auto or Allo Auto MM, Hodgkins, etc.
Allo AML, CML, etc. Allo provides GVL/GVT Find relative HLA match
Goal 8/8 antigen
Start unrelated search
NMDP *
Constant updates Up to 50 fold increase Growth hormones Neupogen (G-CSF) Poor mobilization 20% Add Mozobil (AMD3100)
May need Allogeneic Auto partial
Allo complete *
Neutropenia
Fever
Infection
Bleeding Inpatient Controlled exposure
Lots of lab samples No chemo *
Only Growth hormones
Related Apheresis Urgent need Residual chemo
Donor cells 'seed' marrow
Proliferate Initial due to HPC's (2-4 wks)
Sustained due to HSC's ANC = WBC x Neutrophils
3 days at >500 GVHD Delay discharge
Pain, bleeding
Higher risk in
-MUD
-<8/8 HLA match % recipient
% donor CELLULAR THERAPY LAB Five Specialized CLS
Perform all processing
cell calculations,
communication,
documentation,
marrow procurement,
transplanting
maintaining equipment


Split into bags depending on WBC *

Add freezing solution SLOWLY
20 ml Normosol
10 ml DMSO
Pull off Culture and Gram Stain
Place in step down freezer
Store in LN2 indefinitely Pull off CD34 *
Calculate CD34 dose:

WBCxCD34+% /kg wt. RN's, PA's, NP's, occ Dr.'s TRANSPLANT GOALS Minimum of 2 CD34/kg
Auto-2 doses of 3 CD34/kg
Allo-5-8 CD34/kg
Best GVL w/least GVHD CELLULAR THERAPY
LABORATORY

HPC LAB Data
management
&
Communication
70% Quality
&
Maintenance
10% Processing
&
Transplants
20%
Equipment
Clean Room
Maintain Inventory
Control Process all
OR collect
Cell doses
Thawing
Patient
Family

Self review
Engraftment
IDM results


Freezing
Storage
100s
BMT Team
Aperesis
Couriers
Labs NMDP
Databases
Research FDA
FACT
AABB
+ FOR
PRODUCTS

Molecular Microbiology
Hematology Blood bank
For
INPATIENTS ADD-
Phlebotomy
Specimen Processing
Chemistry Anatomic pathology
Pathology Data, Supervisors, HO's, Medical Director's, and Support staff
Etc... Usually off chemo Replenish with own cells
Less tumor/disease Cell counts 3 wks, 6 wks, 8 wks
Full transcript