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Transitioning from Inpatient to Outpatient Post Transplant

When you first leave the hospital after your transplant, there is often a great sense of nervousness, anticipation, fear, and even excitement. You have spent several weeks becoming a transplant recipient, learning the day-to-day routine of blood tests, observations and medications.
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However, the prospect of going home on your own can be very daunting. Our staff and doctors will ensure that you leave the hospital with instructions on what to do if you become unwell. Remember that although you are going home, and an essential part of the transplant process is complete, there are still many months of recovery ahead of you.
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Overview          Follow Up Expectations          Reasons for Readmission         FAQs

What to expect during follow up

Close monitoring and observation following a transplant are usually required. Part of this monitoring involves regular blood tests as well as medical reviews. Several other tests will be performed to assess the outcome of your transplant. The frequency of these appointments depends on the time since your transplant and how you are managing and progressing.
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Initially, you will see the doctor twice a week and have blood tests performed each time. If your doctor is concerned about your progress, you may need to increase the frequency of your visits for additional monitoring or treatment.
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Frequent and repetitive visits to the hospital for tests can become tiresome, especially during the first few weeks. The frequency of your visits will be continually reviewed and kept to a minimum where possible. Should other problems develop, you may need to see other specialists. Regular and continuous monitoring allows doctors to identify and treat any new issues promptly.
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Transfusions
Some patients continue to need blood and platelet transfusions after they go home. Irradiated blood products are necessary for recipients of donor transplants for at least the first year post-transplant. Irradiated blood is blood that has been treated with radiation (by x-rays or other forms of radioactivity) to prevent Transfusion-Associated Graft-versus-Host Disease (TA-GvHD).
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Readmission to Hospital
Keep in mind that readmission to the hospital after a transplant is not an uncommon occurrence. There are various reasons for readmission, and they range from being straightforward to more complex. The length of your stay during readmission depends on the problem being treated.
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Some common reasons for readmission are:

Infections

The types of infections mentioned below are a common reason for readmission following a transplant.
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Viral Infections
Cytomegalovirus (CMV) is a virus detected by blood tests and can be present with, or without, any symptoms. CMV can cause infection almost anywhere in your body. When your immune system is weak, exposure to or reactivation of CMV can be severe and even life-threatening in some cases.
.

Fortunately, significant progress has been made in preventing CMV infections, especially in patients who carry or are at risk of reactivating the virus. Here at CFCH, we carry out weekly blood tests for CMV as this virus can be detected at minimal levels. Early treatment of the CMV virus while it is still at low blood levels usually allows for the clearance of the infection without any progression to organ involvement.
.

Most CMV reactivations happen during the first few months after the transplant; however, it can happen later on. Patients may experience repeated reactivations and may require treatment on and off for several months.
.

Some viruses can present as a common cold or flu and cause inflammation of the airways or lead to pneumonia. It is essential to contact the clinic if you develop any of these symptoms. We will inform you if you need to have any tests done.
.

A standard test is a nose and throat swab that is taken to detect the presence of respiratory viruses. These viruses may cause a runny nose or sore throat. Treatment for these viruses vary and depend on which, if any, are detected.
.

BK virus, which usually causes cystitis or the inflammation of the wall of the bladder, can be problematic after transplant. This inflammation can result in painful, frequent urination, and blood in the urine. Urine testing in a laboratory is used to identify this virus. If the symptoms and discomfort remain or worsen, our doctors request that you see another specialist.
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Bacterial infections 
Bacterial infections are a common reason for readmission after a transplant. One of the most common bacterial infections can come from the Hickman line or PICC lines. These infections are often associated with chills or fever.
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Bacterial infections can very quickly make you very unwell. It is vital that you contact our transplant team immediately if you have a temperature above 38˚C, or if you feel ill even without a temperature. Your body’s ability to develop a temperature may be compromised by drugs such as steroids or paracetamol.
.

Fungal infections
Fungal infections may arise when blood counts are low following a transplant. These infections usually occur in the chest or sinuses but may be present elsewhere. Fungal infections cannot be adequately diagnosed on a standard X-ray.
.

If our doctor suspects a fungal infection, they might arrange for you to have a CT scan. Fungal infections can appear later even after the blood counts have recovered in some patients.
.

Most patients are given preventative medication after being discharged to reduce the risk of fungal infections. Typically, patients will stop this medication a few months after the transplant. Patients who have GVHD, or need to continue immuno-suppression, remain at risk of fungal infections. They may need to continue with the medication for longer.
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Kidney Problems

After your transplant, the function of your kidneys will be monitored. A blood test and weight check will be done at least once a week. Your kidneys perform several vital jobs such as regulating calcium, water and other necessary substances while removing waste from the body.
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There are several reasons why the function of the kidneys can become abnormal. It can be related to your medication, an infection or dehydration. Mild kidney problems are common, but you may be admitted for treatment until your blood levels become healthy again.
.

Occasionally, the kidneys can become damaged and may not work properly, and you may need additional visits to the hospital for monitoring.
.

Liver problems
The function of the liver needs to be monitored after your transplant. There are several reasons why liver function might become abnormal such as your medication, an infection, graft versus host disease (GVHD) or veno-occlusive disease (VOD).
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VOD is a disease where the blood flow through the small veins of the liver is partially blocked. VOD causes symptoms such as jaundice (yellowing of skin or eyes), swelling or distension of the abdomen and fluid accumulation, and it can be life-threatening.
.

VOD usually occurs during the first few weeks after the transplant. In some cases, it can happen later and is more common in patients who have had very high doses of chemotherapy for their transplant. While typically mild, VOD can be a severe problem, and treatment seeks to minimise its effects.
.

Treatments for VOD are available and have improved the outcome for patients suffering from it, making the life-threatening disease rarer than it used to be. Recovery is aided by the liver’s amazing ability to recover and regenerate from the effects of such diseases.
.

Nausea and Vomiting

It is not unusual for nausea with or without vomiting to persist for several weeks or months after the transplant. There are several possible causes for this which might include infections and GVHD. As nausea can affect your appetite and diet, it is essential to discuss this with our team so that they investigate and treat appropriately.
.

Diarrhoea

Diarrhoea can occur after the transplant and when persistent, it can cause significant weight loss and malnutrition. There are several potential causes, and the diarrhoea may be caused by more than one problem simultaneously. You should let our team know if you have new and persistent diarrhoea so that they can take appropriate and prompt action.
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Bleeding

You may still need to have platelet transfusions after going home. You should contact our transplant team if you develop any new bruising, bleeding (e.g. blood in your urine or stools), or a persistent nosebleed.
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Although bleeding can occur later on after your transplant, this is generally not considered to be normal and must be reported to our team immediately so that they can investigate the cause. There can be many possible reasons for bleeding.
.

The bleeding does not mean that the transplant has not worked, and it is usually necessary to make many adjustments to your treatment as you progress through your recovery.
.

Thrombotic thrombocytopenic purpura (TTP)
Thrombotic thrombocytopenic purpura (TTP) is a rare condition which can happen after a transplant. Small clots develop within the circulation and cause platelets to be used up, resulting in a low platelet count or thrombocytopenia.
.

The exact cause of TTP is uncertain; however, it is thought to involve a protein in the blood called von Willebrand factor (vWF) which malfunctions and becomes sticky. The platelets may clump together, particularly in the small vessels supplying the brain and the kidney.
.

Some drugs, such as cyclosporin, are linked to TTP, although very few patients who take this drug develop this problem. TTP is also associated with certain infections and total body irradiation (TBI) treatment. The symptoms related to TTP include fever, headaches as well as diarrhoea and easy bruising. High blood pressure may also develop if the vessels of the kidney become affected. Our doctors may review all your medications and choose to stop cyclosporin.
.

Hickman/PICC line removal
The Hickman/PICC line is a potential source of infection at any stage of your treatment. Your Hickman/PICC line will usually be removed once it is no longer required, or if it becomes infected after the transplant. Removing the line is a simple procedure and is generally done in the clinic.
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Medication
You will need to continue with your prescribed medicines, including creams, lotions and mouthwashes, until our team advises otherwise. You will need to continue taking some of the medication for at least a year. Certain drugs, such as antifungal and antiviral drugs, which help to protect you from infections, need to be taken for even longer.
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You may still need to continue taking immunosuppressive drugs such as tacrolimus. You must remember that these drugs should be taken regularly and as instructed. Their levels need to be monitored so that you benefit with minimal side effects. If the drug level is too low, the drug will not work properly. If the level is too high, it can damage the kidneys or cause more infections.
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Remember that although you are being sent home from the hospital, you are still on the road to recovery. Our transplant team will be with you through this journey to support you and help you manage your recovery.
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FAQs

View All FAQs
 What is the recovery period for a bone marrow transplant?
Read more

 How long are you in the hospital for a bone marrow transplant?
Read more

 What are the possible complications of a stem cell transplant?
Read more

 Can stem cell transplant patients have visitors?
Read more

 When can you go back to work after a stem cell transplant?
Read more

 What are the long-term side effects of a bone marrow transplant?
Read more

 Can you live a normal life after a stem cell transplant?
Read more

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Cytomegalovirus (CMV)
Cytomegalovirus (CMV) is a virus detected by blood tests and can be present with, or without, any symptoms. CMV can cause infection almost anywhere in your body. When your immune system is weak, exposure to or reactivation of CMV can be severe and even life-threatening in some cases.
.

Fortunately, significant progress has been made in preventing CMV infections, especially in patients who carry or are at risk of reactivating the virus. Here at CFCH, we carry out weekly blood tests for CMV as this virus can be detected at minimal levels. Early treatment of the CMV virus while it is still at low blood levels usually allows for the clearance of the infection without any progression to organ involvement.
.

Most CMV reactivations happen during the first few months after the transplant; however, it can happen later on. Patients may experience repeated reactivations and may require treatment on and off for several months.
.

Some viruses can present as a common cold or flu and cause inflammation of the airways or lead to pneumonia. It is essential to contact the clinic if you develop any of these symptoms. We will inform you if you need to have any tests done.
.

A standard test is a nose and throat swab that is taken to detect the presence of respiratory viruses. These viruses may cause a runny nose or sore throat. Treatment for these viruses vary and depend on which, if any, are detected.
.

BK virus, which usually causes cystitis or the inflammation of the wall of the bladder, can be problematic after transplant. This inflammation can result in painful, frequent urination, and blood in the urine. Urine testing in a laboratory is used to identify this virus. If the symptoms and discomfort remain or worsen, our doctors request that you see another specialist.

Bacterial infections are a common reason for readmission after a transplant. One of the most common bacterial infections can come from the Hickman line or PICC lines. These infections are often associated with chills or fever.
.

Bacterial infections can very quickly make you very unwell. It is vital that you contact our transplant team immediately if you have a temperature above 38˚C, or if you feel ill even without a temperature. Your body’s ability to develop a temperature may be compromised by drugs such as steroids or paracetamol.

Fungal infections may arise when blood counts are low following a transplant. These infections usually occur in the chest or sinuses but may be present elsewhere. Fungal infections cannot be adequately diagnosed on a standard X-ray.
.

If our doctor suspects a fungal infection, they might arrange for you to have a CT scan. Fungal infections can appear later even after the blood counts have recovered in some patients.
.

Most patients are given preventative medication after being discharged to reduce the risk of fungal infections. Typically, patients will stop this medication a few months after the transplant. Patients who have GVHD, or need to continue immuno-suppression, remain at risk of fungal infections. They may need to continue with the medication for longer.

After your transplant, the function of your kidneys will be monitored. A blood test and weight check will be done at least once a week. Your kidneys perform several vital jobs such as regulating calcium, water and other necessary substances while removing waste from the body.
.

There are several reasons why the function of the kidneys can become abnormal. It can be related to your medication, an infection or dehydration. Mild kidney problems are common, but you may be admitted for treatment until your blood levels become healthy again.
.

Occasionally, the kidneys can become damaged and may not work properly, and you may need additional visits to the hospital for monitoring.
.

The function of the liver needs to be monitored after your transplant. There are several reasons why liver function might become abnormal such as your medication, an infection, graft versus host disease (GVHD) or veno-occlusive disease (VOD).
.

VOD is a disease where the blood flow through the small veins of the liver is partially blocked. VOD causes symptoms such as jaundice (yellowing of skin or eyes), swelling or distension of the abdomen and fluid accumulation, and it can be life-threatening.
.

VOD usually occurs during the first few weeks after the transplant. In some cases, it can happen later and is more common in patients who have had very high doses of chemotherapy for their transplant. While typically mild, VOD can be a severe problem, and treatment seeks to minimise its effects.
.

Treatments for VOD are available and have improved the outcome for patients suffering from it, making the life-threatening disease rarer than it used to be. Recovery is aided by the liver’s amazing ability to recover and regenerate from the effects of such diseases.
.

It is not unusual for nausea with or without vomiting to persist for several weeks or months after the transplant. There are several possible causes for this which might include infections and GVHD. As nausea can affect your appetite and diet, it is essential to discuss this with our team so that they investigate and treat appropriately.
.

Diarrhoea can occur after the transplant and when persistent, it can cause significant weight loss and malnutrition. There are several potential causes, and the diarrhoea may be caused by more than one problem simultaneously. You should let our team know if you have new and persistent diarrhoea so that they can take appropriate and prompt action.

You may still need to have platelet transfusions after going home. You should contact our transplant team if you develop any new bruising, bleeding (e.g. blood in your urine or stools), or a persistent nosebleed.
.

Although bleeding can occur later on after your transplant, this is generally not considered to be normal and must be reported to our team immediately so that they can investigate the cause. There can be many possible reasons for bleeding.
.

The bleeding does not mean that the transplant has not worked, and it is usually necessary to make many adjustments to your treatment as you progress through your recovery.
.

Thrombotic thrombocytopenic purpura (TTP)
Thrombotic thrombocytopenic purpura (TTP) is a rare condition which can happen after a transplant. Small clots develop within the circulation and cause platelets to be used up, resulting in a low platelet count or thrombocytopenia.
.

The exact cause of TTP is uncertain; however, it is thought to involve a protein in the blood called von Willebrand factor (vWF) which malfunctions and becomes sticky. The platelets may clump together, particularly in the small vessels supplying the brain and the kidney.
.

Some drugs, such as cyclosporin, are linked to TTP, although very few patients who take this drug develop this problem. TTP is also associated with certain infections and total body irradiation (TBI) treatment. The symptoms related to TTP include fever, headaches as well as diarrhoea and easy bruising. High blood pressure may also develop if the vessels of the kidney become affected. Our doctors may review all your medications and choose to stop cyclosporin.
.

The Hickman/PICC line is a potential source of infection at any stage of your treatment. Your Hickman/PICC line will usually be removed once it is no longer required, or if it becomes infected after the transplant. Removing the line is a simple procedure and is generally done in the clinic.

Locations

Contact

WhatsApp : +65 6256 8836
Email : contact@cfch.com.sg

.

Consultation Hours

Monday to Friday : 8.30am – 5.30pm
Saturday : 8.30am – 12.30pm
Closed on Sunday & Public Holidays

 

Find us On Facebook

Drop a Line

If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

© Centre for Clinical Haematology | 2021

    Contact Us

Locations

Contact

WhatsApp : +65 6256 8836
Email : contact@cfch.com.sg
.

Consultation Hours

Monday to Friday : 8.30am – 5.30pm
Saturday : 8.30am – 12.30pm
Closed on Sunday & Public Holidays
.

Find us on Facebook

Drop a Line

If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

© Centre for Clinical Haematology | 2021