Rejection can sometimes be stopped by making changes to the immune-suppression medica- tions. • Graft-versus-host disease is a process during which the new bone marrow recognizes the child’s body as foreign and attacks certain organ systems, such as the skin, gut, and liver. Symptoms include rash, nausea, vomiting, diarrhea, decreased appetite, and increased liver function tests. • Infections develop as a result of the chemotherapy regimen and immune suppression. Children are at high risk of developing infections. Infections can be caused by bacteria, viruses (often as a result of reactivation of viruses that are already living in the body), fungi, or other organisms. • Toxicity or damage to organs: Multiple organs in the body can be affected. The organ and the extent of damage are dependent on the type of HSCT the child has received as well as the com- plications he or she has experienced. Additional written materials specifically addressing HSCT will be provided if a transplant is recommended for your child.
n SUPPORTIVE CARE
Venous Access Device A venous access device (VAD), sometimes called a central line, is an IV catheter that may be used for the duration of your child’s therapy. There are different types of VAD. Your child’s healthcare team will discuss the risks and benefits of the different types. The VAD is inserted surgically when your child is under sedation or general anesthesia. A VAD can be used to administer medication, blood products, IV fluids, or nutritional support when needed. It also may be used to draw blood for testing purposes. The VAD may remain in your child for the duration of treatment and will be removed during surgery when it is no longer needed. Blood Product Transfusion RBCs are the cells that carry oxygen to different parts of the body. When a child’s hemoglobin is low, his or her heart has to work harder to pump blood. Children with a low hemoglobin level often feel tired (es- pecially with activity), have headaches, and may feel nauseated. Your child may receive an RBC transfusion to increase hemoglobin in the body and to ease the work of the heart by carrying oxygen to all parts of the body. This also may help him or her feel better. Packed RBC transfusions consist of blood donated by healthy people. The blood is stored in a bag and infused into the child through his or her IV access, such as a VAD. Blood transfusion risks include allergic reactions such as itching, hives, or difficulty breathing. Your child will be monitored for a reaction very closely by the nurse. Platelets are the parts of the blood system that prevent and stop bleeding. Children who have a low platelet count are at increased risk of bleeding. They may have bruising, gum bleeding, or little red spots on their skin called petechiae. Platelets can be infused to temporarily increase the platelet count. The platelet transfusion process is similar to an RBC transfusion. The reaction risks are the same, and your child will be monitored closely during the platelet transfusion. Although transfusions of blood and platelets may be necessary to help prevent serious complications,
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