The first major milestone towards bone marrow stem cell engraftment occurs when your child’s ANC (absolute neutrophil count) is greater than 500 for three consecutive days.  Along with this increase in neutrophil count comes your child’s ability to fight bacterial and fungal infections.

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Until you/your child’s immune function completely recovers, one of the major concerns after bone marrow stem cell transplant is infection.  It takes approximately 6-12 months and sometimes longer for the other types of white blood cells (T and B lymphocytes) to increase in number and fight infections.  The time frame varies with the type of transplant performed and from individual to individual.

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The T-cells help fight fungal and viral infections.  The B-cells make antibodies, which also help the body fight infections. T lymphocyte recovery occurs before B-cell recovery. Until T-cell recovery occurs, your child will have to take several precautions in order to decrease his/her chance of potential infections. This includes the use of several medications such as Septra and Acyclovir.  A monthly immunoglobulin infusion may be used to provide functioning antibody until the B-cells can start working correctly.

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These precautions help decrease the risk of potentially fatal infections, while maintaining a normal family lifestyle.  In spite of all these precautions, infections may develop or exposure may occur which are beyond anyone’s control. The goal of these precautions is to minimize occurrence of infection.  In general, once the T-cells grow back and are functioning properly, any isolation precautions may be stopped, your child may return to work/school, stop taking the preventative medications and resume a normal life.

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There are several general precautions you should take to decrease your child’s risk of being exposed to potential infections.  An important question that you may have is “with whom can my child have contact?”

 

Here are some general guidelines your physician may have:

• Avoid Crowds

• Enclosed shopping centers

• Grocery Stores

• School

• Church and other enclosed gatherings

• Movie Theaters

• Restaurants

• Parties

• Airplanes

 

Avoid contact with visitors and friends who are or have been recently ill.  Screen all visitors for:

• Runny noses.

• Cold sores.

• Sore throat.

• Diarrhea.

• Vomiting.

• Fever.

• Rashes.

• Red or runny eyes (conjunctivitis or “pink eye”).

• Chicken pox exposure.

• Any other symptoms that lead you to believe the visitor may be ill.

Screen all visitors, especially children.  Your child will not be required to wear a mask at home or around screened visitors, however, it may be recommended that a mask be worn:

• When visiting the hospital or clinic for follow-up care (crowded halls, elevators, known ill people).

• Unavoidable crowded situation.  (It is a good idea to have a mask available at all times).

• Around construction sites, fields being farmed, anywhere dust or dirt is being kicked up into the air or when it is very windy.

 

If a family member becomes ill, he/she should limit contact with your child until they recover from the illness.  It is not necessary for the ill family member to stay away from the home. If a family member is exposed to chicken pox, TB (tuberculosis), herpes, hepatitis, please contact your doctor immediately.

GOOD HAND WASHING: Good hand washing is the best way to prevent the spread of infections.  You should supervise and teach all of your children how to wash their hands after using the toilet, after playing with toys or pets and especially before eating.  If you have a baby, you must wash your hands after handling diapers.  It is a good idea to have family/friends follow these hand washing guidelines:

• Use paper towels at sinks instead of hand towels

• Use pump antibacterial soap

• Carry waterless soap with you for hand washing where a sink is not available

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TEMPERATURE TAKING: Take your child’s temperature if you feel your child is listless, warm, irritable, chilled or not acting like his/herself.  Do not routinely take a temperature unless your child has symptoms.   NO RECTAL TEMPERATURES SHOULD BE DONE.  Observe for any signs/symptoms of infection.

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SCHOOL: Your child will likely not attend school for approximately 6 months or longer.  A home tutor may be arranged following discharge from the hospital so that he/she will not fall behind in school. An Education Specialist or school teacher can help to arrange for a home tutor. 

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PETS:  Animals presently in the house are usually allowed to stay.  Do not introduce any new pets into the home until your child is off isolation.  Attempt to prevent your pet from licking your child’s face and teach your child not to kiss the pet.  Do not allow your child to come in contact with animal waste (i.e. litter box) or pet food/dish.  Remember to use good hand washing after handling the pet.  Ask your transplant team about their recommendations about pets. 

Finally, it is important to AVOID the following (until your transplant physician gives you permission):

• Lakes, beaches, oceans and swimming pools (swimming)

• Hot tubs

• Sandboxes and gardens (dirt) (playing)

• Woodchips/bark

• Construction sites

• Remodeling

• Open dirt fields

• Barns/farm animals

• Crowds/crowded areas

• Unnecessary personal contact (shaking hands, kissing)

• Second hand smoke – no one should be allowed to smoke anywhere inside the house whether or not your child is present.

 

MOUTH CARE: Good oral hygiene continues to be important for your child’s care after the bone marrow stem cell transplant.  Keeping your child’s teeth, mouth and gums clean is essential to protect him/her from tooth decay and infection.  After discharge from the hospital your child should brush his/her teeth with a soft bristle toothbrush after meals and at bedtime.  Notify your doctor is you notice sores, reddened areas, any white patches or bleeding in your child’s mouth or on the lips. IMPORTANT: If your child requires dental work while he/she has a central line, they may need an additional antibiotic to protect them against infection.   Please discuss this with your doctor and dentist.

 

SKIN: Your child may use regular soap and water to take baths. Your child should bath daily.

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Your child can be outdoors following discharge from the hospital.  Activities can range from taking walks to playing in the park (providing platelets are at a safe level - see low platelet precautions).Excessive sun exposure is not good for anyone and in particular for someone who has received chemotherapy or TBI.  Help your child develop a lifelong habit of minimizing sun exposure.  Always make sure that your child covers his/her head with a hat and wears sunscreen (SPF 30) when out in the sun.  If swimming, you must reapply sunscreen often. 

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The skin is also very sensitive to heat, cold and wind.  It may be easier to be overheated, very cold or get wind burns after a bone marrow stem cell transplant.  Special care should be taken to make sure your child is properly dressed for the weather.

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Lotion should be applied immediately after your child’s bath daily.  Hypoallergenic lotions (unscented) such as Lubriderm or Eucerin will work best.

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ACTIVITY: It is important for your child to return to exercise/play once they have been discharged.  However, they should avoid contact sports or activities that can cause bleeding until their platelets are greater than 100,000 or your transplant team has given you permission.

Low platelet precautions: (platelet count < 100,000)

 

• High impacts (jump off couch, curb ECT…)

• Contact sports

• Weight lifting

• Mopeds, ATV, motorcycles, go-carts

• Bicycle

• Skiing

• Skating or roller blades

• You and your child should always wear a seat belt when riding in the car.  Children should be in a car seat through age 4 years (40 lbs.) and a booster seat through age 8 or (80 lbs.)

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IMMUNIZATIONS: Your child will not receive any childhood vaccines until his/her immune system is recovered.  The bone marrow transplant team will keep you informed as to when it is safe to resume vaccinations.  No live vaccines should be given until cleared with your transplant team.