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How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients

Authors
  • Zinter, Matt S.1
  • Dvorak, Christopher C.2
  • Auletta, Jeffery J.3, 4
  • 1 Division of Critical Care Medicine, UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA , (United States)
  • 2 Division of Allergy, Immunology, and Blood and Marrow Transplantation, UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA , (United States)
  • 3 Division of Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children’s Hospital, Columbus, OH , (United States)
  • 4 Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, OH , (United States)
Type
Published Article
Journal
Frontiers in Oncology
Publisher
Frontiers Media SA
Publication Date
Sep 16, 2020
Volume
10
Identifiers
DOI: 10.3389/fonc.2020.581447
PMID: 33042850
PMCID: PMC7526343
Source
PubMed Central
Keywords
License
Unknown

Abstract

Pediatric allogeneic hematopoietic cell transplant (HCT) survival is limited by the development of post-transplant infections. In this overview, we discuss a clinical approach to the prompt recognition and treatment of fever and hypotension in pediatric HCT patients. Special attention is paid to individualized hemodynamic resuscitation, thorough diagnostic testing, novel anti-pathogen therapies, and the multimodal support required for recovery. We present three case vignettes that illustrate the complexities of post-HCT sepsis and highlight best practices that contribute to optimal transplant survival in children.

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