After receiving bone mist of a fractionation, consisting of the removal of plasma and erythrocyte (autoeritromassa the next day reinfuziruetsa donor), in order to concentrate the bone marrow, which is used ex tempore Infusion for the recipient (with Altkm) or shorter (with ATKM). For preservation of zamorazivateli software, which is automatically adjusted freezing bone marrow. Storage is most often used liquid nitrogen at a temperature of -196 ° C. Stage IV. Conditioning. The main objective of this phase is the maximum possible eradikation Tumor Clone dostigauschayasa by high doses of chemotherapy and (or) radiation therapy. There are three groups of protocols conditioning : * protocols using only drugs (mielosan in total dose of 16 mg / kg, ziklofosfan -120 mg / kg vepezid in dose 30 mg / kg, etc.). * himiolucevaya combination therapy (eg ziklofosfan in total dose of 120 mg / kg + irradiation whole body instantly or fraktin in total dose of 5 to 14 Gy). * Total exposure of the body dose 13-17,5 Gy. V stage. Reinfuzia bone marrow. After 48 h post-conditioning intravenously (through a central catheter, implantiruemy before air conditioning) are native (with Altkm) or razmorojenny (with ATKM) bone marrow. VI phase. Restoring kostnomozgovy blood. This is a complex and long-term (average of three to six weeks). Prizivlenie bone marrow controlled the sternalnah punction and trepanobiopsi. At the same time, in patients after Altkm the prevention and treatment RTPH. This phase is marked by the emergence of deep neutropenia, and trombozitopenia high risk of complications, especially infection and bleeding. If induced kondizionirutm medical associations to trombozitopenia specialized office mielotransplantation is usually organizational (trombokoncentrata harvesting), the infectious complications in the face of neutropenia extremely dangerous. Although the use of powerful antimicrobial drugs, a significant number of patients have life-threatening infections, which are most often begins at 10-14-i day after reinfuzii bone marrow and an average continues to 21-35 days. Infectious complications related to the development of postzitostaticski agranulozitoza (number Klebsiella <0.5 * 109/l); With the life-threatening infectious complications normally associated with neutropenia <0.1 * 109/l. Neitropenica phase tends to be associated with the period of maximum damage to the gastrointestinal mucosa and respiratory tract. The first clinical sign of infectious complications, fever, and only 40% of patients managed to find its genesis. The most severe infectious complication is sepsis. Gram-otricationogo disease sepsis usually enterobacteria and sinegnanaya wand. The main way of infection at the same time, the flow of germs through damaged mucous membrane of the gastrointestinal tract. Of gram-polaugitionah microorganisms causing infectious complications is often It'sa Staphylococcus caused by the often podklucicnae catheters. The localized infections of the defeat of mucous membranes (mukozita), which often has mixed (gribkov-virusno-bak erialny) genesis, and pneumonia, most often caused by golden stafilokoccom. Gram-negatus flora is a leading contributor to infections vulvar and perineum. In the long neutropenia sharply increasing frequency of fungal infections, which shows that 1 / 3 of patients, particularly after TCM in patients with acute leukaemia and religion anaemia. The most frequent agents are kind of fungi and Candida Aspergilla. Localized of fungal infection treated reasonably well, but invasive mikozy almost always end in death. The viral agents that cause complications of TCM include viruses Herpes simplex and Herpes zoster, as well as cytomegalovirus (CMV) infection. Clinically viral defeat usually defeat mucosal of the oral cavity (mukozitom) or enteritom.
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