Hemorrhagic Cystitis:
This means there is blood in the urine. It is a side effect of cytoxan, one of
the chemotherapeutic agents used prior to transplant. The breakdown products of
cytoxan are extremely caustic to the lining of the bladder. That is the reason
the Foley catheter is inserted prior to giving cytoxan. Hemorrhagic cystitis may
be mild or severe. Hemorrhagic cystitis can start within a few days of receiving
cytoxan or weeks later and may be recurrent.
Mild:
- Signs/Symptoms: Yellow or light pink, clear to pink urine with blood
detectable by hemacomabistix.
- Treatment: Aggressive po/IV hydration and diuretics (lasix).
Severe:
- Signs/Symptoms:F requent voids with small amounts of urine with each
void; red urine which may have blood shreds or clots; bladder spasms and pain
with urination.
- Treatment: Aggressive IV hydration, diuretics, platelets to promote
clotting and blood to replace blood loss. Occasionally inserting a small scope
(cytoscope) into the bladder through the urethra and cauterizing the lining
of the bladder is necessary.
Gastrointestinal (GI) Bleeding:
- Signs/Symptoms: Emesis with blood clots or stool with either frank
blood (visibly red stools) or tarry black stools.
This sort of bleeding can have several different causes, although the symptoms
may be the same. GI bleeding can be caused by side effects of the chemotherapy,
GvHD, or an infection in the gut. It is important to accurately determine the
cause as the treatments are different for each cause. The doctor may order an
endoscopy (a tube passed down the throat and into the stomach) or a sigmoidoscopy
(a tube passed through the rectum and into the large bowel) in order to get
an accurate diagnosis. This may include taking biopsies and cultures of those
tissues.
Treatment of GI bleeding depends on the cause, as follows:
- Chemotherapy: Decrease irritation to the gut and wait for recovery
of white blood cell count to help heal the damaged tissue.
- GvHD: IV steroids or other immunosuppressives.
- Infection: Antibiotic, anti-viral or anti-fungal agents, depending
on the causative agent.
Whatever the cause, dietary restrictions (usually low-lactose and low-fiber
diets) are usually initiated to decrease irritation of the gut. IV and oral
antacids are routinely used. If the bleeding is severe, platelets and blood
will also be given as needed.
Nose Bleeds:
The cause is usually low platelets, dry air and/or irritation of the nasal passages.
- Treatment: A cool compress will stop minor nose bleeds. Persistent
or severe nose bleeds require a nasal packing of either salt pork or gel foam
and sometimes a platelet transfusion. On rare occasions, a nose bleed may
require cauterization, which is done by the ENT surgeons.
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