Supportive Care of Hematopoietic Stem Cell Donors.

Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another's life. They deserve comprehensive supportive care to accompany them throughout the donation process.

Bone Marrow Harvest: A White Paper of Best Practices by the NMDP Marrow Alliance.

Data on recent bone marrow harvest (BMH) collections from the NMDP has shown that bone marrow (BM) quality has decreased based on total nucleated cell count in the product. To ensure that quality BM products are available to all recipients, the NMDP Marrow Alliance was formed in April 2021 to increase the capability of BM collection centers to safely deliver high-quality products consistently and to identify and disseminate guidelines for performing BMH. This white paper describes the best practices for BMH as defined by the NMDP Marrow Alliance.

Noninfectious cutaneous manifestations of HIV infection in children.

Skin infections and proliferative conditions affecting the skin commonly occur in children with HIV/AIDS and are differentiated from infections in immunocompetent children by unusual severity and distribution and age at onset. Skin manifestations of HIV disease usually are the result of various causes,from concomitant infection to nutritional deficiencies. Photographs to aid in the identification and appreciation of the atypical presentation of skin manifestations resulting from noninfectious complications of pediatric HIV infection are presented.

Infectious cutaneous manifestations of HIV infection in children.

Cutaneous infections that can also be seen in immunocompetent patients tend to occur early in the course of HIV infection in children. The level of suspicion for the presence of HIV is elevated when these infections are manifested in extensive distributions, at unusual ages of the patient, or with unexpected severity or have a poor response to therapy. With progressive deterioration of the immune system, cutaneous infections become more specific and include organisms or disease patterns typically not seen in immunocompetent children.