الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 237 |  |  |
| | | from | 237 | | |
Abstract
Hematopoietic stem cell transplantation has become the most important modality in the treatment of hematologic and non-hematologic malignancies. This treatment increases year after year all over the world and all over the Egyptian governorates. The selection of the candidate for transplant is a very challenging process and depends on several factors.
One of the important comorbidities that make the patient risky for post transplant complications, is obesity with body mass index < 35 kg/m2. Also, under nutrition is one of the factors that affect the patient negatively during transplantation, and leads to late engraftment and increased length of hospitalization.
Moreover, the process of transplantation itself significantly affects patient’s nutritional status and worsens it, intensity of conditioning regimens, gastrointestinal side effects of treatments, psychological stress, lack of interest in food intake, unappetizing presented meals, restrictions in types of food presented, catabolic stress due to infection, fever, engraftment, graft versus host effect, all these factors allow the patient to be a candidate for malnutrition.
Nutritional status of the patient planned to bone marrow transplant is a vital component in the pre transplantation assessment and evaluation. Complete nutritional assessment must be done at admission, immediately pre transplantation, and weekly follow up of patients for their nutritional status is very necessary.
These patients are exposed to severe immunosuppression, so the food safety practices are highly important for them to be applied. There are a specific food safety and handling practices to be applied by food makers, nurses, kitchen workers and patients. Assessment of these factors and education about them are very necessary.
The aim of this study was:
To assess nutritional status of the patients prior to hematopoietic stem cell transplantation and identify related factors that affect nutritional status pre transplantation period.
Materials and method:
The study was carried out at Bone Marrow Transplant Unit, Almoasaa University hospital at Alexandria University and Bone Marrow Transplant Unit, Nasser Institute hospital for treatment and research at Cairo affiliated to the Ministry of Health. The sample of this study comprised 40 adult patients of both gender planned for bone marrow transplant and diagnosed with hematologic and non-hematologic malignancy.
Tools of the study:
Three tools were used for data collection in this study:
Tool I: Socio demographic and clinical data of patients submitted to hematopoietic stem cells transplantation, structured interview schedule.
This tool was developed by the researcher to identify characteristics of patients and baseline clinical data, it included two parts:
• Part 1: Socio demographic data
• Part II: Clinical data
Tool II: Patient’s nutritional assessment record prior to hematopoietic stem cells transplantation.
This tool was developed by the researcher to assess nutritional status for patient’s pre hematopoietic stem cells transplantation and included 5 parts.
• Part I: Anthropometric measurements
• Part II: Biochemical markers assessment
• Part III: Physical signs of malnutrition
• Part IV: Dietary history and dietary intake
• Part V: Caloric requirement assessment
Tool III: Nutritional related factors affecting patients prior to hematopoietic stem cells transplantation scale.
This tool was developed by the researcher to assess and identify related factors affecting patient’s pre transplantation and it included three parts:
• Part I: Patient’s related factors during hospitalization
• Part II: Disease and therapy related factors
• Part III: Hospital related factors (environmental factors)
Data collection:
A convenient sample of 40 adult patients with hematologic and non-hematologic malignancy and planned for bone marrow transplant were selected.
The study was carried out on four phases pre transplantation:
• Initial phase pre transplant: Conducted on the first 2 days of admission
• Second phase pre transplant: Conducted on the second day of starting the conditioning chemotherapy
• Third phase pre transplant: It was conducted at mid distance between admission and transplant.
• Fourth phase pre transplant: It was conducted at minus one day or day pre transplant.
The main results of this study were:
• Two thirds (75%) of studied patients were in age group (20-40) years.
• More than three quarters (82.5%) of studied patients were married.
• More than two thirds (72.5%) of the studied patients were low educated.
• Around two thirds (60%) of studied patients were from rural areas.
• The mean length of hospital stay for the studied patients were (34.65) days.
• Around half of studied patients (47.5%) were diagnosed with acute myeloid leukemia.
• All the studied patients (100%) were receiving the transplanted cells from the peripheral blood, either the donor’s peripheral blood (allogenic transplant) or from patient’s own peripheral blood (autologous transplant).
• More than half (52.5%) of the studied patients were exposed to smoking for a period (7.5% quitter, 20% passive smoker and 25% active smoker).
• There was a statistically significant difference between body mass index measurements from admission until the day pre transplantation (P <0.001).
• There was a statistically significant difference between body fat percent measurements from admission until the day pre transplantation (P=0.002)
• There was a statistically significant difference between serum albumin measurements from admission until the day pre transplantation with (P <0.001).
• There was a statistically significant difference between total proteins measurements from admission until the day pre transplantation with (P<0.001).
• More than two thirds (77.5%) of patients used frying as the usual cooking method.
• More than two thirds of patients (75%) used synthetic margarine for frying.
• The majority of studied cases (92.5%) had allogeneic type of transplantation.
• More than two thirds (70%) of patients had myeloablative conditioning regimen.
• There was a statistical difference between sore mouth from admission until the pre transplantation day (P=0.007).
• There was a statistically difference between difficulty with swallowing from admission until the pre transplantation day (P=0.001).
• There was a statistically significant difference between anorexia from admission until the pre transplantation day (P<0.001).
• There was a statistically significant difference between vomiting from admission until the pre transplantation day (P<0.001).
• There was a statistically significant difference between diarrhea from admission until the pre transplantation day (P=0.006).
• No statistical difference between knowledge level regarding food safety and handling practices on admission and pre transplant.
• The bone marrow units weren’t compliant with standard practices related to environmental factors that affect nutritional status of the patient with statistical difference between two hospitals.
• The food makers units weren’t compliant with standard practices related to environmental factors that affect nutritional status of the patient without statistical difference between two hospitals
• There was a highly statistical difference between type of conditioning regimen and length of stay (P<0.001).
• There was a statistical difference between type of conditioning regimen and engraftment period (P=0.031 and 0.032) respectively.
• There was a highly statistical significant difference between ideal and mean caloric intake pre transplant (P<0.001).
• There was a highly statistical significant difference between body mass index pre transplantation and engraftment period (days to reach absolute neutrophil count < 1000) with (p<0.001) respectively.
• There was a highly statistical significant difference between body mass index pre transplant and type of conditioning (p=0.009).
• There was a statistical difference between body fat percent pre transplantation and engraftment to reach ANC < 1000 (P=0.022).
The main recommendations are:
1. Patients should be subjected to nutritional screening at unit admission, and scheduled nutritional assessment weekly during the period of transplantation.
2. In dependency on body mass index only in nutritional assessment and using bioelectrical impedance analysis.
3. Provide possibilities for food and water safety and handling practices application according to published recommendations.