Nursing care issues in autologous bone marrow transplantation.

The significant growth in annual numbers of autologous bone marrow transplant (ABMT) procedures can be attributed to early promising results and improvements in supportive care. Expert nursing care is an important component of the care provided by the multidisciplinary transplant team. Nurses are challenged by the developing and rapidly changing nature of ABMT indications, the complexity of the therapy regimen, and the management of acute and long-term effects and toxicities. Nursing care issues pretransplant include assisting the eligible patient in locating and transferring to an ABMT center, assisting with the informed consent process, exploring insurance and financial coverage, and planning for bone marrow and/or peripheral stem cell harvesting. During the transplant, nurses administer complex therapies, provide symptom management, and encourage and support patients and families through the period of pancytopenia and the accompanying physical and emotional debilitation. Post-ABMT, nurses play a key role in helping patients readjust to their former roles.

Effects of plasma collection systems and processing parameters on the quality of factor IX concentrate.

Using pilot-scale production of our present factor IX (II and X) concentrate, we have studied the effects of starting plasma source and processing parameter on two in-vitro indicators of product quality - yield and thrombogenic potential. Plasma source did not affect factor IX yield but had a marked effect on thrombogenic potential. Factor IX concentrates produced from plasma derived through centrifugation-based technology showed significantly higher thrombogenic potential than products derived from plasma derived through a filtration-based system. Removal of Cohn fraction I prior to ion-exchange chromatography resulted in a drop in factor IX yield and thrombogenic potential, as did heat treatment to 80 degrees C for 72 h. We conclude that a membrane-filtration-based plasmapheresis system may be the preferred method of plasma procurement for factor IX concentrate production.