QUESTION: I have a patient who had a bone marrow transplant and I am curious if I can continue giving HDIVC or whether there is a better formula to help her heal? She has previously tolerated 60g HDIVC.
ANSWER: Post Bone Marrow Transplant folks can be tricky. Since the normal parameters for HDIVC are OK (eGFR, G6PD…) and she tolerated 60 Grams in the past then your considerations need to shift to lower immune function and monitoring labs. We do IVs in the post BMT people a lot and it can be done quite safely. Same doses (we normally are using 50-75 grams per testing of ASC levels). Very strict aseptic technique is required, and (see your IV notes) site prep with Hibicleans or another IPA+Chlorhexadine is standard of care. (If the patient is allergic to chlorhexadine, painted and dried betadine is acceptable). Watch the CBC (and eGFR) – but generally they are fine.