Abnormal Echocardiography 7 Days after Stem Cell Transplantation May Be an Early Indicator of Thrombotic Microangiopathy

Abstract

Cardiac complications after hematopoietic stem cell transplantation (HSCT) can lead to significant morbidity and mortality. Cardiac evaluation during the first 100 days after HSCT is usually performed only if clinically indicated, and no studies have examined whether routine screening is beneficial in this patient population at high risk for tissue injury. We conducted a single-center prospective clinical study to screen for cardiac complications in pediatric and young adult patients. One hundred consecutive HSCT patients underwent scheduled echocardiographic screening on day +7 after transplantation, independent of their clinical condition. At least 1 abnormality was identified in 30% of cases. Seventeen children had a pericardial effusion, 13 elevated right ventricular pressure, and 3 reduced left ventricular function. Survival was reduced in children with any echocardiographic abnormality at day 7 (67% versus 80% in those with and without, respectively, abnormality, P = .073). Moreover, raised right ventricular pressure at day +7 was significantly associated with transplant-associated thrombotic microangiopathy (TA-TMA; P = .004) and may indicate early vascular injury in the lungs. These data suggest that echocardiography 7 days after HSCT can detect early cardiac complications of HSCT and may identify early vascular injury associated with TA-TMA.

Histologic Features of Intestinal Thrombotic Microangiopathy in Pediatric and Young Adult Patients after Hematopoietic Stem Cell Transplantation

“…Histological changes are typically multifocal and may not be present in small representative biopsies. Previous reports and our personal experience examining autopsy and surgical bowel resection specimens showed that iTMA may affect mesenteric arterioles, causing ischemic bowel necrosis, and may not necessarily be visible in smaller submucosal vessels [6,7,19,23,24]. It is important to consider iTMA based on the highly suggestive clinical symptoms of intestinal bleeding and severe pain in patients with systemic hrTMA.…”

Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation

“…Perhaps less intuitively, the occurrence of TA-TMA was also strongly associated with MBI-LCBI. Recent work from our own center has shown that a degree of TA-TMA is frequent after HSCT, occurring in about one-third of patients if monitored carefully [12,18]. Moreover, it is evident that TA-TMA leads to systemic vascular injury and widespread tissue injury, including the intestine [19,20].…”

Pericardial effusion requiring surgical intervention after stem cell transplantation: a case series

“…Previous analyses revealed an overall incidence of PEF in pediatric HSCT patients of 4.4–17.6%. 1–4 Timely diagnosis is important as untreated PEF can quickly progress to tamponade, requiring immediate surgical intervention. 5 The true etiology of PEF is unclear as it commonly arises in the setting of the transplant recipient’s physiology being altered by multiple factors, including the conditioning regimen, GvHD and underlying diagnoses.…”

“…Recently, it has been proposed that TA-TMA may play a key role in the development of PEF. 4,7 TA-TMA describes vascular endothelial injury resulting in micro-angiopathic hemolytic anemia, platelet consumption, fibrin deposition and thrombosis. 8 The association between TA-TMA and PEF may be explained by the development of (poly-)serositis due to the pro-inflammatory nature of TA-TMA.…”