Late Effects After HSC Transplantation

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The page below is a sample from the LabCE course Hematopoietic Stem Cell Transplantation. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Late Effects After HSC Transplantation

The development of less toxic conditioning treatments, prevention of GVHD and effective infection control measures have resulted in many transplant patients surviving from a fatal disease and having an improved quality of life. For those patients who survive two years after transplantation, the risk of dying is still significantly higher than normal individuals of the same age group. The most common causes of death in this group of patients are recurrent malignancy, secondary malignancy, infection, chronic graft versus host disease, and respiratory and cardiovascular diseases. A listing of these conditions and their most likely causes is shown in the table.
Long term complications after HSC transplantation
Disease or ConditionPathology
Cardiovascular diseaseIonizing radiation, hypothyroidism, steroid therapy, growth hormone deficiency
Secondary malignancy Ionizing radiation, pre-transfusion chemotherapy
Pulmonary diseaseInjury to small airways and bronchioles as a result of chronic GVHD
InfectionFailure of T and B cell systems in transplant immunosuppression of chronic GVHD
Bone mineral lossSteroid therapy, hypogonadism, chronic GVHD
Ocular GVHDIonizing radiation, methotrexate
Endocrine disorders*Steroid therapy, ionizing radiation
Chronic kidney disease Ionizing radiation, steroid therapy, chronic GVHD
Esophageal and swallowing problemsSteroid therapy, chronic GVHD
Anorexia, nausea, vomittingInfections, chronic GVHD
Diarrhea and abdominal painInfections, chronic GVHD
Liver diseaseInfection, GVHD, iron overload, recurrent malignancy
Biliary tract diseaseSteroid therapy, GVHD, iron overload
Iron overloadRed Cell Transfusions
Pyschological issuesPost-traumatic stress, fear of relapse, chronic GVHD
Cognitive declineIonizing radiation, inflammatory cytokines (tissue necrosis factor)
*Endocrine disorders may include but is not limited to diabetes mellitus, hypogonadism, thyroid disease, adrenal insufficiency, and pituitary dysfunction.
Early detection of the complications that occur after transplantation is essential for HSC transplant patient’s long-term survival and quality of life. Laboratory professionals play a key role as members of the transplant team. All departments of the clinical laboratory help in the management of HSC patients. Whether it is hematology, blood bank, microbiology, clinical chemistry, immunology or anatomic pathology, the laboratory professionals working in these areas provide essential information that saves lives.

Excess iron in liver tissue stained with Prussian Blue iron stain