Rehabilitation During Transplant

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All patients with documented baseline parameters (pre-transplant), an individualized strength, endurance, cardiovascular and balance training should be prescribed by the PT based on the patient’s individual ability. Please note, that the exercise program needs tailoring based on patient’s day-to-day symptoms throughout the in-patient admission. 


Low platelet: 

Platelet count (<20) has historically been a concern and considered as a contraindication for exercises, however, majority of the HSCT patients are able to tolerate and benefit from exercises despite low platelets (<10). Furthermore, some studies have also reported no association between minor bleeding events with intensities of PT interventions and association between minor bleeding events and platelet counts [1,2].  However, since patients undergoing HSCT have complex needs and clinical judgement must be used to design any rehab program and ensure patient safety. 


Haemoglobin levels:

The patients who have haemoglobin level below  8 g/dL  should not receive any intense PT management, as majority of the studies have indicated risk to patients like reduced exercise performance and the development of exercise-induced STsegment depression [3]. Hence exercising with low haemoglobin should be considered by the therapists on individual patient basis with the patient’s overall clinical picture in mind.


Blood Transfusion: 

A well monitored PT session may be safe for individuals with hematologic malignancies and those who are receiving an RBC transfusion. Furthermore, adverse events related to RBC transfusion are believed not to be influenced by PT intervention[6].

References:

 

  1. Ibanez K, Espiritu N, Souverain RL, Stimler L, Ward L, Riedel ER, Lehrman R, Boulad F, Stubblefield MD. Safety and Feasibility of Rehabilitation Interventions in Children Undergoing Hematopoietic Stem Cell Transplant With Thrombocytopenia. Archives of physical medicine and rehabilitation. 2017 Aug 12.
  2. Wolin KY, Ruiz JR, Tuchman H, Lucia A. Exercise in adult and pediatric hematological cancer survivors: an intervention review. Leukemia. 2010 Jun;24(6):1113.
  3. Lipinski MJ, Dewey FE, Biondi‐Zoccai GG, Abbate A, Vetrovec GW, Froelicher VF. Hemoglobin Levels Predict Exercise Performance, ST‐Segment Depression, and Outcome in Patients Referred for Routine Exercise Treadmill Testing. Clinical cardiology. 2009 Dec;32(12):E22-31. 
  4. Rexer P, Kanphade G, Murphy S. Feasibility of an exercise program for patients with thrombocytopenia undergoing hematopoietic stem cell transplant. Journal of Acute Care Physical Therapy. 2016 Apr 1;7(2):55-64.
  5. Rosenfeldt AB, Covert S. Physical Therapy Intervention for an Individual With Severe Thrombocytopenia. Journal of Acute Care Physical Therapy. 2017 Oct 1;8(4):133-40.
  6. Rosenfeldt AB, Pilkey LM, Butler RS. Physical therapy intervention during a red blood cell transfusion in an oncologic population: a preliminary study. Journal of Acute Care Physical Therapy. 2017 Jan 1;8(1):20-7.