Question

A 6-year-old child is admitted to the PICU with respiratory failure post-bone marrow transplant. Discuss the various causes of respiratory failure in a post bone marrow transplant recipient. Highlight the relation to the time phase following the transplant. [5+5]

Hint:

Close monitoring of respiratory function and early intervention in the post-transplant period are critical to prevent long-term pulmonary complications.

Answer 1

Respiratory failure in a post-bone marrow transplant (BMT) child can arise from several causes. These causes can be classified based on the time phase after the transplant. Understanding the timing and etiology is crucial for proper management.
Step 1: Causes of Respiratory Failure Early Post-Transplant (0-30 Days):
1. Infection: Early after the transplant, infections such as bacterial, viral (e.g., RSV, CMV), and fungal (e.g., Aspergillus) are common causes of respiratory failure due to immunosuppression.
2. Graft-versus-Host Disease (GVHD): GVHD affecting the lungs can lead to inflammation and lung damage, contributing to respiratory distress.
3. Acute Respiratory Distress Syndrome (ARDS): ARDS can be triggered by various factors such as infections, transfusions, or inflammation post-transplant.
Step 2: Causes of Respiratory Failure Late Post-Transplant (30 Days and Beyond):
1. Chronic Lung Disease (CLD): Chronic graft-versus-host disease can result in long-term pulmonary damage and lead to respiratory failure.
2. Infections: Late infections like pneumonia and opportunistic infections (e.g., fungal infections) can still occur due to immunosuppressive treatment.
3. Pulmonary Veno-occlusive Disease (PVOD): This is a rare but serious complication of BMT where blood vessels in the lungs become blocked, leading to respiratory failure.
Step 3: Relation to Time Phase:
- Early phase respiratory failure is primarily due to infections and ARDS.
- Late phase failure is more often caused by chronic GVHD, opportunistic infections, or PVOD.