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University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository

Specialty

Hematology / Oncology

Abstract

ABSTRACT

Patients with hematologic malignancies undergo allogeneic hematopoietic cell transplantation (allo-HCT) as a possible curative therapy for their diseases. Bone marrow (BM) is harvested from a healthy donor to provide the graft for allo-HCT. The risk of serious complications from a BM harvest is minimal. This case report details the unusual clinical course of a 21-year-old, healthy, female donor who developed Group A streptococcal bacteremia and septic shock following a BM harvest. The donor underwent an uneventful harvest in the operating room (OR) under general anesthesia. On postoperative day (POD) 2, she became persistently febrile, hypotensive, and poorly responsive to fluid resuscitation. Blood cultures grew Group A Streptococcus pyogenes after 10 hours. Following clinical stabilization on intravenous antibiotic therapy, she reported worsening left hip pain for several days. Pelvic magnetic resonance imaging (MRI) revealed sacroiliitis and adjacent osteomyelitis of the sacroiliac joint (SIJ). Given her persistent pain and functional impairment, she required surgical debridement of the SIJ. She was treated with a 6-week course of antibiotics and worked with physical therapy to regain mobility. The depth and positioning of a BM needle during the harvest along with accidental inoculation of pathogenic skin flora likely induced these serious complications. Proper handling of BM needles and preventative skin cleansing techniques are important considerations to prevent anatomical injuries and infectious complications following BM harvest.

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