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Evaluation for infection before hematopoietic cell transplantation

John R Wingard, MD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD


The infusion of hematopoietic cells to reestablish marrow function in an individual who has had his or her bone marrow ablated with chemotherapy and/or radiation has become standard therapy for many malignant and nonmalignant diseases. The term "hematopoietic cell transplantation" (HCT) will be used throughout this review as a general term to cover transplantation of hematopoietic cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). (See "Sources of hematopoietic stem cells".)

Patients can develop bacterial, fungal, viral, and/or parasitic infections following HCT, particularly following allogeneic HCT (figure 1). Infection in such patients is associated with high morbidity and mortality. Thus, prevention of infection is a major goal involving determination of risk, careful selection of donors, infection control measures, and prophylactic and preemptive antimicrobial therapy.

This topic review will discuss appropriate pretransplantation screening tests. An overview of the infections that can occur in association with HCT and prophylaxis against some of these infections are discussed separately. (See "Overview of infections following hematopoietic cell transplantation" and "Prevention of infections in hematopoietic cell transplant recipients" and "Prophylaxis of invasive fungal infections in adults with hematologic malignancies" and "Prevention of viral infections in hematopoietic cell transplant recipients".)


In 2009, guidelines for preventing infectious complications after hematopoietic cell transplantation were published, which represent the collaboration of several organizations from Europe and North America, including the European Blood and Marrow Transplant Group, the American Society of Blood and Marrow Transplantation, the Canadian Blood and Marrow Transplant Group, the Infectious Diseases Society of America, and the United States Centers for Disease Control and Prevention [1]. Our recommendations are generally in keeping with these guidelines.


The pretransplantation evaluation is designed to prevent posttransplant infections by excluding unsuitable donors and by defining specific infection control policies and antimicrobial prophylaxis and therapy, which will be necessary after transplantation.

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Literature review current through: Nov 2017. | This topic last updated: Oct 09, 2017.
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