Title:
NEUTROPENIC DIET FOR INFECTION PREVENTION IN BONE MARROW TRANSPLANT ADOLESCENT PATIENT
BACKGROUND
A special dietary care known as neutropenic diet is crucial to promote the recovery process for a patient with acute lymphoblastic leukaemia undergone bone marrow transplant.
CLIENT HISTORY
Mr IH a 16 years old boy is staying in Terengganu with his family. He was associated with fever, multiple swelling over the neck, armpit and inguinal region past one week upon admission. He had completed five cycles of chemotherapy for lymphoblastic leukaemia. His grandmother had a history of breast cancer. He was admitted for bone marrow transplant.
ASSESSSMENT
He is underweight with BMI 16.8 kg/m2 and had no history of weight loss.Laboratory values revealed low for haemoglobin, urea and creatinine.PG-SGA indicated Stage C (Score 11). The dietary intake had been worsening since admission due to loss of appetite (918.8 kcal, 22.2g protein), not achieved recommended requirement.
NUTRITION DIAGNOSIS
Inadequate protein-energy intake related to loss of appetite as evidenced by diet history. Energy: 918.8kcal (31% from requirement : 2950kcal), protein : 22.2 g (28% from requirement: 84.5g)
OBJECTIVE MANAGEMENT AND NUTRIENT PRESCIPTION
Short term goals:
1) To provide adequate energy and protein.
2) To prevent weight loss.
3) To prevent infection.
Long term goals:
1) To optimise good nutritional status.
2) To attain normal BMI.
 Energy : 2950 kcal (Schofield Equation)
 PROTEIN : 84.5g, NPC:N (122:1)
OUTCOME AND FOLLOW UP
There was a different in energy-protein intake and weight before and after transplant, (D-3):1885.8 kcal/d, 89.2g/d, and 49 kg and (D+5): 1046.8 kcal, 50.3g/d, and 46 kg as shown respectively. No infection was noted throughout all follow-ups.
DISCUSSION
‘Low–micro-organism diets are indicated to prevent sepsis in transplant recipients. Nonetheless, such diets are often fed to patients with neutropenia to minimize acquisition of organisms from food sources and food handlers.’(Dadd et al. 2003)
‘Nutritional requirements in patients undergoing transplantation are increased due to the intense catabolism.’
(Kruger et al. 2001)
From the previous study, it is noted that neutropenic diet and high-calorie high protein diet is necessary for a better outcome in transplant.
LEARNING POINTS
- Dietary intake plays an important role in determining the patient’s nutritional status.
- Pre and post-transplant need a special and specific intervention.
- Serve the best for the ummah because you are the torchbearer for the ummah.
