title: Total parenteral nutrition delays platelet engraftment in patients who undergo autologous hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  One of the major challenges in the post-transplant period is nutrition. In this prospective, non-randomized study, total parenteral nutrition (TPN) was given to 31 patients and partial parenteral nutrition (PPN) was given to 30 patients undergoing autologous hematopoietic stem cell transplantation for solid tumors or hematologic malignancies to compare the effects of these parenteral nutrition modalities on post-transplant hematological engraftment, blood chemistry, and supportive therapy requirements.
  
  
  METHODS
  All patients in the TPN group and 17 patients in the PPN group received growth factor in the post-transplant period. Both groups did not differ with respect to sex, age, and reinfused CD34(+) cell numbers.
  
  
  RESULTS
  After transplantation body mass index and body weight decreased significantly in both groups (P < 0.001). Whereas serum albumin concentrations did not decrease significantly in the TPN group, it fell markedly in the PPN group at the end of parenteral nutrition (P = 0.019). After parenteral nutrition, blood chemistry was also remarkable for serum urea and glucose levels, which were elevated significantly in the TPN group (P < 0.001 and P = 0.03, respectively). Patients receiving TPN had a higher incidence of positive microbial cultures and clinical infection than did patients receiving PPN (64.5% versus 40%, P = 0.05). The most striking result was a delay in platelet engraftment for the TPN group compared with the PPN group (15.54 and 12.93 d, respectively; P = 0.014). This difference was also noted in patients using growth factor in the PPN group (P = 0.017). Parallel to these results, platelet transfusion requirement increased in the TPN group compared with the PPN group (1.93 versus 1.16 U, P = 0.004). Both groups were unremarkable for leukocyte recovery and red blood cell transfusion requirement.
  
  
  CONCLUSIONS
  Consequently, TPN has some pitfalls of hyperglycemia, infection tendency, delayed platelet engraftment, and increased platelet transfusion requirement. Therefore, it should not be used as a standard nutrition support for patients undergoing autotransplantation.
authors.affiliation: Department of Hematology, Gülhane Military Medical Academy, 06018 Etlik, Ankara, Turkey. aturkercetin@yahoo.com
authors.forename: Türker
authors.initials: T
authors.lastname: Cetin
authors.forename: Fikret
authors.initials: F
authors.lastname: Arpaci
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Dere
authors.forename: Mustafa
authors.initials: M
authors.lastname: Turan
authors.forename: Bekir
authors.initials: B
authors.lastname: Oztürk
authors.forename: Seref
authors.initials: S
authors.lastname: Kömürcü
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozet
authors.forename: Murat
authors.initials: M
authors.lastname: Beyzadeoğlu
authors.forename: Kürşad
authors.initials: K
authors.lastname: Kaptan
authors.forename: Cengiz
authors.initials: C
authors.lastname: Beyan
authors.forename: Atilla
authors.initials: A
authors.lastname: Yalçin
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology; D001792:Blood Platelets / Q000502:physiology*; D001943:Breast Neoplasms / Q000628:therapy; D005260:Female; D005334:Fever; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D017713:Platelet Transfusion; D011446:Prospective Studies