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Pericardial effusion requiring surgical intervention after stem cell transplantation: a case series

Bone Marrow Transplantation volume 52, pages 630–633 (2017)Cite this article

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Pericardial effusion (PEF) is an increasingly recognized complication following hematopoietic stem cell transplantation (HSCT). Previous analyses revealed an overall incidence of PEF in pediatric HSCT patients of 4.4–17.6%.1, 2, 3, 4 Timely diagnosis is important as untreated PEF can quickly progress to tamponade, requiring immediate surgical intervention.5 The true etiology of PEF is unclear as it commonly arises in the setting of the transplant recipient’s physiology being altered by multiple factors, including the conditioning regimen, GvHD and underlying diagnoses. This makes this population unique with regard to the rate of PEF progression, the requirement of surgical intervention and the risk for subsequent re-accumulation. The literature to date lacks a detailed description of clinical presentations, associated symptoms, comorbid conditions and results of imaging studies in pediatric patients who, following HSCT, present with PEF requiring pericardiocentesis and drainage. This case series aims to narrow this gap in the literature and to also provide guidance regarding echocardiographic surveillance for PEF and follow-up after surgical intervention.

An IRB-approved retrospective review of the medical records of 409 consecutive HSCT recipients, who underwent transplant between January 2012 and April 2016 at Cincinnati Children’s Hospital Medical Center, was performed. We identified ten patients (Table 1) requiring pericardiocentesis for clinically significant PEF. Clinical significance was defined as clinical and/or echocardiographic signs of tamponade or concern for progression to tamponade in the setting of large PEF. Clinical and laboratory information of the 10 patients identified was extracted from their medical records. Echocardiograms were obtained before transplantation, post-HSCT days +7, +30, +100, upon admission to the intensive care unit, and as clinically indicated. All imaging was reviewed by cardiologists with advanced training in echocardiography. The diagnosis of transplant-associated thrombotic microangiopathy (TA-TMA) was made utilizing criteria previously defined.6

Table 1 Patient demographics, physical exam and imaging findings
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Authors and Affiliations

  1. Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    T M Pfeiffer, S J Rotz, A Pate, J Hlavaty, M Grimley, K Myers, J El-Bietar, S M Davies, S Jodele & C Dandoy

  2. Division of Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    T D Ryan, R Hirsch & M Taylor

  3. Division of Critical Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    R Chima

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  1. T M Pfeiffer
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  2. S J Rotz
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  4. R Hirsch
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  5. M Taylor
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  6. R Chima
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  7. A Pate
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  11. J El-Bietar
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  12. S M Davies
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  13. S Jodele
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  14. C Dandoy
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Correspondence to C Dandoy.

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Pfeiffer, T., Rotz, S., Ryan, T. et al. Pericardial effusion requiring surgical intervention after stem cell transplantation: a case series. Bone Marrow Transplant 52, 630–633 (2017). https://doi.org/10.1038/bmt.2016.331

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