Aplastic Anemia — Instructions for Ordering Equine ATG — Clinical Pathway

Aplastic Anemia — Instructions for Ordering Equine ATG — Clinical Pathway

Instructions for Ordering Equine ATG Therapy at CHOP

Special Instructions

  • Please feel free to contact pharmacist with any pharmacy questions or concerns
  • Please call any Bone Marrow Failure Team Member for any questions or concerns involving the protocol
  • All doses of ATG are to be given on inpatient service. Pt should be in a single patient room. HEPA filtered, positive pressure room.
  • All patients should have a consent for Blood Transfusions signed on admission. This consent will cover consent for all Blood Product Transfusions and the ATG Infusions.
  • ATG is to be given through a PICC or Central Line. Central line may be maintained until no longer transfusion dependent. It is preferred that the PICC line is removed prior to discharge after IST is complete but this is left up to the attending physician’s preference.

All orders for ATG & Pre Treatment drugs should be placed by the Hematology Fellow and Attending the evening prior to the infusion start, so that all ATG Infusions can begin between 0800 and 1000 each day.

  • Fellow placing the orders should pend orders in EPIC once completed
  • Attending physician should review and sign orders by evening prior to infusion start
  • Call MD for additional instructions if dose cannot be given during this time period.
  • Pre-medicate each dose of ATG with Acetaminophen PO and Diphenhydramine IV

Infusion reactions and response

  • For severe reactions including shortness of breath, wheezing, chills, severe myalgias, hypo/hypertension, hives, or chest pain with any dose of ATG, STOP THE INFUSION & CALL MD IMMEDIATELY.
  • For minor reactions, including fever or other side effects not mentioned above, MD should be called for bedside assessment, but infusion may be continued while awaiting assessment
  • Consider Meperidine prn for chills with ATG
  • For management of anaphylaxis, follow standard hospital pathway. Patient Care Manual # TX-17-01

Supportive Care

  • Transfuse when platelet count < 20 k or Hgb < 9 g/dl on ATG infusion days.
  • Lab Monitoring:
    • CMP, Magnesium, Calcium, Phosphorous on days 1, 3, and 5 with each cyclosporine level
    • CBC with diff daily
    • First cyclosporine level should be checked as a morning trough prior to the 5th or 6th dose. Subsequent trough levels should be obtained after consultation with clinical pharmacy
  • For PCP prophylaxis, antifungal prophylaxis, and treatment of suspected bacterial infection, please refer to the current CHOP Antimicrobial Stewardship Program Guidelines for “Hematology patient with Acquired Aplastic Anemia”.