Information for Patients & Families
For Patients
Guides written by Dr. Suparno Chakrabarti and Dr. Mahak Agarwal to help patients and families prepare for Bone Marrow Transplantation.
For Patients
Your BMT Journey
What to expect before, during, and after your Bone Marrow Transplant.
If you do not have a double lumen central venous catheter, you need one for the transplant period. The transplant doctor or an anaesthetist will place the line in the operating room, before the conditioning starts.
This CVL remains in place for the entire transplant period. It may be used to give intravenous (IV) fluids, medications, blood products, and for the transplant itself. It is also used to draw most blood samples. The BMT nurses will flush the line with a medication (heparin) to keep it from clotting.
When the transplant doctor decides that the line is no longer needed, it will be removed in the operating room or at the bedside.
The Journey
The BMT Process — Four Stages
Dr. Suparno Chakrabarti explains the four stages involved in Bone Marrow Transplantation.
One will undergo complete medical check-up to evaluate one's suitability to go through the BMT procedure. This involves the following:
- Blood Tests
- Chest X-ray and CT Scans
- Tests to assess the condition of heart and lungs
- Bone Marrow Tests
Patients will be counselled in detail about the procedure, the complications, the chances of success, the cost and the possible length of stay in the hospital. Patient will be encouraged to go through the educational material/booklet and discuss any queries or doubts that he/she might have.
High dose of chemotherapy or radiotherapy is given to destroy the diseased marrow or destroy the cancer cells and make space for the new bone marrow cells. It also suppresses the immunity of the patient so that the new bone marrow is not rejected.
The Transplant Procedure: The transplant procedure is actually fairly simple — the stem cells or bone marrow cells to be transplanted are given as a blood transfusion through the central line. This usually takes from one to several hours. Just before the infusion, the patient may be given medication to help avoid any reaction. A monitor is used to check breathing, heart rate and blood pressure during the procedure.
After high dose chemo-radiotherapy the blood stem cells are destroyed and normal blood cells are not produced. The patients need to be kept in a clean room within the BMT unit in strict isolation during this time. They also need a lot of blood and platelet transfusion. Most patients get serious infections during this period and need treatment with antibiotics.
Early Phase (first 3 months): There are two types of white blood cells: neutrophils and lymphocytes. Once the neutrophil count is above the critical value of 500 cells per microlitre, the patient can come out of critical isolation. This is called engraftment — the first sign that the transplanted blood stem cells are functioning. There is also a risk of graft-versus-host disease (GVHD) at this stage.
Late Phase (3 months–12 months): The immunity against viruses takes a very long time to recover. Even though some immunity is restored, the patient is still at risk of infections with viruses and fungus. This is more so if they are being treated for GVHD, which can become chronic and lingering. If the patient is well, the frequency of check-ups and blood tests reduce over several months.
Once transplanted bone marrow starts to grow, or engraft, the white blood cell count will rise. Once the white blood cell count reaches safe levels, the patient can be moved from the high-level isolation (clean room) to the low-level isolation. In low-level isolation, standard precautions are taken like hand washing and not visiting if sick. This period is also known as Step down isolation.
For Patients
Clean Room Guide
Protective isolation details, precautions, and equipment in the BMT Unit.
Transplant patients have very low immunity to fight bacterial, viral and fungal infections and therefore need to be isolated into CLEAN ROOMS which will protect them from infections.
Air Handling Unit (AHU)
Each room of the BMT Unit has its own dedicated Air Handling Unit (AHU) to provide 10–15 Hepafiltered fresh air changes per hour. This means the fresh air entering the patient's room is first treated through special filters. Treated fresh air then passes through 0.3 Micron High Efficiency Particulate Air Filter (HEPA). HEPA removes all the bacteria, viruses and fungus. This hepafiltered air passes through a laminar floor to reach the patient's room at the desired humidity and temperature.
Automatic and Selective Control System
Automatic and selective control system provides positive air pressure in the BMT room compared to ante room and the BMT corridor. This has been done to ensure that, on opening the door of the BMT Room or the ante room, no outside air from BMT corridor or the ante room enters the BMT room.
Anteroom
Ante room is a small room between the corridor and the BMT room for maintaining positive air pressure in the BMT room.
Stainless Steel Doors, Vinyl Flooring and Cladding of Walls
Stainless steel doors and vinyl surfaces are most practical to clean with disinfectants to maintain high standards of hygiene and infection control.
- Do not carry any valuables e.g. jewellery, cash etc. to the BMT room
- Ring the bell outside the BMT unit, so that the nurse can decide whether to let you in or not.
- If allowed, keep your cell phone, toys, games, pictures etc. in the pass box fitted with ultraviolet light for 20 minutes before taking them to the BMT room.
- Enter the change room
- Change shoes
- Change into sterile clothes, wear cap and mask.
- Wash your hands with soap and water by following 6 step hand wash instructions, written on the wall above the sink.
- Use all the three disinfectants (placed above the sink) one by one. Dry your hands
- Enter the BMT corridor.
- Enter the Anteroom, scrub again as mentioned above, wear a sterile gown and then enter the BMT room.
Attendants
No attendants are allowed except with children and very sick patients with the doctor's permission. Only one attendant is allowed in the BMT unit at any time.
Toilets
Attached toilet is exclusively meant for the patient. Only treated water should be used for patient's bath and mouth wash.
Food
No outside food is allowed inside the BMT room. Patients will be served prescribed, pressure cooked and microwaved food inside the BMT room. Attendants will be served food in the BMT pantry as per their order.
Note: BMT Nurse will explain all the above in detail to the patient and the family for their full cooperation.
Equipment
BMT Unit is equipped with a dedicated X-ray machine, ultrasound machine, dialysis machine and a ventilator to handle any medical emergency.
Furniture and Furnishing of BMT Room
- Centralised oxygen, suction system with double outlets
- State-of-art, six parameter monitors for monitoring heart rate, breathing rate, blood pressure, oxygen saturation and ECG 24x7.
- Infusion pumps
- Syringe pumps
- C.C. TV monitoring system for 24x7 vigilance of the patient
- Television
- Telephone
- Patient bed, bedside locker and desk
- Attendant bed
- Two trolleys for medicines/dressing etc.
For Patients
Nutrition Guidelines
Diet guidelines, restrictions, and nutritional support during BMT.
During bone marrow transplantation, the bone marrow is destroyed by high doses of chemotherapy. This causes a decrease in white blood cells, which help to fight infections. Because of this, it is very important to eat foods that are less likely to contain high levels of bacteria.
When Patients are admitted in the isolation room, they are placed on a low bacteria diet. Most food items served in the hospital are pressure cooked and microwaved before serving to patients.
Home prepared foods are NOT allowed. Commercially packaged items are ONLY allowed after they have been approved by the dietician or nurse. Food should NOT be left at room temperature for longer than one hour.
Eating well is very important during transplant and recovery. Patients may have low appetite, change in taste, dry mouth and/or nausea. There may be times when Patients may not feel well enough to eat. To maintain the nutrition, TPN (Total Parental Nutrition) or tube feeding is started.
Low Bacteria Diet Guidelines
- No restaurant food, take out, cafeteria food or vendor food is allowed.
- All foods must be cooked thoroughly. Avoid rare to medium cooked meats and fish.
- Herbs, spices and pepper should not be added to food after it is cooked, but are allowed when cooked with the food.
- Avoid raw fruits and vegetables including salads, garnishes, stir-fried vegetables, egg rolls and any fruit garnish on a dessert.
- Avoid foil-sealed plastic cups of juices because they do not have best before date.
- Avoid food containing raw eggs including soft cooked eggs.
- Dried fruits, nuts and seeds are not allowed unless cooked in a food item.
For Donors
Donor Guide
Donor for BMT has to be matched with the patient in their 'tissue type'. This is confirmed by typing their HLA antigens.
Family Donor — Fully HLA Matched
Within a family, there is about 25–30% chance of finding such a match in a brother or a sister. If there is no match within the close family, the chances of finding a fully HLA matched donor in distant relatives is remote.
Half-Matched / Haploidentical
We inherit two sets of HLA ANTIGENS; one from each parent. Thus, parents are always half matched with us. In addition, even if the brothers and sisters are not fully matched with the patient, there is 90% chance that they shall be half-matched. BMT from a half matched or HAPLOIDENTICAL donor is feasible in centres with adequate infrastructure and expertise.
Volunteer Unrelated Donors
To find a match with a random person is less than one in a billion. However, if we screen million people of similar ethnic background, we might find a close match. Based on this concept, volunteer unrelated donor registries have been set up in all countries. In India also, we have many volunteer unrelated donor registries. It takes a few months to search for an HLA matched donor in these registries.
Hundred milliliter to a litre of bone marrow (depending on the age of the patient and the donor) is removed from the donor's hip bones under general anesthesia. It is an extremely safe procedure and is completed within two to three hours. The donor can be discharged on the same day or next morning and he can go back to his work within two to three days. Bone marrow is naturally regenerated in the body within 2 to 3 weeks.
No. The donor receives an injection of a growth-factor for 4 days and on the fifth day the donation of blood stem cells is done. It is similar to a long blood donation through a machine and no operation or general anaesthesia is required. The donor can go back to work on the same day.
Patient Testimonials
Patient Stories
Real stories from patients and families who have been treated at Bloods R Us under Dr. Suparno Chakrabarti and Dr. Mahak Agarwal.
"My father was diagnosed with Mantle Cell Lymphoma on 3rd Feb 2021. My father start receiving his treatment from Dr. Suparno and his team and he is fine now with his health."
"The care and dedication shown by the entire Bloods R Us team is truly remarkable. From diagnosis to treatment and follow-up, every step was handled with professionalism and compassion."
"I am very satisfied with my course of treatment and the doctors and staff under Dr. Suparno sir are very good and cooperative."
"The treatment was done by expertise doctors."
"I have taken treatment of Acute Myeloid Leukemia (AML) for my daughter. My daughter had a successful Bone Marrow Transplant."
"Story of a Lymphoma Patient after his successful Bone Marrow Transplant."
"Success story from Nigeria. Treated for Sickle Cell Disease."