Bone marrow infusion is similar to a blood transfusion. Like blood, bone marrow contains a rich amount of stem cells which are responsible for regenerating white blood cells, platelets, hemoglobin, and other blood components. Bone marrow can be collected in two ways.
- From peripheral blood
- Another way is to collect from BONE of the matched donor
Which Diseases need whole Bone Marrow?
Many non-malignant diseases require a bone marrow transplant, such as aplastic anemia, thalassemia, sickle cell anemia, and Glanzmann thrombasthenia.
Diseases like leukemia and lymphoma, which can be life threatening, often require a peripheral stem cell transplant. During this medical procedure, a phenomenon called the “graft versus leukemia” effect or “graft versus cancer” effect occurs due to the infusion of stem cells. This means that the transplanted stem cells attack any remaining cancer cells in the body, providing an additional defense against the disease.
In allogeneic bone marrow transplants, the cells are infused on the same day as they are harvested or collected. On the other hand, in autologous transplants, the collected cells are first preserved and then infused into the patient after administering conditioning chemotherapy. The objective of this high-dose chemotherapy is to myeloablation or destroy the diseased bone marrow of the patient.
Stem cell infusion in allogeneic bone marrow transplant:
After collecting bone marrow from a living healthy donor, it is transfused into the patient’s vein via a central catheter on the same day of collection, which is usually referred to as day zero or the transplant day. However, in an autologous transplant, the stem cells are melted in a tub called a water bath. The water used in the water bath is RO or distilled water. The temperature of the water bath must be kept at 37°C and should not exceed it, as this may damage the stem cells.
As soon as the frozen bag is melted or thawed, it should be infused into the patient because the preservative known as DMSO starts damaging the stem cells if it is melted. The bone marrow or stem cells should be given through an IV set without a filter. It is also necessary that the bone marrow dose should be calculated based on the patient’s body weight. Moreover, the stem cell dose should not be less or more than the required amount, which is calculated by CD34 count from the collected marrow or stem cells.
Less cell dose causes engraftment failure, and more cell dose causes the chances of graft versus host disease. Therefore, the cell dose should be according to the recommended amount.
What to do in case of Incompatibility of blood group between patient and donor?
During a bone marrow transplant, it is essential to ensure that the blood group of both the patient and donor match. If there is a minor mismatch, the likelihood of a reaction is lower. However, in case of a major ABO grouping mismatch, the collected marrow’s red cells are separated via a process called the red cell reduction process. In the peripheral stem cell collection, red cells are reduced manually, whereas in the whole bone marrow harvest, red cells are separated with the help of a reduction kit through an apheresis machine.
What to do before stem cell infusion?
Before receiving stem cells, it is important for the patient to take antihistamine and steroids to prevent potential reactions. Along with that, patients should be informed that the color of their urine may appear slightly reddish, it is due to the presence of DMSO, a preservative used in the stem cells.
After Bone Marrow Infusion:
After the infusion of stem cells, it is essential to administer intravenous fluids to the patient. This is done to ensure that the stem cells are evenly distributed throughout the patient’s body. Additionally, it is recommended to encourage the patient to consume a sufficient amount of fluids to minimize the risk of kidney injury associated with DMSO. It is necessary to flush out DMSO from the patient’s body.
What could be the complications after bone marrow/stem cell infusion?
After a bone marrow infusion, it is possible for the infused marrow to cause a reaction in the patient’s body. This reaction typically occurs in half-matched transplants (haploid identical transplants) and is known as Cytokine Release Syndrome (CRS).
Infusing stem cells safely involves following specific protocols under the supervision of trained healthcare staff to prevent complications.