Care of Patient after BMT.

After a bone marrow transplant (BMT), the patient needs to take excellent care at home. A minor mistake or careless behavior leads to a major loss, as a bone marrow transplant is a very sensitive procedure in which a patient’s bone marrow is damaged OR destroyed, and new marrow from a matched sibling is transplanted.

When the donor’s new bone marrow starts working, and if the patient is fit for discharge, the physician decides to send the patient home with proper discharge teaching. Bone marrow transplant doctors and nurses give proper discharge instructions to patients.

Important Teaching Points Include:

Take Prescribed Medication Regularly:

Your transplant consultant will prescribe a list of medications at discharge. Medication may include immunosuppressants to avoid transplant rejection.

Antibiotics for several days to prevent bacterial infections, antifungal medication to prevent fungal infections, antiviral medicine to prevent viral infections, and supportive medication to manage minor symptoms such as nausea, body aches, and joint pains. Instruct the patient to take prescribed medications at the said time.

Personal Hygiene: Care of Patient after BMT.

Take excellent care of personal hygiene. Moreover, Daily taking baths and wearing clean clothes and undergarments keeps the patient neat, clean, and fresh and prevents them from getting infections.

Use Hygienic Food: Care of Patient after BMT.

You can use all types of foods and fruits after the transplant, but they should be well-cooked and hygienic. Moreover, the food should be homemade.

Avoid restaurant dining with friends and family:

Avoid restaurant dining with friends and family. However, the food cooked in restaurants may not suit you. This may further have a bad impact on your health. As in a restaurant, food is cooked for a large number of people, and that could not be hygienic.

Secondly, in restaurants, there is a crowd of people, which also increases the risk og getting infections, such as respiratory infection, viral infections, or bacterial infections.

Furthermore, avoid using used utensils in such places, as this also increase risk of acquiring infections such as Epstein-Barr virus (EBV).

Maintain good Hydration:

Keep yourself well hydrated by drinking more water or fluids. Maintaining hydration is very important after a transplant to protect the kidneys from the side effects of medication.

Avoid going to crowded places: Care of Patient after BMT.

Being an immunocompromised individual, going to crowded and open spaces may increase the chances of getting infections. However, avoid going out in crowded places like markets, parks, and malls.

Due to immature or suppressed immunity, you can get infections like the flu, Tuberculosis, and COVID-19 very easily. This kind of infections further lowers your ability to fight against infections, and lead you to more complications.

Avoid self-medication: Care of Patient after BMT.

Avoid taking over-the-counter medication, which can interact with your transplant medications and can decrease or increase their effectiveness. So, it is recommended to consult your healthcare provider before taking any medication.

Food to drug interaction:

Some specific medications in transplant have severe interactions with other foods or drugs. Your healthcare provider will teach you and warn you regarding the interaction of such medication with food.

Protect yourself from getting infections:

Avoid close contact with someone who has a fever, active coughing, or flu at home. After a transplant, the patient’s immunity is not developed properly, and the patient is also on immunosuppressants, which further suppresses immunity. Also, use a separate toilet for at least 4-5 months after your transplant.

Keep yourself active:

Avoid energy-consuming exercises, such as going to the gym or fast running. This may drain your energy and lead to weakness. Engage in light activities like walking as much as you can tolerate, and avoid staying in bed all day. Lying on the bed all the time leads to muscle wasting, backache, constipation, and lethargy. So, be active and energetic, and focus on your physical health as well.

Take proper rest: Care of Patient after BMT.

Get proper sleep as your body needs regeneration of all body tissues affected by high-dose chemotherapy.

Avoid drug-food interaction: Care of Patient after BMT.

Avoid grapefruit (Chakotra) with the medicine cyclosporine (the most important medicine for transplant), which can affect cyclosporine levels in your blood. This anti-rejection is prescribed for patients with allogenic bone marrow transplant and requires proper monitoring during its course.

following are the precautionary measures to avoid cyclosporin toxicity.

Do not exceed the dose without your physician’s advice, and take the medication on same time of the day.

Proper monitoring of the levels of antirejection medication is very necessary to avoid complications and toxicities. The level is usually taken at least half an hour before the next dose, and should have at least a gap of 12 hours from the previous dose

. Avoid food or drugs with this medication, such as grapefruit,s ome antifungle medical; these fruits and medictaion increases the level of the medication in the blood and lead to brain or kidney toxicity.

What are the toxicities associated with anti-rejection medication?

The following are some organ toxicities associated with high levels of anti-rejection medication, such as cyclosporin or tacrolimus.

Effects on the brain:

In brain toxicity, patient many experience fits and headaches with elevated blood pressure, which is known as PRESS.

Effects on the kidneys:

These medications have effects on patients’ kidneys with elevated creatinine and other renal tests. To avoid this effect, the patient should be well hydrated. The patient should be instructed to maintain a good hydration level by drinking water or fluids.

Stay near the transplant center: Try to stay near the transplant Centre for at least one to two months to get immediate care in case of an emergency.

Consult your doctor:

Consult your doctor immediately if you notice the following symptoms:

• Fever: consecutive two spikes of 100.5°F OR one spike of 101°F
  • Severe vomiting and diarrhea. These can be signs of GUT GVHD.
  • Skin rash: (a sign of skin GVHD) never delays consulting your transplant physician.

(What is GVHD?)

 So, after the transplant, good care at home and early detection and management of symptoms can have more successful results and keep the patient safe from complications.