Hospital admission ,Testing & Examination
After entering the Bone Marrow Transplant (BMT)ward, the patient first baths and then disinfects her/his body with a chlorine solution and wears sterile clothing.
The patient is instructed by the ward nurse in the inpatient room and receives training on room equipment and the names of nursing staff and physicians and other services required.
Routine necessary tests for receiving bone marrow
will be done and the patient is instructed on why and when to take a mouth wash.
Getting a central venous catheter or central line
Since patients undergoing bone marrow transplant, need to inject a lot of medication and regular blood samples are needed , it is best to implant a catheter in the central vein for IV medication injection, blood transfusions and taking blood samples .It also reduces the number of needle pokes the patient will need. A central venous catheter is inserted in the operating room by the surgeon
Collecting stem cells
After general health tests and examination depending on whether the stem cells are harvested
autologous or allogeneic ,stem cells need to be removed either from the patient or donor.
Stem cells harvesting can be done through two methods. The first method is collecting stem cells traditionally from the pelvic bone in which a needle penetrating into your pelvic bone through a surgical procedure and the second way is called PBSC and requires taking injection called G-CSF (Granulocyte Colony Stimulating Factor) for five days prior to the transplant to make sure Blood Stem Cells are released into the bloodstream from the marrow ,then stem cells are collected nonsurgical by the help of a device called Aphaeresis unit and are stored for transplant.
After stem cell collection, the patient undergoes chemotherapy appropriate to his or her condition with or without radiation.
This chemotherapy makes the diseased bone marrow cells of the recipient person
wiped out . In allogeneic transplant that stem cell is taken from the donor, at the same time that the stem cells are harvested from the donor , chemotherapy is performed for the patient.
Usually stem cell infusion or stem cell injection is preformed 12 to 14 hours after the last day of chemotherapy. These cells are injected via the CN catheter and usually based on the number of stem cell bags that lasts 6 - 3 hours.
Injecting cells is performed by BMT nurse and during the injection, vital signs and physical condition of the patient are checked.
Required training is provided by the BMT nurse at each stage.
With engraftment of bone marrow and growth in the number of WBC and platelet cells the patient's general condition is getting better.
At this stage, training is needed to prepare the patient's home environment.
Training the patient's family about the necessary care after transplantation is provided by the BMT nurse.
Bone marrow samples are taken before discharge. The CV catheter is removed by the nurse at the doctor's request .Necessary training on how to take oral medications at home ,how to take care of yourself and how to continue isolated conditions are provided by the nurse. Patients are required to visit the clinic and for periodic post-transplant examinations