BONE-MARROW TRANSPLANT

General Information

DEFINITION--Removal of bone marrow from a donor for introduction into the bloodstream of a recipient.

BODY PARTS INVOLVED

• Donor: Ilium (part of the hip joint).
• Recipient: Vein.

REASONS FOR SURGERY--

Strengthening of the recipient's immune system, which has become weakened from one of the following:

• Acute leukemia. > Severe combined immunodeficiency disease (See Glossary). > Severe aplastic anemia. SURGICAL RISK INCREASES FOR BOTH DONOR OR RECIPIENT WITH > Obesity. > Smoking. > Poor nutrition. > Recent or chronic illness. > Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone. > Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--General surgeon, hematologist or pediatrician.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; studies of bone marrow of both donor and recipient.
• After surgery: Blood studies in recipient to determine success of transplant.

ANESTHESIA--Spinal, epidural or general anesthetic.

DESCRIPTION OF OPERATION

• Before surgery, the donor is examined for communicable diseases, and the recipient is treated with immunosuppressive drugs. Sometimes, the recipient also receives radiation treatment.
• Marrow is harvested from the back of the pelvic bone of the donor or with a needle-syringe technique.
• The bone marrow is filtered and then injected into one of the recipient's veins.

POSSIBLE COMPLICATIONS

Donor:

• Excessive bleeding.
• Surgical-wound infection. Recipient:
• Rejection of transplanted bone marrow.
• Uncontrolled infections.

AVERAGE HOSPITAL STAY

• Donor: overnight.
• Recipient: varies from 3 weeks to several months.

PROBABLE OUTCOME

• Donor: minimum risk.
• Recipient: 20-80% survival rate in patients with otherwise incurable diseases.

Postoperative Care

GENERAL MEASURES---The recipient should be isolated from attendants, family and visitors to protect the recipient from infection.

MEDICATION---

Donor:

• Your doctor may prescribe: Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. Antibiotics to fight infection. > You may use non-prescription drugs, such as acetaminophen, for minor pain. Recipient: > Immunosuppressants to prevent rejection of bone marrow. > Antibiotics to prevent infection.

ACTIVITY---

For donor and recipient:

• Return to daily activities and work as soon as possible. > Avoid vigorous exercise for 6 weeks after surgery.

DIET--Donor and recipient should have a clear liquid diet until gastrointestinal function resumes. Then a well--balanced diet will promote healing.

Call Your Doctor If

Any of the following occurs in either the donor or recipient:

• Nausea or vomiting.
• Increased pain, swelling, redness, drainage or bleeding in the surgical area.
• Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• New, unexplained symptoms. Drugs used in treatment may produce side effects.