In this video, Dr. Sunil Bhat takes us through the entire bone marrow transplant process for thalassemia major. He explains each ...

part-6-bone-marrow-transplant-in-thalassemia-major-the-transplantation-process

Part 6 | Bone Marrow Transplant in Thalassemia Major – The Transplantation Process

[Music] hello uh friends I'm Dr Sunil B here I'm the director and clinical lead of periodic hematology on College and B transplantation at the Nar Bangalore um we have been do this series on thalis measure um this is my third short video on the bone M transplantation in Talis Maia we have discussed two important aspects donor as well as pre-transplant preparation now today we're going to be talking about what the transplant you know is going to be like for the patient and the families so the transplant when we have selected a donor whether it's a full match whether it's a half match with a family donor unrelated donor we also counsel the family talk to them about the potential problems and the preparation before transplantation then we make the arrangements for the patient to be admitted for the transplant per se now the transplant before we admit them we make sure that the patient is well they don't having any infections which can be problematic during transplantation you know their organ functions are okay their heart is okay their Dental is okay the lungs are okay all of that is done as a pre part of pre-transit preparation and and evaluation the second is the donor we also need to make sure the donor is healthy donor doesn't car any infections anything which can be transmitted to the patient their organ functions are okay and it's not going to be harmful for them to donate or even they should not transmit something to the patient so when all that is done we are satisfied with all this we admit the patient for the transplantation now the transplant we I basically divide into four phases first phase is what's called as conditioning or in Lay langage called as chemotherapy what happens this phase which lasts for 6 to 8 days is that the patients get a cocktail of chemotherapy or drugs which are called as conditioning drugs idea of these drugs is to destroy the bone marrow of the patient so that is phase one second phase would be the giving the cells from the donor which is the transplant day or the activity of the transplantation the third phase is what we call as period of low blood counts or period of epia when the new cells have not started working yet and the patient has got low blood counts the fourth phase is going to be period of recovery from the transplantation so going in one by one first phase as I said is conditioning so during this conditioning what we do is that we give them 6 to 8 days of drugs medicines which are given through I line for all the patients we put a Center Line either it's called a Hickman line or a chemoport or a pick line and these lines are used for giving these medications to the patient and they last for as I said 6 to 8 Days idea of these medications is to destroy the bone of the patient completely now these drugs these days are well tolerated you don't have any major problem during this phase but yes some of them may have side effects especially of vomiting um you know some may have you know toxicities especially with regards to heart you know you may have fever rashes with some of the medications but that the are the SS which are can be easily tackled and not of a huge concern once the condition is over the patient then under goes a transplant and Transplant is actually giving the cells of the donor to the patient now whoo the donor is a related unrelated donor whether cells have been collected from the vein which is called as peral stem cell collection or they have collected from the bone marrow it's called as bone marrow Harvest these cells are given to the patient but the in Fusion of the cells is like a blood transfusion it goes again into the vein so there's no surgery involved to the patient it will be a infusion like a blood transfusion it will take depending on how many cells you giving or what it may range from 1 hour to 4 hour if the whole infusion uh May last and these are the cells which are given to the patient now once we given these cells to the patient then then the third phase sets in and that's a phase which is the probably the most difficult phase why because we have destroyed the bone we of the patient the new cells have been given from the donor but they have not started working yet so the patient is not making any blood at that point of time the bone is not functioning hemoglobin is low white cell count is low platelet count is low and we are giving these from outside we can give hemoglobin from out like a blood transfusion we can give plat from a plat transfusion the white cells are very important as cells in the body and they remain low for Next almost 2 weeks and that's why this patient during this phase are very very high risk of infections and that is why during this phase they're kept in special bone met transplant units which are heper filter the food comes in is U eradiated air which they breathe is filtered so that they don't carry get infections from outside the nurses are very very trained there's one is to one nursing and special precautions for infection prevention and there can be other things which can happen during this phase patient can some sometimes mouth ulcers tummy ulcers which can be painful they may not be able to eat properly they may not able may be vomiting they may be you know passing lot of loose tools and during that phase we support them either with the tube feeding or sometimes we give also something call as total parental nutrition from the from the central line which helps their nutrition to be going right third is you know inection risk and fever invariably comes during this phase and we always put them on antibiotics take blood cultures and look off the infections now this fever mucositis or the pain to various degrees you know this question of giving blood products later on during this phase is kind of universal all the patients will have this problem or not eating some vomiting some loose motion happens each and every patient but some patients May develop other complication which can be any and every organ in the body they may have compli the brain they have complication in the lung they may have complication in the liver they may comp the kidneys and we keep on checking these on a frequent intervals so that we can identify them early and address them this period which is very critical as I said lasts for approximately two to sometimes 3 weeks also when the blood has not been started making the new mer has not started working yet after two to 3 weeks the new cells which come from the donor they start working and that's called as engraftment so white cells improve first then the plates improve and then the hemoglobin improves in that order used most of the times you know happens that order and what when that happens things start getting better these ulcers start getting better the vomiting starts getting better the lose motions start getting better fevers if are there they start getting better and the next four to 5 six days is the bone this these new blood cells start working and they come to normal levels and when they come to the normal levels that's a time when we discharge them from the hospital to home and then they come out on on a followup after that so this is approximately a one month of admission to the hospital on average it can be longer if there's any complications it can be shorter if the recovery has been pretty smooth and these are the various phases of the transplantation and you know we need to know as a doctor as as a family as a as a patient what all is expected during these phases and this should be explained to the families in great detail because very important for them to be mentally and physically prepared for what all is expected dur this during this one month of transplantation where they admitted to the hospital so we always hope and pray that the new cells which are coming up in 2 to 3 weeks time are from the donor because that's what we want we want the donor cells to start kicking in and and start multiplying in the patient's body and when they do it you know everyone is happy patients are happy we are happy and you know uh things usually start getting after that so that's what a one month of Journey during the transplant for a thalis patient would look like thank you very much [Music]

Dr.

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