Bone marrow transplant

    
A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy
bone marrow stem cells.

Bone marrow is the soft, fatty tissue inside your bones. The bone marrow produces blood cells. Stem
cells are immature cells in the bone marrow that give rise to all of your different blood cells.

Description

Before the transplant, chemotherapy, radiation, or both may be given. This may be done in 2 ways:
 Ablative (myeloablative) treatment. High-dose chemotherapy, radiation, or both are given to kill any cancer
cells. This also kills all healthy bone marrow that remains, and allows new stem cells to grow in the bone
marrow.
 Reduced intensity treatment, also called a mini transplant. Lower doses of chemotherapy and radiation are
given before a transplant. This allows older people, and those with other health problems to have a transplant.
There are three kinds of bone marrow transplants:

 Autologous bone marrow transplant. The term auto means self. Stem cells are removed from you before you
receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer. After high-dose
chemotherapy or radiation treatments, your stems cells are put back in your body to make normal blood cells.
This is called a rescue transplant.
 Allogeneic bone marrow transplant. The term allo means other. Stem cells are removed from another person,
called a donor. Most times, the donor's genes must at least partly match your genes. Special tests are done to see
if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents,
children, and other relatives are good matches. Donors who are not related to you, yet still match, may be found
through national bone marrow registries.
 Umbilical cord blood transplant. This is a type of allogeneic transplant. Stem cells are removed from a
newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a
transplant. Umbilical cord blood cells are very immature so there is less of a need for perfect matching. Due to
the smaller number of stem cells, blood counts take much longer to recover.
A stem cell transplant is usually done after chemotherapy and radiation is complete. The stem cells
are delivered into your bloodstream usually through a tube called a central venous catheter. The
process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone
marrow. Most times, no surgery is needed.

Donor stem cells can be collected in two ways:

 Bone marrow harvest. This minor surgery is done under general anesthesia. This means the donor will be
asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The
amount of marrow removed depends on the weight of the person who is receiving it.
 Leukapheresis. First, the donor is given several days of shots to help stem cells move from the bone marrow
into the blood. During leukapheresis, blood is removed from the donor through an IV line. The part of white
blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient.
The red blood cells are returned to the donor.
 stomal therapy
A stomal therapist is a Registered Nurse who has undergone specialist training in stomal therapy and
PEG tubes.

Stomal therapists educate patients, partners or their carer's in the pre and post-operative care of their
stoma or PEG tube.

What is a stoma?
A stoma is a surgically created opening which allows the elimination of body wastes such as urine and
faeces from the body.

A stoma may be permanent or temporary.

Why do people need a stoma?

Trauma to the bowel
Cancer
Radiation damage to the bowel
Abnormalities a person is born with (congenital)
Inflammatory bowel conditions
To protect a join in the bowel (anastomosis)

Types of stomas
Colostomy
A surgical opening into the large bowel (or colon)
A colostomy may be temporary or permanent
Ileostomy
A surgical opening into the small bowel (or ileum)
An ileostomy may be temporary or permanent
Ileal Conduit
A stoma made from a piece of small bowel to divert urine
What is a PEG tube?
A PEG tube is a tube inserted surgically into the stomach through the abdomen. Please have a read
of this information sheet for details on how to care for your PEG tube.
Care of the bolus extension tubing
For MIC-KEY low profile tubes
 Use warm soapy water to rinse after each feed.
 Rinse out with plain water and then using 50ml syringe, flush with firm pressure to ensure all soap is
removed.
 Shake dry and then towel dry.
 Place in zip lock bag or plastic sealed container and store in fridge.
 Take out 30mins prior to feeding to soften tube.
 PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible
feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition,
fluids and/or medications to be put directly into the stomach, bypassing the mouth and
esophagus. This brochure will give you a basic understanding of the procedure - how it's
performed, how it can help, and what side effects you might experience.

 How is the PEG performed?

 Your doctor will use a lighted flexible tube called an
endoscope to guide the creation of a small opening through
the skin of the upper abdomen and directly into the
stomach. This procedure allows the doctor to place and
secure a feeding tube into the stomach. Patients generally
receive an intravenous sedative and local anesthesia, and
 an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of
the procedure or the next day.

 Who can benefit from a PEG?

 Patients who have difficulty swallowing, problems with their appetite or an inability to
take adequate nutrition through the mouth can benefit from this procedure.

 How should I care for the PEG tube?

 A dressing will be placed on the PEG site following the procedure. This dressing is usually
removed after one or two days. After that you should clean the site once a day with diluted
soap and water and keep the site dry between cleansings. No special dressing or covering is
needed.

 How are feedings given? Can I still eat and drink?

 Specialized liquid nutrition, as well as fluids, are given through the PEG tube. If the PEG tube
is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on
oral intake. Although a few PEG patients may continue to eat or drink after the procedure, this
is a very important issue to discuss with your physician.

 Are there complications from PEG placement?

 Complications can occur with the PEG placement. Possible complications include pain at the
PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction
of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of
gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel
wall). Your doctor can describe for you symptoms that could indicate a possible complication.

 How long do these tubes last? How are they removed?

 PEG tubes can last for months or years. However, because they can break down or become
clogged over extended periods of time, they might need to be replaced. Your doctor can
easily remove or replace a tube without sedatives or anesthesia, although your doctor might
opt to use sedation and endoscopy in some cases. Your doctor will remove the tube using
firm traction and will either insert a new tube or let the opening close if no replacement is
needed. PEG sites close quickly once the tube is removed, so accidental dislodgment
requires immediate attention.

Ticket Details

10000140373804 13351 / DHN ALAPPUZHA

Transaction ID : PNR No. : 6418596571 Train No. / Name :
1 E

Date of Booking : 19-Aug-2018 Class : THIRD AC Quota : PREMIUM TATKAL

Date of Journey : 20-Aug-2018 From : DHN To : MAS

Boarding At : DHN Date Of Boarding 20-Aug-2018 Reservation Up to MAS

 : :

Scheduled Departure*
10:30 Hrs
:

New Time table will be effective w.e.f 15.08.2018. Departure time printed is liable to change. Please check correct Departure
from Railway Station Enquiry, Dial 139 or SMS Rail to 139.

Passenger Details

Sl. No. Name Age Gender Status Coach Seat / Berth / WL No

1 DEVIKA KIRUBA 52 Female CNF B1  30 

Fare Details

Distance : 1789 KM

Ticket Fare : Rs. 4370.00

Service Charge (Inclusive of GST) : Rs. 0.00

Travel Insurance Premium (Inclusive of GST) : Rs. 0.00

Total Fare : Rs. 4370.00 *