BONE MARROW

TRANSPLANT
SUBMITTED TO: DR. KARANJOT SINGH
SUBMITTED BY: JASMEEN KAUR
WHAT IS BONE MARROW TRANSPLANT?

• A bone marrow transplant is a treatment that replaces

unhealthy marrow with a healthy one. It is also called a
blood or marrow transplant (BMT).
WHAT IS BONE MARROW?

• Bone marrow is the soft, spongy tissue inside the bones that
makes blood forming cells (blood stem cells). These cells
turn into blood cells including:
• White blood cells to fight infections.
• Red blood cells to carry oxygen throughout the body.
• Platelets to control bleeding.
• Blood forming cells
are also found in the
blood stream and the
umblical cord blood.
TYPES OF BONE MARROW TRANSPLANT

1. Autologus Transplants: Autologus transplants involve

the use of person’s own stem cells. They typically
involve harvesting the cells before beginning a damaging
therapy to cells like chemotherapy or radiation. After
treatment is done, the own cells are returned to the body.
• This type of transplant isn’t always available. It can
only be used if the patient have a healthy bone
marrow. However, it reduces the risk of some serious
complications, including GVHD.
2. Allogenic Transplants: Allogenic transplants involve the
use of cells genetic match. Often, a compatible realtive is the best
choice, but genetic matches can also be found from a donor
registry.
• Allogenic transplants are necessary if a condition that has
damaged bone marrow cells.
• However, they have a higher risk of certain
complications, such as GVHD. Also probably need to
be put on medications to supress the immune system so
that the body doesn’t attack the new cells. This can
leave susceptible to illness.
• The success of an allogenic
transplant depends on how
closely the donor cells
match own.
WHAT DIESASE CAN BMT TREAT?

Bone marrow transplants can treat:

• Blood cancer like leukemia or lymphoma.
• Bone marrow disease like aplastic anemia.
• Other immune system or genetic diseases like sickle
cell disease.
WHAT ARE THE COMPLICATIONS ASSOCIATED
WITH A BONE MARROW TRANSPLANT?

A bone marrow transplant is considered a major medical procedure and

increases your risk of experiencing:
• A drop in blood pressure.
• A headache.
• Nausea
• Pain
• Shortness of breath
• Chills.
• A fever.
The above symptoms are typically short-lived, but a bone marrow
transplant can cause complications. The chances of developing
these complications depend on several factors including:
• Age
• Overall health.
• The disease being treated for.
• The type of transplant be received.
Complications can be mild or very serious, and they can include:
• Graft-versus-host disease(GVHD), which is a condition in
which donor cells attacks the body.
• Graft failure, which occurs when transplanted cells
don’t begin producing new cells as planned.
• Bleeding in the lungs, brain, and other parts of the body.
• Cateracts, which is charactetized by clouding in the lens
of the eye.
• Damage to vital organs.
• Early menopause.
• Anemia, which occurs when the body doesn’t produce enough red
blood cells.
• Infections
• Nausea, diarrhea or vomiting.
• Mucositis, which is a condition that causes inflammation and
soreness in the mouth, throat and stomach.
INDICATIONS

• Bone marrow transplant is done to treat a number

cancerous and non-cancerous conditions such as:
☆ Cancerous conditions:
• Leukemia.
• Lymphoma
• Multiple myloma
• Myelodysplasia
☆ Non-canerous conditions:
• Aplastic
• Hemoglobinpathies
• Immunodeficiency disorders and conditions affecting blood present
rom birth.
• Leukemia:Leukemia, a cancer of the
blood-forming tissues characterized
by a large increase in the numbers of
white blood cells (leukocytes) in the
circulation or bone marrow.
• Lymphoma: This type of
cancer starts in the white blood
cells, or lymphocytes. As it is
present in the bloodstream, it
can spread, or metastasize, to
different parts of the body.
• Multiple myloma:Multiple myeloma is a cancer that forms in a type
of white blood cell called a plasma cell. Plasma cells help you fight
infections by making antibodies that recognize and attack
germs.Multiple myeloma causes cancer cells to accumulate in the
bone marrow, where they crowd out healthy blood cells. Rather than
produce helpful antibodies, the cancer cells produce abnormal
proteins that can cause complications.
• Mylodysplasia:Myelodysplastic syndromes are a group
of disorders caused by poorly formed blood cells or ones
that don't work properly. Myelodysplastic syndromes
result from something amiss in the spongy material inside
the bones where blood cells are made (bone marrow).
• Aplastic anemia: Aplastic anemia is a condition in which occurs when the
body stops producing enough new blood cells. Aplastic anemia leaves the
feeling fatigued and with a higher risk of infections and uncontrolled bleeding.
A rare and serious condition, aplastic anemia can develop at any age. It may
occur suddenly, or it can occur slowly and get worse over a long period of
time. Treatment for aplastic anemia may include medications, blood
transfusions or a stem cell transplant, also known as a bone marrow transplant.
• Hemoglobinpathies:Hemoglobinopathies are inherited conditions that affect
the number or shape of the red blood cells in the body. These conditions can
be very different from one another. Some hemoglobinopathies can cause life-
threatening symptoms, while others do not cause medical problems or even
signs of the condition. Mild hemoglobinopathies may require no medical
treatment. However, when severe cases are left untreated, they can cause a
shortage of red blood cells (anemia), organ damage or even death.
• Immunodeficiency disorders and condition affecting blood present form
birth: Immunodeficiency disorders are a group of inherited conditions
affecting the immune system. From the time of birth, the immune system of
a child with a IDD does not function properly and cannot fight off
infections, due to a problem in white blood cells, such as T lymphocytes or
B lymphocytes. A defective immune system can cause children to get sick
faster and for longer periods of time from usual childhood infections.
HOW BONE MARROW TRANSPLANT IS
PERFORMED?
• In allogenic transplant, bone marrow cells will be
harvested from the donor a day or two days before the
procedure. If own cells are used, they’ll be retrived
from the stem cell bank.
Cells are collected in two ways:
During a bone marrow harvest cells are collected from both hip
bones through a needle. The patient is under anesthesia for this
procedure, meaning be asleep and free of any pain
• Leukapheresis: During leukapheresis, a donor is give five
shots to help the stem cells move from the bone marrow and
into the bloodstream. Blood is then drawn through an
intravenous(IV) line, and a machine seperates out the white
blood cells that contains stem cells.
A needle called a central venous catheter, or a port, will
be installed on the upper right portion of the chest. This
allows the fluid containing the new stem cells to flow
directly into the heart. The stem cells then disperse
throughout the body. They flow through the blood and into the
bone marrow. They’ll become established there and begin to
grow.
The port is left in place because the bone marrow transplant
is done over several sessions for a few days. Multiple sessions
give the new stem cells the best chance to integrate themselves
into the body. This process is known as engraftment.
 HOW CAN PHYSIOTHERAPY HELP?

Physiotherapy uses exercises to build your muscles, improve

your movement and improve your health. A specially trained
health care professional called a physiotheraist can:
• Assess(check) and treat if muscles are weak and have a
difficulity time to moving around.
• Create exercise program to help muscles become stronger.
• Do a functional assessment before go to home from the
hospital, if needed. A functional assessment measures
how well you are able to do difficult daily tasks.
• Help to understand the benefits of exercise programs
that will help to take part in the recovery.
WHAT ARE THE BENEFITS OF EXERCISE?

Exercise can:
• Help prevent or improve weak muscles.
• Help prevent other problem that come with being in bed for a long
time, such as skin and breathing problems.
• Help to improve the health and energy levels.
• Help to cope while you get your treatment.
• Keep the patient active and help to do more things own.
 EXERCSE WHILE PATIENT IS IN THE HOSPITAL

1. Strenthening exercises:
• Strengthening exercise will help muscles
become stronger.
• Provide with weights if needed.
2. Riding the stationary bicycle: This
will improve endurance.
• Start with no resistanceand pedal at an
even speed.
• Start with 5 to 10 min a day and increase
tp 15 to 20 min a day at even speed
3. Walking:
• The patient is recommended get out of room and
walk around the unit at least 3 times a day.
• Start with 1 lap around the nursing station each time
and increase the distance when the patient feel he
can.
• Blood level guide for exercise: It is
important to keep tract of the blood counts to
know whether or not the patient should use
of energy for exercise. If While exercise, this
guide will help to know how much to do.
DON’T EXERCISE IF YOU:

• Are very tired or feel very weak.

• Feel dizzy
• Feel your heart beating very fast or skipping beats.
• Have bad nausea ( Feel like you are going to throw up)
• Have shortness of breath.
• Have a fever that is greater than 38°C or 101°F.
EXERCISES AT HOME:

• Turn the head to one side

until he feel a stretch. Hold
for 20-30 seconds. Do the
same on the other side.
Repeat 10 times.
• Move the chin towards the
chest until he feels a stretch
in the back of the neck.
Hold for 20-30 seconds.
Repeat 10 times.
• Slowly tilt the head sideways. Bring
ear towards the shoulder until feel
stretch on the opposite side (don’t lift
the shoulders). Hold for 20-30
seconds. Slowly bring the head upright
again. Do the same on the other side.
Repeat 10 times.
• Roll in shoulder in circles
back to front 10 times. Then
roll the shoulder in circles
front to back 10 times.
• To begin, relax the shoulders.
Bring both shoulders up
towards the ears. Slowly lower
back to the relaxed position.
Repeat 10 times.
• Sit with both feet on the floor.
Slowly straighten the legs and
hold for 10 seconds. Repeat
10 times on both legs.
• Sit with both feet on the floor.
Keep the knee bent as he lift his
leg up off the seat. Hold for 5
seconds. Return to the starting
position. Now do the same with
other leg. Repeat 10 times.
• Lie on the side of a bed. Keep the
bottom leg bent and upper leg straight.
Lift upper leg up, keeping the foot
parallel to the ceiling. Hold for 5
seconds. Slowly lower the leg to the
starting position. Repeat 10 times with
both legs.
• Lie on the back. Bend the leg
and bring your knee slowly
towards the chest. Slowly bring
the leg back to the starting
position. Do the same with other
leg. Repeat 10 times.
• Lie on the back or sit on a chair
or on the edge of the bed. Bend
and straighten the ankles.
Repeat 10 times with both the
ankles.
• Stand up straight and hold on to
a support. Lift the leg backward
slowly. Keep the knee and body
straight. Don’t lean forwards.
Slowly bring the leg back down.
Repeat 10 times with both legs.
• Stand up straight and hold on to a
support. Slowly lift the leg to the
side. Keep the trunk (middle of
your body) straight while doing
exercise. Slowly bring the leg
back down. Repeat 10 times with
both legs.
• Stand up straight and hold on to a
support. Place the feet shoulder width
apart. Slowly bend the knee to a squat.
Don’t bend the knees too much. Only
bend them about 30 to 40 degrees
( Less than half way down). Return to
the starting poition. Repeat 10 times.
• Stand up straight and hold on to a
support. Slowly bring the knee and
bring the heel up towards the
buttocks. Hold for 5 seconds.
Return to the starting position.
Repeat 10 times on both legs.
• Stand up straight and hold
on to a support. Slowly push
up onto the toes. Return to
the starting position. Repeat
10 times.