LOTUS - Institute Of Haematology, Oncology and Bone Marrow Transplantation 


 

Newsletter 1 April 2012



Jun 21, 2014

Dear colleagues,

Last 3 months were very exciting as we performed our first Stem Cell (Bone Marrow) Transplant at Lotus Institute in Nashik. It was possible due to your good wishes and hence now Nashik becomes the 10 centre in India to perform such a feat. We continue our quest for regular updates in Haematology and Oncology.

Aims and objectives:

Case 1:

Referred By Dr Praveen Jadhav, Dr Prashant Purandare and Dr N Kasliwal

Mast AK, is a 14 year old male referred for raised WBC and joint pain. He was diagnosed to have acute Lymphoblastic leukemia. Further studies showed him to have a genetic abnormality (Philadelphia Chromosome 22 ). His chances of survival with just chemotherapy were only 10%. Such patients need a stem cell transplant for survival. He responded well to initial chemotherapy.

Procedure for a bone marrow transplant:

  • Mast AK had only one sibling, 11 year old brother. We did a special type of matching called HLA (Human Leucocyte Antigen) typing. There is 25% chance of a sibling being match! Luckily for AK, his brother VK was a complete match.
  • Donor (VK) was evaluated and was fit to donate the stem cells. He received 5 injections of granulocyte colony stimulating factor (Neupogen) to “BRING” his stem cells from bone marrow to his “peripheral blood”.
  • The donor was “harvested”on apheresis machine on day 5, the same machine we use to harvest platelets (SDP).
  • Our patient was admitted for preparative chemotherapy 9 days prior to the transplant date. The date of harvest from the donor was matched exactly with the day our patients bone marrow was “EMPTY” to receive the new stem cells.
  • Harvested stem cells were given through a central line as we give blood transfusion.
  • The donor was discharged on the same day! He had no complications.
  • The new stem cells took 14 days to settle in and after 2 weeks the patient WBC count normalized and he was discharged.
  • The patient has to be kept in a special room (transplant room) with air filters and double door to reduce chances of infection as the risk of sepsis is very high.
  • All our staff (cleaning, nursing and medical) is trained for the procedure. This is very important and hence there were no untoward complications during the procedure.
  • On Day 28 after the transplant we performed  bone marrow on our patient and sent it for special test called “chimerism assay” which detects the percentage of “donor” cells in the recipient and expectedly the patient had”100%” donor cells!
  • Our patient does not need any chemotherapy and is cured of leukemia.
  • He will be revaccinated after 1 year as he is “newborn” from immune system point of view!

Indications for bone marrow (stem cell) transplant:

  • Acute leukemia.
  • Lymphoma and Hodgkin’s disease, Multiple Myeloma.
  • Thalassaemia major and sickle cell anaemia.
  • Immunodeficiency disorders, Aplastic anaemia panerai replica watches etc.

Case 2:

Ref by Dr Sameer Badakh, Shrirampur.

3 year old female was referred for easy ecchymosis (bruises) and prolonged bleeding after trauma. On examination she had ecchymosis but no purpura. Basic investigations like CBC, PT, APTT, S.Fibrinogen, Thrombin time were normal. Platelet aggregation studies confirmed the diagnosis of Glanzmann’s thrombasthenia.

What is Glanzmann’s thrombasthenia?

It is a qualitative platelet defect where the number of platelet are normal, but there is a defect in the platelet aggregation and hence a platelet plug is not formed at the bleeding site and the patient has easy bruising and bleeding from mucosal surfaces. This disorder is not diagnosed on routine testing and we need to perform special studies “PLATELET AGGREGATION STUDIES”. We use variety of platelet aggregation agonists like collagen, epinephrine, ADP to study platelet aggregation.


Treatment:

  • Platelet transfusion is the only treatment for this disorder, even though the platelet count is normal!
  • Female patients usually have problem at menarche.
  • FFP and Cryoprecipitate should NOT be used.

Platelet Aggregometer Installed at LOTUS diagnostics:

We have installed platelet aggregometer at LOTUS Tag Heuer Aquaracer Replica diagnostics 2 months ago. Now we can boast of a “Complete” coagulation and bleeding workup in Nashik.
Other indications of platelet aggregometer?

  • Detect resistance to Aspirin and clopidrogel before a coronary artery stenting as the incidence of resistance and hence stent blockade is as high as 15-25 % in some studies. We may be able to detect the anti-platelet drug resistance beforehand and treat patient with alternative anti-platelet agent if required.


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