Jun 21, 2014
I wish you fruitful and happy new year. I thank each one of you for the faith shown in me in last 2 years. Last year was a busy one and we performed our first allogeneic bone (stem cell) marrow transplant in Nashik. It was first time in India where it was performed in a tier 2 city as this was only done in metro cities. Nashik becomes only the ninth city to perform such a feat and I would like to thank my team for their efforts.
We will soon be performing our first Autologous bone marrow transplant for a patient with Myeloma.
Bone marrow or stem cell transplant is a complex procedure where stem cells (Allogeneic: If the donor is a sibling or unrelated person and Autologous: if one own’s stem cells are used) are given through intravenous line and then they help in restoring the haematological and immune system.
Bone Marrow Transplant Case:
20 years old female had Aplastic Anaemia. It is a disease where blood cell production is severely reduced and the bone marrow is “empty”. She required regular blood with platelet transfusion. We had tried cyclosporine therapy for 3 months with no success. Bone marrow transplant is the best and the only long term curative option for such patients.
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How is Bone marrow transplant done?
- The patient is worked up for the fitness of the procedure. Cardiac, renal and hepatic assessment is carried out and after proper consent the transplant is planned.
- We then tested the patient siblings and she had 2 brothers and 2 sisters. More the better for us! Her brother was typed for HLA (Human Leucocyte antigen) which is unique is a given individual and is inherited from parents. There is only 25% chance that the patients HLA will match their siblings. Her elder brother was HLA match.
- I did the donor assessment with complete body check with viral markers and organ evaluation. He was fit for stem cell donation.
- We have to condition the patient’s marrow (the new “home” for the donor stem cells) with chemo-immunotherapy. We used cyclophosphamide and antithymocyte globulin for the conditioning and this takes 7 days.
- After the conditioning, we then remove stem cells from the donor. In this case we did a bone marrow harvest, where 900ml of bone marrow is aspirated from the donor after giving him general anaesthesia. The donor may need blood transfusion after the procedure.
- We then take the marrow and then omega moon luxury replica watches infuse it through a central line (Hickman Line) over 3 hours just like blood transfusion.
- The new marrow takes approximately 2-3 weeks to settle in and then start functioning producing new blood cells.
- We have to give medication to prevent rejection (cyclosporine and methotrexate) so that the new marrow stays in the recipient system.
- Some patients get “graft versus Host disease” where the donor cells mount an immunological attack on the recepient’s body cells and can present with rash, hepatic and gastrointestinal system involvement.
- Patient has to stay in a single room with strict aseptic precautions for atleast 4 weeks.
- During and 6 months after the transplant the host has reduced immunity and can get various infections including viral, atypical bacterial and fungal infections and hence we give prophylactic medications to prevent such events.
- We have to follow up such patients monthly for 6 months and then regularly for 5 years.
Indications for Bone Marrow Transplant:
- Sickle Cell anaemia.
- Aplastic anaemia.
- Myelodysplastic syndrome.
- Acute leukemia.
- Chronic leukemia.
- Multiple Myeloma.
- Hodgkin’s Lymphoma.
- Non-Hodgkin’s Lymphoma.
- Severe combined immunodeficiency disease.
- Other congenital immunodeficiency syndrome.
We are performing CBC on 5 part differential cell counter, which gives more precise results with regard to platelet count and extensive differential white cell count.
Chronolog Platelet Aggregometer:
We will soon be installing platelet aggregometer which is helpful in evaluating patients with bleeding disorders where routine coagulation tests (PT, APTT and platelet count) are normal. It can also detect anti-platelet drug resistance (i.e aspirin, clopidrogel), which is useful in cardiac patients who have undergone angioplasty and in whom the stent is blocked. We can also perform such tests prior to insertion of coronary stents.
We also perform entire thrombophilia screening (Protein C, Protein S, Anti thrombin III and Factor V leiden) along with Lupus anticoagulant, D-Dimer. It is done at much lower costs then Mumbai Laboratories. Such tests are to be performed after regulated venesection where the plasma has to be separated within 1 hour and stored at -25 celcius. We perform all coagulation tests on fully automated Instrumentation Laboratories (IL) USA 7000 machine.
We are shifting to our state of the art LOTUS Institute of Haematology and Oncology on 17 January 2011 for OPD services and inpatient services will start from 14 February 2011. I will run daily OPD from 17 January. I will still visit Mumbai on Tuesday and Friday (Bombay Hospital, Sion Hospital and MGM Hospital, Vashi) but will come back same day eveining.
Monday: 11-5 pm
Tuesday: 7-9 pm
Wednesday: 11-5 pm
Thursday: 11-5 pm
Friday: 7-9 pm
Saturday: 11-5 pm.
Address for OPD:
LOTUS Institute of Haematology and Oncology,
Bhavik Nagar, opp. Kusumagraj Smarak, Vidya Vikas Circle, Off. Gangapur Road, Nashik 400013.
Tel no. for appointments: 0253-2574967, 2572002.
Formal opening ceremony of our centre will take place in last week of February and you all will get a formal invitation nearer the date!