Transplantasi sumsum tulang dan unsur-unsur penting ditemukan di sana

Bone marrow transplantation is a medical procedure that aims to renew damaged bone marrow. It is no longer possible to produce healthy blood cells. A bone marrow transplant is also called a stem cell transplant.
Bone marrow is a hollow tissue that is located in some human bones, such as the pelvis or chest bones. Bone marrow consists of blood stem cells which can produce new blood cells, including red blood cells, white blood cells and platelets.

Bone marrow can be damaged due to diseases, such as cancer and infections, or due to treatments, such as chemotherapy and radiation therapy for cancer. When the bone marrow is damaged, blood cell production is disrupted, resulting in blood cells that are not healthy, not functioning normally or whose production is reduced.

One way to treat this disease is by doing a bone marrow transplant or stem cells. This procedure is carried out by inserting healthy blood stem cells into the recipient's body to enable it to restore the function of the bone marrow in the production of healthy blood cells.

The purpose of a bone marrow transplant is:

Renew damaged or destroyed bone marrow.
Provides new blood stem cells that can help kill cancer cells directly.
Maintain disease and restore normal bone marrow function after chemotherapy or radiation treatment.
Prevent more serious bone marrow damage from genetic diseases.

Healthy blood stem cells can be obtained from donors (allogeneic bone marrow transplantation) or the patient's body (autogenous bone marrow transplantation). The patient's own blood stem cells or donors will be collected and stored in a cold room and returned or placed in the patient's body at the time of transplantation.
Indications for bone marrow transplantation

Some conditions that indicate bone marrow transplant include:

Aplastic anemia
thalassemia
Myelodysplasia Syndrome
leukemia
lymphoma
Multiple myeloma
Congenital neutropenia (a congenital disease that causes recurrent infections)

Before a bone marrow transplant

Patients and donors must do the following (allogeneic transplant) before undergoing a bone marrow transplant.

Preparations for patients. The patient or recipient must follow a number of steps before the transplant process, including:

Talk to the doctor. The doctor will explain the transplantation process, as well as the side effects and risks of complications that the patient may experience after the transplant procedure.
The patient will undergo a series of tests and pre-transplant procedures to check his general health and condition and to make sure he is physically fit for the transplant. This evaluation process takes several days or more. The types of tests and procedures performed include:
Medical history and general physical examination.
Assessment of emotional and psychological conditions.
Cardiac examinations, such as ECG (electrocardiography) and echocardiography.
Lung examination, such as chest X-ray and spirometry.
Blood tests, which include the calculation of blood counts, blood chemistry and examination of viruses in the blood.
CT or MRI.
HLA (Human Leukocyte Antigen), which identifies human leukocyte antigens, proteins found in most human cells, must be compared between donors and recipients.
Bone marrow biopsy.
After all tests have been completed and the patient is declared ready for a bone marrow transplant, the doctor inserts a long thin tube into a large vein in the patient's chest or neck (central venous catheter). This catheter will be in the patient's body as long as the patient is undergoing treatment that involves inserting blood stem cells, as well as the necessary drugs and blood transfusion.
Preparations for donors If a bone marrow transplant is performed using an allogeneic method, several preparations must be made by the donor, including:
The doctor will explain the procedure that must be followed for bone marrow donation and the risk of complications that may occur to the donor.
Donors will undergo HLA (human leukocyte antigen) tests to identify cell compatibility between donors and recipients.
If the HLA test shows a match, the donor will undergo additional tests to ensure that he does not suffer from genetic diseases or diseases that can be transmitted to the recipient.
After the donor is declared fit, he goes through the process of collecting blood stem cells.

Sources of donors can come from siblings, parents, family members, or unrelated individuals.

Procedure for bone marrow transplantation

A patient goes through several stages to undergo a bone marrow transplant:

Take blood stem cells for transplantation. After the patient completes the examination, blood stem cells will be collected, stored and given with preservatives for later use in transplants. There are three ways to take blood stem cells, which are obtained from the patient himself (autologous) or donor (allogeneic), namely:
Blood (apheresis). This procedure consists in separating the stem cells that are in the blood using a machine called an apheresis machine. This procedure usually lasts 3 hours and can be repeated. Following are the steps for the apharesis procedure:
The doctor will give drugs that stimulate the production of blood stem cells, so that the number of stem cells in the blood increases. Medications are given as injections for 4 consecutive days.
On the fifth day, the doctor will do a blood test to check the number of stem cells in the patient's bloodstream.
If there are enough stem cells in the blood, the apheresis machine will be connected to the patient's blood vessels.
With this machine, the patient's blood will be filtered and separated between stem cells and other blood components. The separated blood will be returned to the patient's body.
Bone marrow (bone marrow harvest). Another method of collecting blood stem cells is with a special syringe in the pelvic bone. The steps of gathering stem cells in the bone marrow, namely:
The patient will lie on his stomach.
The doctor will insert a special syringe through the skin through the pelvic bone into the medullary cavity.
The doctor will suck blood and blood stem cells with a syringe.
After the procedure is complete, the doctor will cover the injection area with a bandage.
Umbilical cord blood. Procedure for collecting blood stem cells from the umbilical cord of a newborn. These stem cells will be frozen and stored until needed for transplantation. Cord blood cells usually contain fewer stem cells, so the recipient needs more time to recover.
Bone marrow preparation. Before the blood stem cell transplantation process, the patient will undergo a process of chemotherapy or radiotherapy treatment. The preparation process usually depends on a number of factors, including the type of disease, the general health condition of the patient and the type of planned transplant. The preparation process aims to:
Destroy existing bone marrow cells, leaving room for new stem cells to be transplanted.
Destroy existing cancer cells.
Disrupt the immune system to reduce the risk of rejection of transplanted cells.

Transplantation process. After the preparation process, the patient will rest for several days before undergoing the transplant process. Some things to do during the transplant process:
The doctor will give drugs to patients who receive stem cells through an IV to reduce the risk of preservative effects that are used to protect stem cells when stored.
The doctor will melt the stem cells when it's hot.
After the stem cells are liquid and ready for use, the doctor slowly introduces blood stem cells through a central venous catheter. This process usually takes a few hours. The patient will undergo a bone marrow transplant process in a conscious state but will not feel pain.

When new blood stem cells enter the patient's body, they begin to move to the bone marrow. Once in the bone marrow, these cells multiply and begin to form healthy new blood stem cells (graft). This process usually takes 10 to 28 days after transplantation. An early sign of the transplant process is an increase in the number of white blood cells. This condition indicates that the body's stem cells begin to multiply and form new blood cells. The time needed for blood to return to normal depends on the patient and type of transplant, but usually between 2 and 6 weeks.
After a bone marrow transplant

During the first few weeks after transplantation, the patient will have a small number of red blood cells, white blood cells, and platelets, so that the patient's body will be very sensitive to disease. To overcome this, the doctor will take the following steps:

Keep a close eye on the condition of the patient who is very susceptible to infection.
Give medicines to treat or prevent infection, including antibiotics, antivirals or antifungals.
Monitor blood cell count regularly.
Transfer blood if the patient needs more blood.
Give nutrition by infusion until the patient can eat by mouth.
If a transplant uses an allogeneic method, the doctor will prescribe drugs to weaken the immune system to reduce the risk of the body attacking transplant cells.

After undergoing the recovery process in the hospital and his condition was quite good, the patient was allowed to go home. Some considerations that doctors want patients to return home:

There is no fever for 48 hours.
Can eat and drink by mouth for at least 48 hours.
Nausea, vomiting and diarrhea can be controlled with medication.
The number of blood cells which initially decreased has increased and is no longer considered dangerous.
Have someone to help patients at home and have a supportive home environment

After the patient leaves the hospital, the recovery process lasts from 3 months to 1 year. Patients should not do too much activity and increase their rest until they are completely healed. Several factors influence the duration of the patient / recipient recovery process, including: