Bone Marrow Transplant and Blood Products

I thought it would be good to include a bit on bone marrow and the blood products Harrison has received. We all see the adverts that ask us to Donate, but here are some interesting facts about why this is really such an important thing. Without these donations of blood products (Intragam and Albumin), Harrison quite simply would not be here.

BONE MARROW - The Australian Bone Marrow Donor Registry has some interesting facts about Bone Marrow and is part of a world wide donor registry. We were very lucky to have Ella match Harrison, but think about this...
From - http://www.abmdr.org.au/Default.htm

Many Australians each year are diagnosed with having leukemia or other fatal blood disorders. A bone marrow (or haemopoietic stem cells) transplant is the only possibility of cure for many of these patients. Donors need to be specifically matched to the patient which can make it very difficult to find a donor for certain patients with rare tissue typing. Only 1 in 1000 donors will be a match for a patient requiring a transplant in any given year.

Siblings are the ideal donor for a patient in need of a bone marrow (or haemopoietic stem cells) transplant, but only one patient in three will find a matched donor within their family. The other two in three patients rely on the ABMDR or other international registries to find them a suitable match.

A person's tissue type is directly related to his or her ethnic origin. Australia needs donors who reflects the many different communities. Without this it becomes difficult to find matched donors of non-European or mixed ethnic backgrounds. (See "National Management Board Discussion Paper --- Review of the Registry Size and Composition")

The ABMDR is the tenth largest registry in the world. Within Australia, the Registry is comprised of:

• Transplant Centres

• State Donor Centres

• Tissue Typing Laboratories

• Apheresis Centres

• Marrow Collection Centres

• Tissue Repository"

The process

To test the compatibility of a donor’s marrow with a patient’s marrow, a small sample of blood is drawn from the potential donor and patient. An HLA (human leucocyte antigen) tissue typing test is performed to determine if the "antigens" or markers on the white blood cells of the donor match those on the patient’s white blood cells.

Each person’s bone marrow has distinct genetic characteristics, half of which are inherited from their mother, the other half from their father. A patient with an identical twin has a ready made donor of perfectly matched bone marrow. Many however, will need to find another person related or unrelated, whose bone marrow matches their own.

In a bone marrow transplant, the patient’s diseased bone marrow is destroyed and healthy marrow is infused into the patient’s bloodstream. In a successful transplant the new bone marrow migrates to the cavities of the large bones, engrafts and begins producing normal blood cells.

The new bone marrow infused into the patient must match the genetic makeup of the patient’s own marrow as perfectly as possible. If the new bone marrow is not a good match, it will recognize the patient’s body as foreign material to be attacked and destroyed. This condition is known as graft versus host disease (GVHD), and can be life threatening.

Harrison shows no signs of GvHd at present which is very encouraging indeed... Ella was identified as a "perfect" match with 6 out of 6 HLA matched.

When Is a Transplant Possible

A successful transplant not only requires matched bone marrow but a patient who is healthy enough to undergo the transplant procedure. A medical physician will determine whether a patient should undergo a transplant, by examining the patient’s:

• Age

• General physical condition

• Diagnosis, and

• The stage of the disease

In most patients, their own marrow must be destroyed (called conditioning), then the new donor (healthy) marrow is infused into the patient’s bloodstream over several hours. Unlike other transplants, a bone marrow transplant is performed in the patient’s hospital room. And for Harrison in particular because he did not have immunity before the transplant he did not have any conditioning.

It may take 3 to 4 weeks for the new bone marrow to engraft and begin producing healthy blood cells. The patient remains in the hospital until a sufficient number of healthy new red blood cells, white blood cells, and platelets are being produced by the new bone marrow. It usually takes 4 to 8 weeks before the patient’s immune system is able to defend itself against infection and bleeding.

So far we have not seen any changes after 16 days.

There are several complications that may result from the transplant. These include:

* Rejection

* Graft versus Host Disease (GVHD)

* Infection, and

* Relapse

GvHD is the most problematic, as this can cause death as the new donor cells start attacking the patient's organ as they don't recognise them.

A lot more detailed info can be viewed at http://www.abmdr.org.au/brochure_recip.htm

Intragam - This is the plasma that Harrison receives (IVIG) that gives him a top up of immunoglobulins, which helps keep him healthy and enables him to fight infection - to a degree anyway.

The Australian Red Cross website says this about Intragam and Albumin:

The majority of donated plasma is processed by the Australian plasma fractionator, CSL Bioplasma Ltd, to make a variety of products that the Blood Service distributes to hospitals. These products include:

Intragam

Intragam is used to boost the immune system and in the treatment of some muscle and nerve conditions.

Albumex 20

A concentrated solution of the main blood protein, albumin, present in human plasma, Albumex 20 is used in the correction of protein deficiency sometimes associated with kidney and liver diseases.

http://www.donateblood.com.au - visit the Australian Red Cross Website for more info.

We have been very lucky with Harrison and obtaining blood products for him, and he will continue to require further Intragam (IVIG) infusions every 4 weeks - or until his bone marrow transplant is shown to be a success. Either way there are many anonymous donors out there that have made this possible thanks to their life giving donations of blood.