BONE MARROW TRANSPLANT

DEFINITION
 A procedure in which a patient receives healthy blood-forming cells (stem cells) to replace
their own stem cells that have been destroyed by disease or by the radiation or high doses
of anticancer drugs that are given as part of the procedure.
 The healthy stem cells may come from the bone marrow of the patient or a donor.
 A bone marrow transplant may be autologous (using a patient’s own stem cells that were
collected from the marrow and saved before treatment), allogeneic (using stem cells
donated by someone who is not an identical twin), or syngeneic (using stem cells donated
by an identical twin). Also called BMT.

PURPOSE
The goal of a bone marrow transplant is to cure many diseases and types of cancer. When the doses
of chemotherapy or radiation needed to cure a cancer are so high that a person's bone marrow stem
cells will be permanently damaged or destroyed by the treatment, a bone marrow transplant may
be needed. Bone marrow transplants may also be needed if the bone marrow has been destroyed
by a disease.

A bone marrow transplant can be used to:

 Replace diseased, nonfunctioning bone marrow with healthy functioning bone marrow (for
conditions such as leukemia, aplastic anemia, and sickle cell anemia).

 Regenerate a new immune system that will fight existing or residual leukemia or other
cancers not killed by the chemotherapy or radiation used in the transplant.

 Replace the bone marrow and restore its normal function after high doses of chemotherapy
and/or radiation are given to treat a malignancy. This process is often called rescue.
 Replace bone marrow with genetically healthy functioning bone marrow to prevent more
damage from a genetic disease process (such as Hurler's syndrome and
adrenoleukodystrophy)

INDICATION

The following diseases are the ones that most commonly benefit from bone marrow
transplant:

 Leukemias

 Severe aplastic anemia

 Lymphomas

 Multiple myeloma

 Immune deficiency disorders

NURSING RESPONSIBILITIES

The phases of bone marrow transplantation can be identified as the pre-transplant period, the
immediate post-transplant period, and the late post-transplant period. The pre-transplant period is
characterized by identification of the appropriate type of transplant to be done and, if necessary,
finding an appropriate donor; entry of the patient into the transplant unit; administration of the
preparative chemotherapy/irradiation regime; management of early toxicities; and pre-transplant
supportive care. Nurses play an integral role during the entire transplant process. During the
pre-transplant phase, nursing expertise is exemplified in the administration of chemotherapy,
management of side effects, teaching of transplant procedures to patient and family, and
supportive care
 RENAL TRANSPLANT
DEFINITION
A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor
into a person whose kidneys no longer function properly.
PURPOSE
A kidney transplant is often the treatment of choice for kidney failure compared to a lifetime on
dialysis. A kidney transplant can treat chronic kidney disease with glomerular filtration rate (GFR,
a measure of kidney function) less than or equal to 20 ml/min and end-stage renal disease to help
you feel better and live longer.
INDICATION
 Patients with End-Stage Kidney Disease on dialysis.
 Patients with advanced chronic kidney disease (stage IV or V with calculated or
estimated GFR <20ml/min.
 Patients with chronic kidney disease (stage IV with GFR <30ml/min) that also need
another organ transplant.
 Patients with chronic kidney disease that have type 1 Diabetes that has not responded to
medical treatment may also be considered for a combined kidney-pancreas transplant.
NURSING RESPONSIBILITIES
In the pre-transplantation phase, the nurse plays a vital role in assisting the patient to tackle the
challenges associated with Renal Transplantation. Pre-transplant interventions include:
physical, psychological and educational support to the patient and family members
Since, Kidney Transplantation is an elective procedure, the entire procedure requires extensive
pre-transplant evaluation and the patient is normally maintained on a schedule of pre-transplant
dialysis
Transplant is delayed with the onset of chest pain, infection, pneumonia, or gastrointestinal
bleeding. If the serum potassium exceeds 5.5 mEq/l, the patient is put on dialysis preceding the
transplant procedure.
Post-transplant nursing care for the patient begins in the post-anesthesia care unit (Cunningham
et.al, 1992).
Since the transplant is placed in a heterotropic retroperitoneal location in the lower pelvis, nurse's
awareness of the transplant positioning in the operating room is vital for an effective postoperative
care (Claudia, 2004)
Monitoring Urinary Function
- I&O monitoring q hourly
- Daily Weighing
- Intravenous fluids as ordered
Patient Education and Home care Considerations
- Lifelong regular follow-up consults
- Lifelong immunosuppressive therapy
Psychological Consideration
- Fear or Kidney rejection
- Counsel patient
- Do not give false reassurance
- Provide adequate information to ease anxiety