If your bone marrow has been invaded with cancer cells, hematopoietic stem cell removal may be preceded by one or more courses of chemotherapy. Removal (called harvest) of bone marrow stem cells is done while you are under general or epidural anesthesia. The harvest is done by using a long needle to repeatedly remove a sample of bone marrow fluid from multiple areas in your pelvic and hip bones.
Tips Bone Marrow Growth Factors
Peripheral blood
The harvest of peripheral blood stem cells is similar to the process of platelet donation. It uses an apparatus, called an apheresis device, which removes hematopoietic stem cells from blood by a filtration process. Blood is removed from a vein in one location, filtered, and then returned to a vein in another location. The process does not require anesthesia.
In order for there to be sufficient numbers of hematopoietic stem cells in the blood, you (or the donor) must first be treated with either chemotherapy or a growth factor that stimulates the production of hematopoietic stem cells. Healthy donors only receive growth factor; patients with cancer may receive growth factor alone or chemotherapy plus growth factor. The most commonly used growth factor is granulocyte colony-stimulating factor.
Allogeneic bone marrow harvest People who donate their bone marrow will undergo harvest the day of transplant or one day prior. The donor is usually given general anesthesia to prevent pain.
Following the procedure, pain in the donor is usually relatively minor and can be treated with pain medications such as acetaminophen. The donor may be hospitalized overnight following the procedure, and generally returns to his or her prior state of health within the following one to two weeks.
Myeloablative therapy As noted above, many patients receiving bone marrow transplantation will undergo myeloablative therapy, which destroys bone marrow function as part of the intensive treatment for the patient's underlying cancer. The purpose of this treatment is to reduce the amount of cancer in the body and also to suppress the immune system adequately so that the graft will not be rejected. Depending upon the underlying disease and other factors, this phase of treatment may involve intensive chemotherapy, total body irradiation (radiation therapy), or both.
After your bone marrow or cord blood transplant, your new cells will start to grow and make new blood cells. This is called engraftment. Engraftment is an important milestone in your transplant recovery.
Risk of infection
You will be at highest risk of infection until your new cells engraft. This is because you will have fewer than normal numbers of white blood cells. White blood cells are the part of the immune system that help prevent or fight infections. Your health care team will take steps to protect you from infections and treat any infections that develop. If you experience any symptoms of infection tell your doctor right away. For tips on how to minimize the risk infections, see Infection prevention.
Diet can have significant effect on the immune system function. Overeating, especially consuming foods rich in simple carbs such as sugar and too much fat, can negatively affect the ability of your body to fight infections. Overeating increases insulin which can interfere with immune system function.
On the other hand, malnutrition can have similar effect. Because of this, it is important to have balanced diet which consists of mainly natural, unprocessed foods and avoid overeating.
Also, short term fasting and controlled calorie restriction can actually reflect positively on white blood cell production.
When it comes to exercise, short-term, high-intensity activities such as sprinting are much better in boosting immune system function unlike long distance running. Actually, jogging and especially marathons can have opposite effect on its function.
Many marathon, triathlon and ironman competetors often get sick after such demanding competitons, due to drastic increase in cortisol which is characteristic for these kind of activities. Cortisol suppress immune system which decreases production of white blood cells.
On the other hand, exercises such as sprinting can stimulate activity of the bone marrow and increase growth hormone, while preventing chronic increase in cortisol production.
Managing side effects after a bone marrow transplant
Some important medications you will take after your transplant, such as those used to prevent graft-versus-host disease or infection may cause side effects with different degrees of severity. Tell your health care team about any side effects you experience. Often there are ways to reduce side effects or make medications more tolerable.
Transfusions and growth factors
Until your new cells engraft, you may get red blood cell or platelet transfusions. The number of blood and platelet transfusions you will need will vary greatly between patients and even at different times for the same patient.
After an autologous transplant, when you receive your own cells for the transplant, some patients also receive growth factors. Growth factors are medications that stimulate the marrow to make more blood cells, and help transplanted cells engraft more quickly. A common growth factor for white blood cells is granulocyte-colony stimulating factor. Some patients may also receive growth factors to stimulate the marrow to make more red blood cells or platelets.
Waiting for engraftment
After you receive your transplant, your care team will watch you closely for signs of engraftment. Engraftment is when the new blood-forming cells start to grow and make healthy blood stem cells that show up in your blood.
You will have daily blood samples taken while you are waiting for your cells to engraft. A laboratory will perform a CBC, or complete blood count test. The CBC test shows the numbers of and kinds of cells in your blood.
Neutrophil engraftment
Neutrophils are a type of white blood that are important for fighting bacterial infections. Neutrophils are also an important measure of engraftment.
Neutrophils in your bloodstream will be counted in your CBC. An absolute neutrophil count (ANC) of 500 or more for 3 days in a row is a sign of engraftment.
For patients who receive marrow or peripheral blood stem cells, neutrophil engraftment can occur as early as 10 days after transplant but is more common around 14-20 days. Patients who receive cord blood may need more time to engraft (typically about 25 days but sometimes as long as 42 days).
Platelet engraftment
Platelets help control bleeding. Your CBC test will show the number of platelets in your bloodstream. A platelet count of 20,000 to 50,000 is a sign of platelet engraftment.
For patients who receive marrow or PBSC (peripheral blood stem cells), platelet engraftment often happens a little bit after neutrophil engraftment. For patients who receive cord blood, it may be 8 weeks or longer after transplant before platelets engraft.
Your diagnosis, "bone marrow growth disorder," is indeed rather vague. All blood cells - red blood cells, white blood cells, and platelets - are manufactured in our bone marrow. You have evidence of a deficiency or suppression of both your red cells (anemia) and white cells (neutropenia). Hopefully, your hematologist is searching for the exact cause of these deficiencies or suppression of your bone marrow.
Anemia can be associated with many symptoms, including fatigue, rapid heartbeat, shortness of breath, etc., and this is probably at least partially responsible for your feeling "tired and sluggish." The treatment for anemia depends on the cause or causes. You are apparently deficient in B12 and B6, which can lead to anemia, and therefore are being treated with vitamin supplementation. Procrit is a medication that is biologically indistinguishable from a naturally occurring hormone called erythropoietin. Procrit stimulates the bone marrow to make additional new red cells. It cranks up the production at the red cell factory (the bone marrow). It is not a "cure" for an underlying problem, but it can be extremely helpful in raising red blood cell counts and thus in resolving the symptoms associated with anemia.
White blood cells help us fight off certain types of infections - particularly bacterial infections. Your low count could put you at increased risk. There is a medication for stimulating white blood cell production. Its effect on white blood cells is analogous to that of Procrit on red cells. It's called neupogen. As for your condition "veering into leukemia if not treated," I'd suggest you talk to your hematologist and ask for more details.
Since this is an HIV information site, I'll assume you are also HIV-positive. You should also have your HIV specialist discuss your condition with your hematologist. Bone marrow suppression can result from certain HIV medications (such as AZT) or certain HIV/AIDS-related opportunistic infections.
Your "tired and sluggish feelings" should improve as your Procrit kicks in and your anemia improves. The usual starting dose is 40,000 units once per week. It's self-administered by a small injection given just under the skin.
Build Strong Bones
Characterized by weak and brittle bones, osteoporosis and its precursor osteopenia affect 44 million Americans and cause more than 2 million bone fractures every year, according to the American Academy of Orthopaedic Surgeons (AAOS). Fortunately, there's a lot you can do to keep your bones strong and lower your risk of osteoporosis. It's never too early to start.Click through the slideshow to learn simple ways to keep your bones strong.
Start Young
Think of your bones as a retirement savings account; you need to bank a lot of funds when you're young so that you have plenty to draw on as you get older. Bones reach peak density when you're in your 20s. From then on, your job is to keep those levels up by getting enough calcium and vitamin D, exercising, and taking other steps.
Milk It
Milk is full of calcium (the foundation of healthy bones) and vitamin D (helps the body absorb calcium). On its own, vitamin D helps build and repair bones and keeps muscles strong, which reduces the risk of falls.
Aim for 1,200 mg of calcium a day—about four glasses of nonfat milk or three cups of nonfat yogurt—and 1,000 of vitamin D, according to the National Osteoporosis Foundation. If you don't do dairy, drink calcium- and vitamin D-fortified orange juice, or non-dairy fortified milks like soy, almond or coconut milks and consider taking supplements.
Don't Smoke, Limit Drinking
Smoking increases the rate of bone loss. Women who smoke have lower levels of estrogen and tend to hit menopause sooner, both of which accelerate bone loss.
If you drink, keep it to no more than two drinks a day for men and one drink a day for women. Anything more will interfere with your body's ability to absorb calcium and will also slow new bone formation.
Meat in Moderation
The popular saying “all things in moderation” definitely applies to meat, especially when it comes to healthy bones. Calcium and phosphorous help the body digest animal protein. Eating too much red meat, fish, pork, and poultry can sap these resources from the bone.
On the other hand, protein deficiency hinders calcium absorption in the intestines. The solution? Limit your animal protein intake to no more than twice a day, and eat small portions—about 3 ounces, or the size of a deck of cards.
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