Deciding to have a transplant is a significant event. It is like embarking on a long, challenging journey. Throughout the journey, patients will access a number of facilities.
For your journey, the transplant process is divided into seven steps that guide a patient. The steps begin with how to prepare for the journey and include what to expect along the way.
The planning phase begins when the patient first considers transplant as a treatment option. The goals of this phase are to make the decision to accept transplantation, to gain access to treatment, and to make preparations to initiate treatment. What shoulb be done are:
Choosing A Transplant Center based on your physician Opinion ,Geographic location ,your Insurance and Personal preference
Selecting A Caregiver A responsible adult who has been educated by the transplant teamer is necessary to assist patient after hospitalization with daily activities, as well as to assess the patient for symptoms that should be reported to the transplant team.
It is necessary to aranage to stay in Tehran throughout the transplant process. And spouses of patients with small children should also arrange somebody to their child care during this period
The preparation phase begins when the patient arrives at the treatment center and begins the process of medical evaluation, orientation, informed consent, and other preliminary activities. Family members will be educated to assume the caregiver role.
The outpatient evaluation or “work-up” may last from two to 10 days, depending on the number of tests that were performed prior to arrival, the complexity of the tests, and the clinical decisions that arise when the results are compiled.
After the medical evaluation has been completed, a conference will be held to discuss the findings. In the conference, the individualized treatment plan will be discussed. Informed consent will be obtained. This is a shared decision-making process between the patient and the health care provider. Included in the conference will be a discussion about the nature and character of the proposed treatment, the anticipated results, the recognized alternative forms of treatment and the risks.
The education program for patients and their caregivers will be performed by an expert nurse and nutritionist to learn how to give and record medications. Report problems and keep safety in food preparation and management of nutrition problems at home.
Prior to the start of the actual transplant process, a central venous access catheter will be placed. The bone marrow or peripheral blood stem cells, hydrating fluids, nutritional supplements, medications, and blood products will be administered through this catheter as needed. Patients who arrive with a central venous catheter already in place will have the catheter assessed by the transplant team and a decision will be made to either use the existing catheter or to replace it.
A bone marrow harvest is a surgical procedure requiring general or spinal anesthesia. Multiple aspirations from the crests of the pelvic bone will be performed. If the marrow is to be used for an autologous transplant, it may be cryopreserved (frozen) and stored. If the marrow is to be used for an allogeneic transplant, the marrow will be infused within 24 hours of harvest.
The process of collecting peripheral blood stem cells is divided into three stages: mobilization, collection and reinfusion. Mobilization is accomplished by administration of medication that causes the stem cells to leave the tissues they normally occupy and to circulate in the bloodstream. These cells are then collected using a pheresis machine. Once pheresed, autologous stem cells may be cryopreserved, while allogeneic stem cells are infused immediately.
The conditioning phase begins the actual transplant process.
During this phase, high-dose chemotherapy, radiation therapy, or both are initiated. Chemotherapy and radiation therapy are given in doses that obliterate the marrow function and result in the greatest possibility of destroying the disease. Depending upon the chemotherapy agents and radiation therapy administration schedule, some conditioning therapy can be administered in the outpatient setting, thus potentially shortening the inpatient stay.
The transplant phase is the infusion of donor bone marrow or stem cells.
After the conditioning regimen is completed, the patient receives the infusion of bone marrow or stem cells. The actual infusion is a relatively simple procedure using the patient’s central venous catheter.
This phase includes close monitoring, supportive treatment, and management of complications while waiting for signs of engraftment (new cell growth).
In addition to watching for the first signs of engraftment, the patient continues to require careful monitoring and management of complications. A systematic method of assessment, providing for the patient’s needs and, at the same time, encouraging the patient’s involvement in their own care will be key to a rapid recovery.
Many patients find the experience of waiting for engraftment stressful. Patients have said that it helps to keep as active as possible, to talk with others, to attend support groups, to request visits by pastoral care representatives, or social workers, and to engage in activities that temporarily allow them to take their mind off of treatment.
The team of physicians and nurses, along with nutritionists, make daily rounds of each patient. This provides an excellent opportunity to ask questions and to be involved in the planning of care.
Approximately 10 to 28 days after transplant, signs that the new bone marrow or stem cells are engrafting (growing and developing) can be expected. Close monitoring will continue along with supportive care. Preparation for the return of the patient to the referring physician or center will begin.
This is the phase after the first signs of engraftment, when the patient is recovering immune and marrow function. As the new immune system is developing, the goal remains to support the patient’s recovery both physically and emotionally.
As the patient recovers and no longer needs intensive medical monitoring and nursing care, preparation for discharge from the inpatient setting will begin.Communication will take place between the primary care team and the physician back home regarding ongoing needs that the patient may have. There also will be some education in long-term follow-up/post-transplant needs and nutrition.
The long-term recovery phase involves leaving the treatment center, dealing with any ongoing clinical issues, and re-establishing life patterns.
Taleghani Hospital BMT center follows patients and also plays as a consultant f or patients and home-town physicians when questions arise about patient care, medications, and so on. Prior to departure, a phone number will be provided for contacting this department.
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