MEDICAL SURGICAL NURSING

STEM CELL AND BONE MARROW TRANSPLANTATION

• SUBMITTED TO• MR.P.YONATANSIR• ASSOCIATE PROFESSER

SUBMITTED BYMRS HEENA MEHTAS.Y.M.SC NURSING

LESSION PLAN

• Title of the course: S.Y. M.SC NURSING• Topic: Stem cell and bone marrow transplantation• Date-08-09-2012 Place: 3RD YEAR B.SC NURSING

CLASSROOM• Class hours: 1 HOURS • No of students: OF 3RD YEAR B.SC.NURSING

STUDENT• Language: LACTURE BY ENGLISH• Teaching Methods: LACTURE CUM DISCUSSION

Anatomy of cell

Function of human cell

• The cell is responsible for all of the functions of metabolism that support the body.

• . Blood cells transport oxygen, GLUCOSE, and other NUTRIENTS throughout the body and collect molecules of metabolic waste that cells in the liver and KIDNEYS dismantle, recycle, or eliminate from the body.

• NERVE cells conduct electrical impulses. MUSCLE cells contract the HEART and move the body.

• Other cells make hormones, absorb nutrients, fight INFECTION, and so on.

• Regardless of their specializations, however, the primary activity of all cells is the synthesis of the enzymes and proteins that carry out the biochemical tasks of living

what is stem cell

• Stem cells are biological cells found in all multicellular organisms,• It can divide (through mitosis)

and differentiate into diverse specialized cell types and can self-renew to produce more stem cells.

• In mammals, there are two broad types of stem cells: • embryonic stem cells, which are

isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues.

Embryonic stem cell

Definition Embryonic stem cells is the removal of cells from the blastocyte 4-5 days post fertilization for medical research.

Adult stem cellAdult stem cells, like all stem cells, share at least two characteristics. First, they can make identical copies of themselves for long periods of time; this ability to proliferate is referred to as long-term self-renewal. Second, they can give rise to mature cell types that have characteristic morphologies (shapes) and specialized functions.

what is bone marrow transplantation

• Bone marrow transplantation (BMT), also called hematopoietic stem cell transplant or hematopoietic cell transplant, is a type of treatment for cancer.

sources of bone marrow stem cell

• Different source of bone marrow stem cell

1)Peripheral blood stem cells ( PBSCs)-

2)Bone Marrow Harvest3)Umbilical Cord Blood Stem cell

Peripheral blood stem cells ( PBSCs)-• PBSCs are collected by an Aphresis .• A process in which the donor is connected to a

special cell separation machine via a needle inserted in the vein. Blood is taken from the vein and circulate though the machine which removes the stem cells and return s the remaining blood and plasma back to the donor though another needle inserted into the opposite arm.

Bone Marrow Harvest

• Bone marrowHarvesting involves collecting stem cell with a Needle placed into the soft cencer of the bone, the marrow. Mosst sites used for bone marrow harvesting are located in the hip and the sternum.

Umbilical Cord Blood

•Stem cell are filtered from blood in the umbelical cord after a baby is born

Indication for bone marrow stem cell transplantation

• multiple myeloma or leukemia• severe combined immunodeficiency

or congenital neutropenia with defective stem cells• children or adults with aplastic

anemia

• sickle-cell disease,• myelodysplastic syndrome, • neuroblastoma,• lymphoma, • Ewing's Sarcoma,(malignant small, round, blue cell

tumour. It is a rare disease in which cancer cells are found in the bone or in soft tissue)

• chronic granulomatous disease and Hodgkin's disease.

types of bone marrow stem cell

• There are two main types of bone marrow transplantation: • autologous and • allogeneic

Autologous transplant • — In autologous transplantation • your own hematopoietic stem cells are

removed before the high dose chemotherapy or radiation therapy.• and are then frozen for storage and later

use. • After chemotherapy or radiation is

complete, the harvested cells are thawed and returned to patient.

Allogeneic• In allogeneic transplantation,• the hematopoietic stem cells come from a donor,

ideally a brother or sister with a similar genetic makeup. If you do not have a suitably matched sibling, an unrelated person with a similar genetic makeup may be used. Under some circumstances, a parent or child who is only half-matched can also be used;

•

Myeloablative transplant •myeloablative transplant uses

very high doses of chemotherapy or radiation prior to transplantation with autologous or allogeneic hematopoietic stem cells.

Non-myeloablative transplant• A non-myeloablative transplant, sometimes

referred to as a "mini" or reduced intensity transplant.

• Allows to have less intensive chemotherapy before transplantation with allogeneic hematopoietic stem cells.

• This approach may be recommended for a variety of reasons including age, type of disease, other medical issues, or prior therapies.

PRE-BONE MARROW TRANSPLANTATION PROCEDURES

• Bone marrow transplantation regimens vary from one patient to another, and• depend upon the type of cancer, • the treatment program used by the

medical center, • the clinical trial protocol (if the patient

is enrolled in a clinical trial), as well as other factors.

BMT procedure• The bone marrow harvest is the same for

autologous and allogeneic transplants. • Harvesting is done under general

anesthesia .• Bone marrow is drawn from the iliac crest

with a special needle and a syringe.

• Several punctures are usually necessary to collect the needed amount of bone marrow, approximately 1–2 quarts. • (This amount is only a small percentage

of the total bone marrow and is typically replaced within four weeks.) • The donor remains at the hospital for 24–

48 hours and can resume normal activities within a few days

• If the bone marrow is meant for an autologous transplant. it is stored at -112–-320°F (-80–-196°C) until it is needed. • If a patient's own bone marrow can be

used for transplantation peripheral stem cells may be harvested from the patient's circulating blood.

• The bone marrow or peripheral stem cells are administered to the recipient via a catheter inserted into a large vein in the chest. • The donor cells look like a bag of

blood and are infused for about 20–30 minutes.• During the infusion, the patient's

blood pressure, pulse, and breathing are monitored.

POST-BONE MARROW TRANSPLANTATION CARE

• A two- to four-week waiting period follows the marrow transplant before its success can begin to be judged.

• The marrow recipient is kept in isolation during this time to minimize potential infections.

• The recipient also receives intravenous antibiotic, antiviral, and antifungal medications, as well as blood and platelet transfusions to help fight off infection and prevent excessive bleeding.

• Blood tests are performed

• daily to monitor the patient's kidney and liver function, as well as nutritional status. • Other tests are performed as

necessary. • Further side effects, such as nausea

and vomiting, can be treated with other medications.

side effect of the bone marrow stem cell transplantation

• The high-dose chemotherapy and total body irradiation required for bone marrow transplantation can have serious side effects

Some of the most common side effects include:• Mucositis (mouth sores) and diarrhea• Nausea and vomiting • Loss of hair • Infertility • Organ toxicity • Secondary cancers • Graft versus host disease • Graft failure • Risk of death

•Summary•Conclusion

Bibliography • Javed Ansari, T/B of medical surgical nursing part-

B,P.V.Book,page no-1211,1212.• Web site• www.cancer.org• www.cell anatomy.com• www.stemcell.com• www.cancer treatment.org• www.wikipedia.com

Assignment

•Write the role of nurse for bone marrow transplantation in pediatric

Thank you and have a nice day