Haematology is the branch of medicine which deals with the study of blood, a vital fluid which is essential for our existence. The bone marrow is a soft, spongy tissue present inside the bones and produces the red and white blood cells and the platelets. The marrow also contains unspecialized cells called Hematopoietic . Stem cell transplant surgeon in india which can turn into other types of cells such as bone marrow cells or any type of blood cells.
Fortis International Care Hospital is one of the best BMT and haematology hospitals in India concerned with the diagnosis and treatment of both benign and malignant disorders of the blood, which is caused by an abnormality in the functioning of the bone marrow. The Department of BMT & Haematology is staffed with skilled and qualified haematologists practicing evidence-based treatment adhering to international standards as well as cutting edge facilities, making it a highly preferred centre for bone marrow treatment and haematology treatment in India. Our haematologists are adept in the complete spectrum of haematology treatment, including bone marrow transplantation, blood cancer treatment, treating leukaemia disease, and other conditions such as an abnormal white blood cell and/or platelet count, enlarged lymph nodes and bleeding or clotting disorders. Our expert specialists are also proficient in the field of paediatric haematology.
Paediatric Haematology is a sub-specialty which deals with the diseases of the blood in pre-teens and adolescents. These ailments can be hereditary, such as thalassemia or sickle cell anaemia, autoimmune diseases affecting the blood like autoimmune haemolytic anaemia, and other white blood cell diseases. For this we adopt a multidisciplinary approach where specialists from different department work in tandem to treat the patients effectively.
Fortis Hospital is a leader in the combined fields of haematology and oncology, as it has the required expertise and infrastructure to diagnose and treat the complete range of blood cancer as well as non-cancerous blood diseases. We are constantly involved in researching different forms of cancer in order to treat them more effectively. We also provide best-in-class patient care and a customized cancer therapy for our patients.
Hematopoietic stem cells (HSCs) are the stem cells that give rise to other blood cells. This process is called haematopoiesis. This process occurs in the red bone marrow, in the core of most bones. In embryonic development, the red bone marrow is derived from the layer of the embryo called the mesoderm.These includes autologous and allogeneic transplants in children and adults including matched unrelated and haplo identical transplants with and without T cell depletion
The conditions which necessitate a Hematopoietic stem cell transplant can be broadly classified into 2 groups and below are the few examples:
Hematopoietic stem cells are taken from the patient either by bone marrow harvest or apheresis for collection of peripheral blood stem cells, cryopreserved and then given back to the patient after high dose chemotherapy.
It is indicated in following conditions
Hematopoietic stem cells are taken from the healthy donor either by bone marrow harvest or apheresis for collection of peripheral blood stem cells.
There are various types of donors used for HSCT
Matched sibling donor (MSD): Haematopoietic stem cells are taken from a genetically matched donor (6/6 or 10/10), usually a brother or sister. This type of MSD can be found only in 25-30 % of cases.
Matched unrelated donor (MUD): As only 30 % of patients who require a stem cell transplant finds a matched sibling donor, for the rest 70 % of cases we have to search for a donor either in Indian or international recognised stem cell registries. If patient finds a 10/10 (or 9/10 in specific conditions) donor, we will approach concerned registries to get stem cells.
Haploidentical donors -A haplo-identical match is when the donor is a parent and the genetic match is at least half identical to the recipient. As many patients don’t have a MSD or MUD, haplo identical hematopoietic stem cell transplants are indicated in such cases. It can be done carried out either by giving post-transplant cyclophosphamide or various T cell depletion techniques like TCR alpha/beta, CD 19 or CD 45 RA depletion.
Umbilical cord blood transplant: Either matched 6/6 or mismatched 5/6 (or 4/6 in specific conditions) unrelated cord blood cells can be used as source of stem cells for transplants(Either single or double units).
We first assess patients to confirm that they will benefit from stem cell transplantation. Several tests are also done to ensure that the patient is fit to undergo the treatment. If an allogeneic transplantation is being planned then we test the patient's brothers, sisters and if required, parents to find an HLAmatched donor within the family. If there is no HLAmatched donor in the family then we assess if the patient will benefit from receiving stem cells from an unrelated donor. An international donor search is then initiated and if such a donor is found, then a matched unrelated transplant (MUD) is done. We also ensure that the donor is fit to donate stem cells.
The patient is then admitted to our BMT unit for the 'conditioning regimen' which prepares his bone marrow space for transplantation. The donor stem cells are harvested either form the bone marrow or the peripheral blood. These stem cells are then infused in to the patient's veins, just like a blood transfusion is given. The patient does not have to undergo any surgery. The patient is then monitored for complications such as infections and these are treated, if they occur. Once the patients are stable and the new bone marrow starts producing blood cells (usually within 2-3 weeks) they are discharged and are followed up in the day-care and the out-patient department usually for 2-4 months to detect any new complication.
In the first few weeks after transplantation, patients are at a risk of infections. To decrease the risk of infections patients are kept isolated in rooms where the air is filtered to prevent fungal infections (HEPA filter). They are given food with a low bacterial load. We monitor patients for infection and attempt to treat these promptly and effectively.
In allogeneic stem cell transplantation patients are given medicines such as Methotrexate and Cyclosporine to prevent the donor cells from attacking the patient's organs, this condition is called as Graft Versus Host Disease (GVHD). Some patients will nevertheless develop GVHD and in most of these we are able to control it. Some patients may develop GVHD which persists after the first 100 days since transplantation and then they are said to have chronicGraft Versus Host Disease (cGVHD).
Occasionally the donor stem cells may be rejected by the patient's body and then we try to support them with transfusions and antibiotics. Some of these patients might benefit from a second stem cell transplantation.
Stem cell donation is generally considered to be a safe procedure. The majority (more than 98.5%) of donors, who donate bone marrow, feel completely recovered within a few weeks. A small percentage (1.34%) of donors experience a serious complication due to anaesthesia or damage to bone, nerve or muscle in their hip region. The risk of side effects of anaesthesia during marrow donation is similar to that during other surgical procedures. Serious side effects of anaesthesia are rare. Common side effects of general anaesthesia include sore throat (caused by the breathing tube) or mild nausea and vomiting. Common side effects of regional anaesthesia are a decrease in blood pressure and a headache after the procedure. For donors who give stem cells from the peripheral blood, less than 1% experience a serious side effect from the donation process. We take all the necessary precautions to ensure the safety and wellbeing of the donor.
We have a multidisciplinary team consisting of renowned medical oncologists, Haematologists, Paediatric haematology-Oncologists, Surgical oncology, Radiation Oncology and Nuclear medicine specialists. We have an expert team of BMT physicians with experience of more than 800 haematopoietic stem cell transplants. We have a state of the art Hematopoietic stem cell transplant unit consisting of 7 bedded facility with high end HEPA filtered rooms, isolation facilities, laminar flow and dedicated BMT trained physicians & nurses.The unit is also supported by a patient centric multidisciplinary team of transfusion medicine physician, intensivists, nephrologists, gastroenterologists, surgeons, cardiologists, endocrinologists, hematopathologist, dietician and physiotherapist.
With our fine expertise, state-of-the-art technology, excellence in super specialty procedures, high success rates, an integrated team approach and world class facilities we ensure to deliver the best quality