Before your Transplant

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BMT Work-up

Before a blood or marrow transplant it is important to make sure all of the organs are healthy and you/your child is free from infection.  Blood tests, scans and other tests will be performed to check each organ system for its level of function and to look for potential sites of infection.  It is also important to evaluate the underlying disease and ensure that you/your child is in remission or at the best point for a bone marrow transplant.

You/your child will undergo a thorough medical evaluation two to three weeks prior to admission. Your medical team will decide what studies need to be done. The evaluation may include some of the tests listed below:

Echocardiogram (Echo):  This test is a type of ultrasound, it records the echoes of sounds sent through the heart.  This test shows the size of the four chambers of your heart as well as how well the heart muscle contracts. 

Pulmonary Function Test (PFT):  This is usually done on kids who are over age 5 or 6 years old.  The test measures your/your child’s lung capacity.  You/your child will be asked to breathe into a mouth piece that is attached to a machine.

CT Scan (Sinuses/Chest):  This is a computed tomography scan, which is a type of X-ray that takes pictures of your/your child’s body.  It provides pictures of the sinuses and chest to evaluate you /your child for potential infections in these areas.

Dental Evaluation:  You/your child will have a dental exam to make sure there are no hidden infections or abscesses or teeth that need pulled.  If your child needs to have significant dental work, the transplant may need to be delayed.

Creatinine clearance:  This is a test done to check how well your kidneys work.  It can be done one of two ways.  A collection of your urine for 24 hours, this can be done at home and brought in to the hospital the next day.  Or a Renal scan can be performed on younger children who are not potty trained yet.  A renal scan is an x-ray that takes pictures of your kidney and tells us how well they work.

Blood tests:  Blood tests will be performed to evaluate the kidneys, liver function, to check for germs that cause infections during a bone marrow transplant, such as CMV (cytomegalovirus), Hepatitis, or HIV.

Depending on the type of transplant and your/your child’s condition, you /your child may have to undergo some additional test.  These may include:

Brain Magnetic Resonance Imaging (MRI):  An MRI scan uses magnets, rather that X-Rays, to produce more detailed images by sending  radio waves into the body and then measures the response with a computer.  The computer makes a picture or image.  This is often used to look at the brain and spinal cord.

Audiogram:  Is a test that measures hearing. Headphones and speakers are used to evaluate your/your child’s response to sound.  The extent of the testing is based on age and the test usually last for about 1 hour.  Parents may stay in the room during the testing.

Developmental/Neuropsychometric testing:  These are special tests that are given by a Psychologist to determine cognitive (intellectual) and psychosocial abilities and milestones of your child.  In addition, to age specific testing, parents are asked to respond to questions.  It usually takes two 4 hour sessions to complete the entire testing.  The information is useful to both parents, the health care team and your child’s teacher, to provide anticipatory guidance and support for learning.

Bone Marrow Aspirate and Biopsy:  Cells are removed from the bone marrow. A bone marrow aspiration and biopsy usually take 20 to 30 minutes to complete.  This test is painful so local anesthesia and sedation are utilized.  These are often done in a special setting so your child can be monitored while receiving sedation.  This is done for patients with leukemia or diseases that may go to the bone marrow or for patients whose bone marrow has failed.

Spinal tap/Lumbar Puncture:  The test is done by inserting a needle between the backbones of the lower back called the lumbar spaces.   A clear fluid called cerebrospinal fluid (CSF) surrounds the brain and spinal cord.  A sample of this fluid is removed using a needle and is tested for cancerous cells or infection.  Another name for spinal tap is a lumbar puncture.  The procedure takes 15 to 30 minutes and patients may need to receive sedation to undergo this procedure.

If your child has cancer, there may be other scans done to determine the stage of your/your child’s disease prior to undergoing BMT.  These will be the scans your child has had previously to monitor their disease.

  • Additional evaluation may be needed with other specialists. These specialists may include: Radiation Oncologist (for patients who will be receiving radiation as part of their bone marrow transplant conditioning regimen), Neurologist (specialist in the nervous system); Endocrinologist (specialist in hormonal glands); Pulmonologist (specialist for the lungs); Cardiologist (specialist for the heart) in addition to others.

While the pre-transplant work-up and evaluation is being completed, a tentative schedule is established for admission for transplant.  This will vary depending on your/your child’s need for additional treatment prior to transplant and if an unrelated donor search is necessary.

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Donor Work-up

It is also important that the donor is healthy.  The donor will have a physical exam and blood tests drawn.

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Medical Disclaimer

The information on the website is intended to introduce you to some of the medical procedures and treatments which you/your child may receive when undergoing a hematopoietic progenitor cell transplant. The information on the website provides general guidelines but cannot replace the recommendations of your primary medical team. Specific patient care treatment options and procedures are the prerogative of each patient and their medical care team. You are encouraged to discuss any concerns or questions you have with your medical care team. Although every attempt has been made to post information that is clear and accurate, no guarantee is made to the reliability, completeness, relevancy, accuracy, or timeliness of the content. No liability is assumed by the Pediatric Blood and Marrow Transplant Consortium for any damages resulting from use or access to information posted on this website.