The anaesthetic management of bone marrow harvest for transplantation

Immediate and long-term somatic effects, and health-related quality of life of BM donation during early childhood. A single-center report in 210 pediatric donors

Since 1968, when Leiden undertook the first successful European pediatric BM transplantation with a 7-year-old sibling donor, more than 300 young children have donated BM in our unit. We first retrospectively studied a cohort of 210 donors, younger than 13 years at donation, to survey procedures of donor eligibility and study immediate effects of BM donation. We then performed a long-term follow-up (FU) and health-related quality of life (HRQoL) study. Despite documentation of previous medical conditions, no child was declared unfit to donate. We found that iron deficiency anemia or low-iron stores in BM did not result in treatment or extended FU. Harvest volumes exceeded 15 mL/kg in 65% of donors, with more than half requiring allogeneic blood transfusions. Donors had no structured FU after their first post-donation control. In this study, 25% of donors reported at least one somatic complaint at long-term FU. Finally long-term HRQoL revealed high scores in most subdomains (representing a higher QoL), compared to norm groups. These results indicate the need for development of (inter)national guidelines for pediatric stem cell donor care management.

Health-related quality of life of unrelated bone marrow donors in Japan

To promote bone marrow donation, both the safety and well-being of healthy unrelated volunteer donors must be protected. This prospective cohort study evaluated donors' health-related quality of life (HRQOL) and identified factors associated with it. Using the Medical Outcomes Study Short Form 36 Health Survey (SF-36) before bone marrow harvesting (BMH), and again 1 week and 3 months after the donors' discharge, we evaluated HRQOL of 565 donors (329 men, 236 women) registered with the Japan Marrow Donor Program (JMDP). We also examined the data routinely collected by the JMDP, such as BMH-related problems and other demographic and medical variables, to determine whether such data could be used to predict donors' HRQOL after discharge. Mean scores of all pre-BMH SF-36 subscales showed better functioning than the national norm. One week after discharge, mean scores on physical functioning (PF) and role-physical (RP) subscales, indicative of physical states, and bodily pain (BP) were approximately 1 SD lower than the national norm; however, mental health (MH) and general health perception (GH) remained above normal; the most frequent BMH-related problems were pain at the donation site and lower back pain, which were associated with lower PF, RP, and BP scores. Female gender and duration of procedure predicted lower PF, RP, and BP. Three months after discharge, mean scores of all SF-36 subscales had returned to baseline levels. These data show that the adverse effects of BMH on donors' HRQOL are transient and can be minimized by better management of pain.

Autologous bone marrow harvesting in outpatients

STUDY OBJECTIVE

To assess the experience with autologous bone marrow harvesting in outpatients.

DESIGN

Retrospective analysis of outpatients who underwent autologous bone marrow harvesting from 1990 to 1992.

SETTING

University-affiliated surgical day hospital.

SUBJECTS

235 outpatients who underwent 264 autologous bone marrow harvests. Patients are candidates for autologous bone marrow harvesting on an outpatient basis if they are Karnofsky performance status of 80-100 and ASA status I, II or III.

MEASUREMENTS AND MAIN RESULTS

The incidence of perioperative complications and hospital admission from the Surgical Day Hospital, the duration of the harvesting procedure and postanesthesia care unit (PACU) stay, details of the postoperative pain management, and costs and charges of the outpatient procedure compared with the same procedure performed on inpatients were assessed. Mean age was 37.7 years +/- 10.5 SD; + 7.7% patients were male and 52.3% were female. The disease process included non-Hodgkin's lymph/ma (30.3%), leukemia (24.3%), metastatic breast cancer (18.4%), Hodgkin's disease (17.3%), testicular carcinoma (6.5%) and other (1.6%). The patients were ASA status II (54.5%) or ASA III (45.5%) and received general endotracheal anesthesia. Each patient had 10.7 ml/kg +/- 2.8 SD of marrow harvested over a period of 110.7 minutes + 30.4 SD and total recovery room time of 233.7 minutes +/- 85.5 SD. Of 251 harvest, only three (1.1%) required hospital admission. PACU complaints included transient hypotension and dizziness (5.3%), nausea (3.8%), vomiting (3.4%), and (1.9%) temperature elevation. 83.7% of patients were reached at home the following day and 4.1% complained of nausea and/or vomiting at home. 6.8% of patients experienced temperature elevation at home. Only 27.1% of patients took the acetaminophen with codeine that was prescribed. The reminder required no opioid at home. Outpatient charge/ inpatient charge was 51.1%, and outpatient cost/inpatient was 74.4%.

CONCLUSION

Autologous bone marrow harvesting is an acceptable ambulatory surgical procedure that results in a very law postanesthesia complication rate. Postoperative pain is easily controlled. The outpatient setting offers cost and time advantages to the patient.

Regional versus general anesthesia for bone marrow harvesting

STUDY OBJECTIVE

To compare regional versus general anesthesia for bone marrow harvesting.

DESIGN

Retrospective study.

SETTING

Inpatients at a bone marrow transplantation unit of a university medical center.

PATIENTS

One hundred sixty-two donors: 63 healthy patients donating heterologous marrow, 99 patients donating autologous marrow.

INTERVENTIONS

Anesthesia and patient charts from 1986 to 1990 were reviewed.

MEASUREMENTS AND MAIN RESULTS

Regionally anesthesized patients required less transfused blood in the perioperative period, even though more bone marrow was aspirated. This group also required less postoperative analgesia. We found no difference between the groups with regard to length of hospitalization or amount of colloid required in the perioperative period.

CONCLUSIONS

Our data suggest that both modes of anesthesia can be safely administered. Further investigations should be carried out to determine whether the two types of anesthesia, regional and general, are equivalent.

Bone Marrow and Peripheral Blood Stem Cell Harvesting

A number of malignant diseases are responsive to supralethal myelotoxic high-dose chemoradiotherapy, and can be treated with hematopoietic stem cell rescue. The number of genetic diseases correctable by replacement of defective pluripotent stem cells with normal stem cells or through gene transfer is ever-increasing. In all these cases, pluripotent hematopoietic stem cells need to be infused, which can be obtained directly from the bone marrow or from the peripheral blood with or without the aid of mobilizing strategies. This article is a detailed review of the technical and medical aspects of stem cell collection from the bone marrow and the peripheral blood.

Anesthetic considerations in the pediatric cancer patient

Cancer is second only to trauma as the leading cause of death in children 1-15 years of age. Pediatric cancer patients have unique physiologic, pharmacologic, and psychologic considerations that present a unique challenge to plan anesthesiologist. A thorough understanding of pediatric tumors, along with chemotherapeutics and their complications, is necessary to plan anesthetic management properly. Special attention is directed to the psychologic needs and preparation of both the patient and parents. Close cooperation and coordination among the pediatric oncologist, surgeon, and anesthesiologist are necessary for safe and expeditious operative care.

[Anesthesia and bone marrow harvesting in children]

Allogeneic bone marrow transplantation is increasingly used to treat a great variety of disorders which range from genetic conditions to leukaemia. Most often, the donor is a healthy sibling of the patient. Bone marrow harvesting in young children is a very painful procedure requiring anaesthesia; this presents yet more risk for the donor. In order to analyse the specific problems related to this procedure, a retrospective study was carried out on 30 anaesthetic records of marrow-harvesting procedures performed between January 1980 and December 1987. The 30 harvests were carried out in 28 patients (15 boys, 13 girls). Mean age of donors was 6 +/- 0.8 yr (range: 13 months to 17 yr). Twenty-seven patients were classed ASA I and one ASA II. The harvests were all carried out in prone and intubated patients. The volume of removed marrow was 350 +/- 80 ml (range 170 to 600 ml). This was equivalent to a mean 21% estimated blood volume (6-37%). Blood transfusion with phenotyped irradiated blood was carried out in 18 patients, and with autologous blood in one. Mean duration of the procedure was 88 +/- 6 min and the mean stay in hospital was three days. The potential risks for the children are discussed, as well as the related legal problems.