�The special nurses: plays a vital role in taking care of bone marrow transplant (BMT) patients�

Bangladesh is a developing country and it faces many challenges especially in the health sectors. Cancer management is a priority due to increased incidence.  Among various types of cancers, the blood cancer has become a challenge in this
country.  
Blood related cancers affect the production and function of our blood cells. Most of these cancers start in our bone marrow where blood is produced.   The bone marrow is the spongy substance soft, fatty and immature cells inside our bones which are called stem cells. Stem cells in our bone marrow mature and develop into three different types of blood cells: red blood cells, white blood cells, and platelets. In most blood cancers, the normal blood cell development process is interrupted by uncontrolled growth of an abnormal type of blood cell.

The bone marrow is the spongy substance soft, fatty and immature cells inside our bones which are called stem cells. Stem cells in our bone marrow mature and develop into three different types of blood cells: red blood cells, white blood cells, and platelets. In most blood cancers, the normal blood cell development process is interrupted by uncontrolled growth of an abnormal type of blood cell.

These abnormal blood cells, or cancerous cells, prevent our blood from performing many of its normal functions, like fighting off infections or preventing serious bleeding and providing energy.
So, these blood related cancers and certain genetic blood and immunity disorder such as leukemia, lymphomas, aplastic anemia, immune deficiency disorders etc are managed and treated by Bone Marrow Transplant (BMT).
Bone Marrow Transplant: Since the first successful hematopoietic stem cell transplant (HSCT) was done in late 1950s (Copelan, 2006). In 2006, a total of 50417 HSCTs were performed worldwide, the majority of which were in Europe (48%) and the Americas (36%) and Asia only (14%) (Gratwohl et al, 2010).
The First “Bone Marrow Transplant” in Bangladesh: A historical landmark was achieved with the introduction of the first Bone-Marrow Transplant (BMT) unit by Dhaka Medical College Hospital (DMCH) in March 2014.
It was a successful collaboration between the best hospitals of Bangladesh and America under the watchful stewardship and assistance of A K Khan Healthcare Trust (AKKHT) and the Ministry of Health & Family Welfare (MHFW), Bangladesh.
Bone Marrow Transplantation is a special procedure to replace the damaged or destroyed bone marrow with the healthy bone marrow under the assistance of expert medical team including: Physicians, Nurses, Medical Technologists and so on by their close monitoring.  
The goal of BMT is to transfuse healthy bone marrow cells into a person in replacement of his or her own unhealthy bone marrow.
In an effort to obtain optimum results from a procedure like bone marrow transplant, training and clinical expertise is indispensably needed. Starting from the very first day, and till the last day of hospital stay, nurses are required to cater the special requirements of the transplant patients at all times.
Nurses play an integral role during the entire process of transplantation. Few of those important nursing roles in dealing with the BMT patients are:
Nursing responsibilities during the time of admission.
Nursing responsibilities while staying at hospital.
Pre Transplant care
During Transplant
Post Transplant care    
Nursing responsibilities during the time of discharge.
Nursing responsibilities during the time of admission
The nurses at BMT are required to fulfill several responsibilities. These include:
Present health status
Past medical history
Past surgical history
Any drug or food allergy:
Any medication they are using
Weight and height of the patient.
Any habit of the patient, e.g. smoking, drinking etc.
Nursing responsibilities to
the patient during staying at the
hospital
Pre -Transplantation Care
During Transplantation Care
Post Transplantation Care
Nurses should focus on daily patient assessment, patient education, direct patient care, symptom management, and supportive care.
a) Pre transplantation
Nurses need to prepare patient for the transplant. They need to take the vital signs including all important investigations.
Should take consent for the transplant procedure.
Nurses also need to explain the procedure of transplant to the patient and family members including any changes they may encounter during and after the transplant.
Since the patient has Central Line (CV), the nurses should make sure that it is clean and sterile for the transplant procedure.
b) During transplantation day
During the transplant day nurses with the help of medical team, transfuse stem cell through the central line.
Nurses should be very careful and alert during the transfusion time for any emergency medical condition.
c) Post transplantation
Over the next 10 to 12 days, after transplant the patient’s blood counts (which help to fight with infection, help prevent from bleeding etc) will go down. This is the time that patients need more attention and care from nurses because they are very vulnerable to infection at this stage.
During this period, the patient is also very prone to developing several complications like mucositis, diarrhea, nausea and vomiting, and fever.
So it is the nurses’ responsibility to manage the complications of patients and help them overcome such problems with the help of medical team.
Early detection of any changes in the patient’s health is very important and must be notified to the concerned persons for proper management.
Nursing responsibilities during the time of discharge
Discharge Teaching: This is one of the important roles of nurses to teach patient and family member what to do once they return home from the hospital. Patients are instructed to call their Nurse or Physician IMMEDIATELY if they have any of the following symptoms:
Fever: Temperature of 100.4 or greater
Trouble breathing or shortness of breath
Bleeding that will not stop
Bleeding from your nose, mouth, or gums when you cough
Blood in urine
Tarry black or bloody bowel movements
Sudden severe headache
Sudden abdominal pain
Nurses should also instruct the post transplant patient and family members about prevention of infections at home by:
Frequent hand washing.
Wearing a face Masks is another way to help prevent infections when the patient are out in public.
Stay away from crowds for 30 days after the transplantation and avoid public places.
Personal Care: Take a bath every day with mild soap.
Should brush teeth at least twice a day using a soft bristled tooth brush.
 Sun Exposure: Chemotherapy and other medications may make the skin more sensitive to the sun so need to protect from direct sunlight by wearing sunscreen, long pants, full shirt and hat.
Should take fresh food, well cooked food and low bacterial diet.
A new era of nursing and patient care has begun in our country and hopefully a bright ray of hope will shine bright for the multitude of our ailing population.n
Meena Gyawali
Head of Nursing Department,
A K Khan healthcare Trust
Dhaka, Bangladesh

Shabnam Sultana Nina
Project Manager
A K Khan Healthcare Trust
Dhaka, Bangladesh

 

�The special nurses: plays a vital role in taking care of bone marrow transplant (BMT) patients�

Bangladesh is a developing country and it faces many challenges especially in the health sectors. Cancer management is a priority due to increased incidence. Among various types of cancers, the blood cancer has become a challenge in this country. Blood related cancers affect the production and function of our blood cells. Most of these cancers start in our bone marrow where blood is produced. The bone marrow is the spongy substance soft, fatty and immature cells inside our bones which are called stem cells. Stem cells in our bone marrow mature and develop into three different types of blood cells: red blood cells, white blood cells, and platelets. In most blood cancers, the normal blood cell development process is interrupted by uncontrolled growth of an abnormal type of blood cell. The bone marrow is the spongy substance soft, fatty and immature cells inside our bones which are called stem cells. Stem cells in our bone marrow mature and develop into three different types of blood cells: red blood cells, white blood cells, and platelets. In most blood cancers, the normal blood cell development process is interrupted by uncontrolled growth of an abnormal type of blood cell. These abnormal blood cells, or cancerous cells, prevent our blood from performing many of its normal functions, like fighting off infections or preventing serious bleeding and providing energy. So, these blood related cancers and certain genetic blood and immunity disorder such as leukemia, lymphomas, aplastic anemia, immune deficiency disorders etc are managed and treated by Bone Marrow Transplant (BMT). Bone Marrow Transplant: Since the first successful hematopoietic stem cell transplant (HSCT) was done in late 1950s (Copelan, 2006). In 2006, a total of 50417 HSCTs were performed worldwide, the majority of which were in Europe (48%) and the Americas (36%) and Asia only (14%) (Gratwohl et al, 2010). The First Bone Marrow Transplant in Bangladesh: A historical landmark was achieved with the introduction of the first Bone-Marrow Transplant (BMT) unit by Dhaka Medical College Hospital (DMCH) in March 2014. It was a successful collaboration between the best hospitals of Bangladesh and America under the watchful stewardship and assistance of A K Khan Healthcare Trust (AKKHT) and the Ministry of Health Family Welfare (MHFW), Bangladesh. Bone Marrow Transplantation is a special procedure to replace the damaged or destroyed bone marrow with the healthy bone marrow under the assistance of expert medical team including: Physicians, Nurses, Medical Technologists and so on by their close monitoring. The goal of BMT is to transfuse healthy bone marrow cells into a person in replacement of his or her own unhealthy bone marrow. In an effort to obtain optimum results from a procedure like bone marrow transplant, training and clinical expertise is indispensably needed. Starting from the very first day, and till the last day of hospital stay, nurses are required to cater the special requirements of the transplant patients at all times. Nurses play an integral role during the entire process of transplantation. Few of those important nursing roles in dealing with the BMT patients are: Nursing responsibilities during the time of admission. Nursing responsibilities while staying at hospital. Pre Transplant care During Transplant Post Transplant care Nursing responsibilities during the time of discharge. Nursing responsibilities during the time of admission The nurses at BMT are required to fulfill several responsibilities. These include: Present health status Past medical history Past surgical history Any drug or food allergy: Any medication they are using Weight and height of the patient. Any habit of the patient, e.g. smoking, drinking etc. Nursing responsibilities to the patient during staying at the hospital Pre -Transplantation Care During Transplantation Care Post Transplantation Care Nurses should focus on daily patient assessment, patient education, direct patient care, symptom management, and supportive care. a) Pre transplantation Nurses need to prepare patient for the transplant. They need to take the vital signs including all important investigations. Should take consent for the transplant procedure. Nurses also need to explain the procedure of transplant to the patient and family members including any changes they may encounter during and after the transplant. Since the patient has Central Line (CV), the nurses should make sure that it is clean and sterile for the transplant procedure. b) During transplantation day During the transplant day nurses with the help of medical team, transfuse stem cell through the central line. Nurses should be very careful and alert during the transfusion time for any emergency medical condition. c) Post transplantation Over the next 10 to 12 days, after transplant the patients blood counts (which help to fight with infection, help prevent from bleeding etc) will go down. This is the time that patients need more attention and care from nurses because they are very vulnerable to infection at this stage. During this period, the patient is also very prone to developing several complications like mucositis, diarrhea, nausea and vomiting, and fever. So it is the nurses responsibility to manage the complications of patients and help them overcome such problems with the help of medical team. Early detection of any changes in the patients health is very important and must be notified to the concerned persons for proper management. Nursing responsibilities during the time of discharge Discharge Teaching: This is one of the important roles of nurses to teach patient and family member what to do once they return home from the hospital. Patients are instructed to call their Nurse or Physician IMMEDIATELY if they have any of the following symptoms: Fever: Temperature of 100.4 or greater Trouble breathing or shortness of breath Bleeding that will not stop Bleeding from your nose, mouth, or gums when you cough Blood in urine Tarry black or bloody bowel movements Sudden severe headache Sudden abdominal pain Nurses should also instruct the post transplant patient and family members about prevention of infections at home by: Frequent hand washing. Wearing a face Masks is another way to help prevent infections when the patient are out in public. Stay away from crowds for 30 days after the transplantation and avoid public places. Personal Care: Take a bath every day with mild soap. Should brush teeth at least twice a day using a soft bristled tooth brush. Sun Exposure: Chemotherapy and other medications may make the skin more sensitive to the sun so need to protect from direct sunlight by wearing sunscreen, long pants, full shirt and hat. Should take fresh food, well cooked food and low bacterial diet. A new era of nursing and patient care has begun in our country and hopefully a bright ray of hope will shine bright for the multitude of our ailing population.n Meena Gyawali Head of Nursing Department, A K Khan healthcare Trust Dhaka, Bangladesh Shabnam Sultana Nina Project Manager A K Khan Healthcare Trust Dhaka, Bangladesh