For the first time in Sri Lanka: Bone marrow transplant surgery

Thursday, 23 October 2014 00:05 - - {{hitsCtrl.values.hits}}

The bone marrow is responsible for many vital tasks in the human body. Though a wide range of treatments exist to treat various ailments in the bone marrow, the only reliable method to completely cure bone marrow related illness is the bone marrow transplant surgery. Until now, this surgery was not available in Sri Lanka. Now, Nawaloka Hospital, one of the leaders in the private hospital industry, has initiated a novel program in the Sri Lankan health Industry; for the first time, bone marrow transplant surgery will be available in Sri Lanka. Preparations are already underway, and in the near future Sri Lankans will have the opportunity to undergo their bone marrow transplant surgeries in Sri Lanka, at minimal cost.

What is bone marrow? Bone marrow is a species of soft living tissue in the hollow core of bones that produces blood cells. The tissue contains stem cells, a special cell species which is different when compared to other cells in the bone marrow or cells in other organs. Most cells in the body have already evolved in unique ways to suit their organs by the time a person is born. For example, the liver cells in a person’s liver have already become liver cells when the person is born. However, bone marrow cells do not evolve in any way, meaning that even an adult’s bone marrow may contain primitive cells that had been present in him as an embryo. This is unique to the bone marrow. Further, these cells retain the ability to divide and become various specialised cells. This means that these bone marrow cells can evolve into any cell type present in the body, leading them to be named ‘Pluripotent Stem Cells’. Though a person’s cells have already finished their development by the time they are born, blood cells are constantly being produced and destroyed. The main function of the bone marrow cells is to constantly produce new blood cells. Therefore, the production of the most important blood cells such as: Red Blood Cells (which carry oxygen around the body), White Blood Cells (which protect the body against foreign substances), Platelets (which aid the clotting of blood), are done by the ‘Stem Cells’ in the bone marrow. The requirement of a bone marrow transplant surgery Upon the infection, deformation or destruction of bone marrow, the production of blood cells by the stem cells will deteriorate, leading to various diseases:

Leukemia – Cancer in the White Blood Cells
Aplastic Anemia – reduction in stem cells of the Red Blood Cells
Myelodysplasia – Unusual activity in blood cells
Thalassemia – Genetic weaknesses in blood cells
Bone decay

These patients often undergo treatments such as Chemotherapy or Radiotherapy, but these treatments do not provide a 100% recovery. Bone marrow transplant surgery on the other hand is proven to totally cure these diseases, as the diseased cells are destroyed and replaced with new, healthy tissue inducing proper, healthy growth of blood cells. The process of bone marrow transplant surgery The grafting of bone marrow is much more complex than the common organ transplants such as the liver. The surgery takes place in a series of treatments over a period of time:

Physical Examination – Evaluating the health of the patient
Conditioning – Preparations for surgery
Transplanting – Transplanting healthy bone marrow
Recovery – Checking for post surgery complications

The process of transplanting bone marrow is a complex one. Mainly, there are two methods by which the transplantation is done. They are: Autologous Transplantation – Introducing healthy bone marrow from the patient’s own body Allogenic Transplantation – Introducing bone marrow from an external donor Autologous transplantation Autologous Transplantation needs the patient to have healthy bone marrow in his body, which is taken and stripped of unhealthy cells before being reintroduced to the body. In this process, the first step is to extract the patient’s bone marrow and separate the healthy bone marrow from the unhealthy tissue. The healthy stem cells are extracted over a period of time, and preserved in a frozen state. This method is called Cryoprecipitation. When the amount of cryoprecipitated stem cells are of sufficient quantity, the patient undergoes surgery. The surgery, taking place in a special Bone Marrow Unit in order to ensure the patients safety, uses specific technique incorporating a series of drugs in order to destroy deformed blood cells in the bloodstream. Then the cryoprecipitated stem cells are transfused into the patient. Afterwards, the areas containing ‘Plurypotent stem cells’ are treated with special drug injections to normalise blood composition. This technique does not benefit those experiencing genetic defects. Allogenic transplantation In this technique, stem cells obtained from a healthy donor are transplanted into the patient’s bone marrow. This often requires the donor to be related to the patient, such as a sibling or a twin, in order to be successful. Only if no such person exists is an outsider used as a donor. When an external donor is used, several factors such as the blood type are taken into consideration before stem cells are extracted. The specialised equipment in the Bone Marrow Unit is used to cryoprecipitate the stem cells before they are transfused into the patient’s body. Overall, there is a probability of the surgery being unsuccessful; that is, the rejection of the grafted bone marrow by the patient’s body. However if the surgery is successful, it means that the patient will be permanently healed. In most cases, the grafting process is immediately followed by a course of immunosuppressive drugs in order to prevent chances of tissue rejection. Because infections may also enter the body with the bone marrow, this is a demanding task. High quality Performing the bone marrow transplant surgery, normally only carried out in developed countries such as Singapore and India, is no simple task. However Nawaloka Hospital, which is constantly striving to improve the health of the Sri Lankan populace, has already invested a vast fortune in this endeavour. Consequently, a bone marrow transplant unit conforming to modern medical standards and containing all necessary equipment is currently under construction. With special attention to the bone marrow transplant units in Singapore and India, Nawaloka Hospital is constructing a bone marrow transplant unit at even higher standards than those observed. The construction, which is taking place under the supervision of several of India’s premier hospitals, is done with the participation of a team of specialists experienced in bone marrow surgery that have joined with Nawaloka Hospital. This team consists of:

Hemotologist
Physicians
Cancer specialists
Bacteriologist

Specialists in several other fields are also included. In addition, another team specialists and a team of nursing staff are currently undergoing special training in bone marrow transplant surgery overseas. Minimal cost Undergoing the bone marrow transplant surgery abroad incurs a large cost. Undergoing the surgery in India requires between 6-8 million rupees and to undergo the surgery in Singapore requires 12-14 million rupees. In contrast, performing the surgery in Sri Lanka at Nawaloka Hospital only requires the relatively paltry cost of 3 million. This is a major advantage for the patient, while also preventing millions of foreign revenue from exiting the country in what is a significant service to the Sri Lankan economy. (Extract from an interview with the Coordinator, Nawaloka Hospital Bone Marrow Unit Dr. Ganeshanathan Kedishwaran and Consultant Physician Dr. K.D. Duminda Shanika Amarasinghe) For more information on the soon to be available Bone Marrow Transplant Surgery, these telephone lines remain open: 011 5577111/0777 999449.