Cancer occurs when changes called mutations take place in genes that regulate cell growth. The mutations let the cells divide and multiply in an uncontrolled way.
Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast.
Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within your breast.
The uncontrolled cancer cells often invade other healthy breast tissue and can travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that help the cancer cells move to other parts of the body.
In its early stages, breast cancer may not cause any symptoms. In many cases, a tumor may be too small to be felt, but an abnormality can still be seen on a mammogram.
If a tumor can be felt, the first sign is usually a new lump in the breast that was not there before. However, not all lumps are cancer.
Each type of breast cancer can cause a variety of symptoms. Many of these symptoms are similar, but some can be different. Symptoms for the most common breast cancers include:
a breast lump or tissue thickening that feels different than surrounding tissue and has developed recently
breast pain
red, pitted skin over your entire breast
swelling in all or part of your breast
a nipple discharge other than breast milk
bloody discharge from your nipple
peeling, scaling, or flaking of skin on your nipple or breast
a sudden, unexplained change in the shape or size of your breast
inverted nipple
changes to the appearance of the skin on your breasts
a lump or swelling under your arm
If you have any of these symptoms, it doesn’t necessarily mean you have breast cancer. For instance, pain in your breast or a breast lump can be caused by a benign cyst.
Still, if you find a lump in your breast or have other symptoms, you should see your doctor for further examination and testing.
There are several types of breast cancer, and they’re broken into two main categories: “invasive” and “noninvasive,” or in situ.
While invasive cancer has spread from the breast ducts or glands to other parts of the breast, noninvasive cancer has not spread from the original tissue.
These two categories are used to describe the most common types of breast cancer, which include:
Ductal carcinoma in situ. Ductal carcinoma in situ (DCIS) is a noninvasive condition. With DCIS, the cancer cells are confined to the ducts in your breast and haven’t invaded the surrounding breast tissue.
Lobular carcinoma in situ. Lobular carcinoma in situ (LCIS) is cancer that grows in the milk-producing glands of your breast. Like DCIS, the cancer cells haven’t invaded the surrounding tissue.
Invasive ductal carcinoma. Invasive ductal carcinoma (IDC) is the most common type of breast cancer. This type of breast cancer begins in your breast’s milk ducts and then invades nearby tissue in the breast. Once the breast cancer has spread to the tissue outside your milk ducts, it can begin to spread to other nearby organs and tissue.
Invasive lobular carcinoma. Invasive lobular carcinoma (ILC) first develops in your breast’s lobules and has invaded nearby tissue.
Other, less common types of breast cancer include:
Paget disease of the nipple. This type of breast cancer begins in the ducts of the nipple, but as it grows, it begins to affect the skin and areola of the nipple.
Phyllodes tumor. This very rare type of breast cancer grows in the connective tissue of the breast. Most of these tumors are benign, but some are cancerous.
Angiosarcoma. This is cancer that grows on the blood vessels or lymph vessels in the breast.
The type of cancer you have determines your treatment options, as well as your likely long-term outcome.
Inflammatory breast cancer (IBC) is a rare but aggressive type of breast cancer. IBC makes up only between 1 and 5 percent of all breast cancer cases.
With this condition, cells block the lymph nodes near the breasts, so the lymph vessels in the breast can’t properly drain. Instead of creating a tumor, IBC causes your breast to swell, look red, and feel very warm. A cancerous breast may appear pitted and thick, like an orange peel.
IBC can be very aggressive and can progress quickly. For this reason, it’s important to call your doctor right away if you notice any symptoms.
Metastatic breast cancer is another name for stage 4 breast cancer. It’s breast cancer that has spread from your breast to other parts of your body, such as your bones, lungs, or liver.
This is an advanced stage of breast cancer. Your oncologist (cancer doctor) will create a treatment plan with the goal of stopping the growth and spread of the tumor(s).
Triple-negative breast cancer is another rare disease type, affecting only about 10 to 15 percent of people with breast cancer, according to the American Cancer Society (ACS).
To be diagnosed as triple-negative breast cancer, a tumor must have all three of the following characteristics:
It lacks estrogen receptors. These are receptors on the cells that bind, or attach, to the hormone estrogen. If a tumor has estrogen receptors, estrogen can stimulate the cancer to grow.
It lacks progesterone receptors. These receptors are cells that bind to the hormone progesterone. If a tumor has progesterone receptors, progesterone can stimulate the cancer to grow.
It doesn’t have additional HER2 proteins on its surface. HER2 is a protein that fuels breast cancer growth.
If a tumor meets these three criteria, it’s labeled a triple-negative breast cancer. This type of breast cancer tends to grow and spread more quickly than other types of breast cancer.
Triple-negative breast cancers are difficult to treat because hormonal therapy for breast cancer is not effective.
Breast cancer can be divided into stages based on the size of the tumor(s) and how much it has spread.
Cancers that are large and/or have invaded nearby tissues or organs are at a higher stage than cancers that are small and/or still contained in the breast. To stage a breast cancer, doctors need to know:
if the cancer is invasive or noninvasive
how large the tumor is
whether the lymph nodes are involved
if the cancer has spread to nearby tissue or organs
Breast cancer has 5 main stages: stages 0 to 5.
Stage 0 breast cancer
Stage 0 is DCIS. Cancer cells in DCIS remain confined to the ducts in the breast and have not spread into nearby tissue.
Stage 1 breast cancer
Stage 1A: The primary tumor is 2 centimeters (cm) wide or less, and the lymph nodes are not affected.
Stage 1B: Cancer is found in nearby lymph nodes, and either there is no tumor in the breast, or the tumor is smaller than 2 cm.
Stage 2 breast cancer
Stage 2A: The tumor is smaller than 2 cm and has spread to 1–3 nearby lymph nodes, or it’s between 2 and 5 cm and hasn’t spread to any lymph nodes.
Stage 2B: The tumor is between 2 and 5 cm and has spread to 1–3 axillary (armpit) lymph nodes, or it’s larger than 5 cm and hasn’t spread to any lymph nodes.
Stage 3 breast cancer
Stage 3A:
The cancer has spread to 4–9 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumor can be any size.
Tumors are greater than 5 cm, and the cancer has spread to 1–3 axillary lymph nodes or any breastbone nodes.
Stage 3B: A tumor has invaded the chest wall or skin and may or may not have invaded up to nine lymph nodes.
Stage 3C: Cancer is found in 10 or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary nodes.
Stage 4 breast cancer
Stage 4 breast cancer can have a tumor of any size, and its cancer cells have spread to nearby and distant lymph nodes as well as distant organs.
The testing your doctor does will determine the stage of your breast cancer, which will affect your treatment.
Although they generally have less of it, men have breast tissue just like women do. Men can develop breast cancer too, but it’s much rarer.
According to the ACS, breast cancer is 100 times less common in white men than in white women. Its 70 times less common in black men than in black women.
That said, the breast cancer that men develop is just as serious as the breast cancer women are diagnosed with. It also has the same symptoms.
Breast cancer survival rate
Breast cancer survival rates vary widely based on many factors.
Two of the most important factors are the type of cancer you have and the stage of the cancer at the time you receive a diagnosis. Other factors that may play a role include your age, gender, and race.
ResearchTrusted Source shows there’s a higher mortality rate in non-white people diagnosed with breast cancer compared with white people. One reason for this may be healthcare disparities.
The good news is breast cancer survival rates are improving.
According to the ACSTrusted Source, in 1975, the 5-year survival rate for breast cancer in women was 75.2 percent. But for women diagnosed between 2008 and 2014, it was 90.6 percent.
Five-year survival rates for breast cancer differ depending on stage at diagnosis, ranging from 99 percent for localized, early stage cancers to 27 percent for advanced, metastatic cancers.
To determine if your symptoms are caused by breast cancer or a benign breast condition, your doctor will do a thorough physical exam in addition to a breast exam. They may also request one or more diagnostic tests to help understand what’s causing your symptoms.
Tests that can help diagnose breast cancer include:
Mammogram. The most common way to see below the surface of your breast is with an imaging test called a mammogram. Many women ages 40 and older get annual mammograms to check for breast cancer. If your doctor suspects you may have a tumor or suspicious spot, they will also request a mammogram. If an abnormal area is seen on your mammogram, your doctor may request additional tests.
Ultrasound. A breast ultrasound uses sound waves to create a picture of the tissues deep in your breast. An ultrasound can help your doctor distinguish between a solid mass, such as a tumor, and a benign cyst.
Your doctor may also suggest tests such as an MRI or a breast biopsy.
If your doctor suspects breast cancer, they may order both a mammogram and an ultrasound. If both of these tests can’t tell your doctor if you have cancer, your doctor may do a test called a breast biopsy.
During this test, your doctor will remove a tissue sample from the suspicious area to have it tested.
There are several types of breast biopsies. With some of these tests, your doctor uses a needle to take the tissue sample. With others, they make an incision in your breast and then remove the sample.
Your doctor will send the tissue sample to a laboratory. If the sample tests positive for cancer, the lab can test it further to tell your doctor what type of cancer you have.
Your breast cancer’s stage, how far it has invaded (if it has), and how big the tumor has grown all play a large part in determining what kind of treatment you’ll need.
To start, your doctor will determine your cancer’s size, stage, and grade (how likely it is to grow and spread). After that, you can discuss your treatment options.
Surgery is the most common treatment for breast cancer. Many people have additional treatments, such as chemotherapy, targeted therapy, radiation, or hormone therapy.
Surgery
Several types of surgery may be used to remove breast cancer, including:
Lumpectomy. This procedure removes the tumor and some surrounding tissue, leaving the rest of the breast intact.
Mastectomy. In this procedure, a surgeon removes an entire breast. In a double mastectomy, both breasts are removed.
Sentinel node biopsy. This surgery removes a few of the lymph nodes that receive drainage from the tumor. These lymph nodes will be tested. If they don’t have cancer, you may not need additional surgery to remove more lymph nodes.
Axillary lymph node dissection. If lymph nodes removed during a sentinel node biopsy contain cancer cells, your doctor may remove additional lymph nodes.
Contralateral prophylactic mastectomy. Even though breast cancer may be present in only one breast, some people elect to have a contralateral prophylactic mastectomy. This surgery removes your healthy breast to reduce your risk for developing breast cancer again.
Radiation therapy
With radiation therapy, high-powered beams of radiation are used to target and kill cancer cells. Most radiation treatments use external beam radiation. This technique uses a large machine on the outside of the body.
Advances in cancer treatment have also enabled doctors to irradiate cancer from inside the body. This type of radiation treatment is called brachytherapy.
To conduct brachytherapy, surgeons place radioactive seeds, or pellets, inside the body near the tumor site. The seeds stay there for a short period of time and work to destroy cancer cells.
Chemotherapy
Chemotherapy is a drug treatment used to destroy cancer cells. Some people may undergo chemotherapy on its own, but this type of treatment is often used along with other treatments, especially surgery.
In some cases, doctors prefer to give patients chemotherapy before surgery. The hope is that the treatment will shrink the tumor, and then the surgery will not need to be as invasive.
Chemotherapy has many unwanted side effects, so discuss your concerns with your doctor before starting treatment.
Hormone therapy
If your type of breast cancer is sensitive to hormones, your doctor may start you on hormone therapy. Estrogen and progesterone, two female hormones, can stimulate the growth of breast cancer tumors.
Hormone therapy works by blocking your body’s production of these hormones or by blocking the hormone receptors on the cancer cells. This action can help slow and possibly stop the growth of your cancer.
Medications
Certain treatments are designed to attack specific abnormalities or mutations within cancer cells.
For example, Herceptin (trastuzumab) can block your body’s production of the HER2 protein. HER2 helps breast cancer cells grow, so taking a medication to slow the production of this protein may help slow cancer growth.
Your doctor will tell you more about any specific treatment they recommend for you.
But if your problem does turn out to be cancer, keep in mind that early treatment is the key. Early-stage breast cancer can often be treated and cured if found quickly enough. The longer breast cancer is allowed to grow, the more difficult treatment becomes.
If you’ve already received a breast cancer diagnosis, keep in mind that cancer treatments continue to improve, as do outcomes. So follow your treatment plan and try to stay positive.
According to statistics from the ACS, approximately 268,600 new cases of invasive breast cancer are expected to be diagnosed in the United States in 2019.
Invasive breast cancer is cancer that has spread from the ducts or glands to other parts of the breast. More than 41,000 women are expected to die from the disease.
Breast cancer can also be diagnosed in men. The ACS also estimates that in 2019, more than 2,600 men will be diagnosed, and approximately 500 men will die from the disease.
There are several risk factors that increase your chances of getting breast cancer. However, having any of these doesn’t mean you will definitely develop the disease.
Some risk factors can’t be avoided, such as family history. You can change other risk factors, such as quitting smoking, if you smoke. Risk factors for breast cancer include:
Age. Your risk for developing breast cancer increases as you age. Most invasive breast cancers are found in women over age 55 years.
Drinking alcohol. Alcohol use disorder raises your risk.
Having dense breast tissue. Dense breast tissue makes mammograms hard to read. It also increases your risk for breast cancer.
Gender. White women are 100 times more likely to develop breast cancer than white men, and Black women are 70 times more likely to develop breast cancer than Black men.
Genes. Women who have the BRCA1 and BRCA2 gene mutations are more likely to develop breast cancer than women who don’t. Other gene mutations may also affect your risk.
Early menstruation. If you had your first period before age 12 years, you have an increased risk for breast cancer.
Giving birth at an older age. Women have their first child after age 35 years have an increased risk for breast cancer.
Hormone therapy. Women who took or are taking postmenopausal estrogen and progesterone medications to help reduce their signs of menopause symptoms have a higher risk for breast cancer.
Inherited risk. If a close female relative has had breast cancer, you have an increased risk for developing it. This includes your mother, grandmother, sister, or daughter. If you don’t have a family history of breast cancer, you can still develop breast cancer. In fact, most women who develop it have no family history of the disease.
Late menopause start. Women who start menopause after age 55 years are more likely to develop breast cancer.
Never having been pregnant. Women who have never become pregnant or carried a pregnancy to full term are more likely to develop breast cancer.
Previous breast cancer. If you have had breast cancer in one breast, you have an increased risk for developing breast cancer in your other breast or in a different area of the previously affected breast.
Breast cancer prevention
While there are risk factors you can’t control, following a healthy lifestyle, getting regular screenings, and taking any preventive measures your doctor recommends can help reduce your risk for developing breast cancer.
Lifestyle factors
Lifestyle factors can affect your risk for breast cancer.
For instance, women who have obesity have a higher risk for developing breast cancer. Maintaining a nutrient-dense diet and getting regular exercise as often as possible could help you lose weight and lower your risk.
Alcohol misuse also increases your risk. This can be having more than two drinks per day or binge-drinking.
However, one report that analyzed worldwide research showed that even one drink per day increases your risk for breast cancer. If you drink alcohol, talk with your doctor about what amount they recommend for you.
Breast cancer screening
Having regular mammograms may not prevent breast cancer, but it can help reduce the chances that it will go undetected.
Women ages 40 to 49: An annual mammogram isn’t recommended, but women should discuss their preferences with their doctors.
Women ages 50 to 74: A mammogram every other year is recommended.
Women 75 and older: Mammograms are no longer recommended.
The ACP also recommends against mammograms for women with a life expectancy of 10 years or less.
These are only guidelines.
Recommendations from the ACS differ. According to the ACS, women should have the option of receiving annual screenings at 40 years old, begin annual screenings at 45 years old, and move to biennial screening at 55 years old.
Specific recommendations for mammograms are different for each woman, so talk with your doctor to see if you should get regular mammograms.
Preemptive treatment
Some women are at increased risk for breast cancer due to hereditary factors.
For instance, if your mother or father has a BRCA1 or BRCA2 gene mutation, you’re at higher risk for having it as well. This significantly raises your risk for breast cancer.
If you’re at risk for this mutation, talk with your doctor about your diagnostic and prophylactic treatment options. You may want to be tested to find out whether you have the mutation.
And if you learn that you do have it, talk with your doctor about any preemptive steps you can take to reduce your risk for developing breast cancer. These steps could include a prophylactic mastectomy (surgical removal of a breast).
In addition to mammograms, breast exams are another way to watch for signs of breast cancer.
Self-exams
Many women do a breast self-examination. It’s best to do this exam once a month, at the same time each month. The exam can help you become familiar with how your breasts normally look and feel so that you’re aware of any changes that occur.
Keep in mind, though, that the ACS considers these exams to be optional, because current research hasn’t shown a clear benefit of physical exams, whether performed at home or by a doctor.
Breast exam by your doctor
The same guidelines for self-exams provided above are true for breast exams done by your doctor or other healthcare professional. They won’t hurt you, and your doctor may do a breast exam during your annual visit.
If you’re having symptoms that concern you, it’s a good idea to have your doctor do a breast exam. During the exam, your doctor will check both of your breasts for abnormal spots or signs of breast cancer.
Your doctor may also check other parts of your body to see if the symptoms you’re having could be related to another condition.
Fortunately for women and men around the world, people are increasingly aware of the issues associated with breast cancer.
Breast cancer awareness efforts have helped people:
learn what their risk factors are
how they can reduce their level of risk
what symptoms they should look for
what kinds of screening they should be getting
Breast Cancer Awareness Month is held each October, but many people spread the word throughout the year.
Disclaimer: This article has been taken from https://www.healthline.com/ as it is. Click here to read the original article.
Blood cancers affect blood cells and bone marrow — the spongy tissue inside your bones where blood cells are made. These cancers change the way blood cells behave and how well they work.You have three types of blood cells:
White blood cells fight infection as part of your immune system.
Red blood cells carry oxygen to your body’s tissues and organs and bring carbon dioxide to your lungs so you can breathe it out.
Platelets help your blood clot when you’re injured.
There are three major types of blood cancer:
Leukemia
Lymphoma
Myeloma
These cancers cause your bone marrow and lymphatic system to make blood cells that don’t work as well as they should. They all affect different types of white blood cells, and they act in different ways.
Leukemia
People who have leukemia make a lot of white blood cells that can’t fight infections. Leukemia is divided into four types based on the kind of white blood cell it affects and whether it grows quickly (acute) or slowly (chronic).
Acute lymphocytic leukemia (ALL). This starts with white blood cells called lymphocytes in bone marrow. People with ALL make too many lymphocytes that crowd out healthy white blood cells. ALL can advance quickly if it’s not treated.
It’s the most common type of childhood cancer. Children ages 3 to 5 are most likely to get it, but adults over age 75 can get ALL, too.
You’re more likely to get it if you:
Have a brother or sister with ALL
Were treated with chemotherapy or radiation for another type of cancer in the past
Have been near a lot of radiation
Have Down syndrome or another genetic disorder
Acute myeloid leukemia (AML). This starts in myeloid cells, which normally grow into white blood cells, red blood cells, and platelets. AML lowers the number of healthy blood cells in all three types. This form of leukemia grows quickly.
AML mainly affects people over age 65. It’s more common in men than women.
You’re chances of getting it are higher if you:
Have been treated with chemotherapy or radiation for cancer
Have been around toxic chemicals like benzene
Smoke
Have a blood disorder like myelodysplasia or polycythemia vera, or a genetic disorder like Down syndrome
Chronic lymphocytic leukemia (CLL). This is the most common type of leukemia in adults. Like ALL, it starts from lymphocytes in bone marrow, but it grows more slowly. Many people with CLL don’t show any symptoms until years after the cancer starts.CLL mainly affects people in their 70s or older. A family history of blood cancer can raise your odds of it, as can spending a lot of time around chemicals like weed killers or insecticides.
Chronic myeloid leukemia (CML). This blood cancer starts in myeloid cells, like AML. But the abnormal cells grow slowly.
CML is slightly more common in men than in women. It usually affects adults, but kids can sometimes get it, too. You’re more likely to get it if you’ve been around high amounts of radiation.
Lymphoma
This is a cancer of the lymph system. This network of vessels includes your lymph nodes, spleen, and thymus gland. The vessels store and carry white blood cells to help your body fight infections.
Lymphomas start in white blood cells called lymphocytes. There are two main types of lymphoma:
Hodgkin’s lymphoma starts in immune cells called B lymphocytes, or B cells. These cells make proteins called antibodies that fight off germs. People with Hodgkin’s lymphoma have large lymphocytes called Reed-Sternberg cells in their lymph nodes.
Non-Hodgkin’s lymphoma starts in B cells or in another type of immune cell called a T cell. Non-Hodgkin’s lymphoma is more common than Hodgkin’s lymphoma.
Both types are divided into a few subtypes. The subtypes are based on where in the body the cancer started and how it behaves.
People who have weak immune systems are more likely to get lymphoma. Infection with the Epstein-Barr virus, HIV, or Helicobacter pylori (H. pylori) bacteria also raises your chances.
Lymphoma is most often diagnosed in people ages 15 to 35 and over age 50.
Myeloma
This is a cancer of the plasma cells in bone marrow. Plasma cells are a type of white blood cell that makes antibodies.
Myeloma cells spread through the bone marrow. They can damage your bones and crowd out healthy blood cells. These cells also make antibodies that can’t fight off infections.
This cancer is often called multiple myeloma because it’s found in many parts of your bone marrow.
Men over age 50 are most likely to get it, and African-Americans have higher odds of it than other people.
Your chances are also higher if you:
Have close relatives with myeloma
Are obese
Have spent a lot of time around radiation
Disclaimer: This article has been taken from https://www.webmd.com/ as it is. Click here to read the original article.
The brain controls and coordinates conscious and unconscious body functions, as well as ‘higher’ functions such as memory, learning and thinking. Like any other part of the body, it is susceptible to bleeding, infection, trauma and other forms of damage. This damage or alteration in brain function sometimes requires brain surgery (neurosurgery) to diagnose or treat these problems.
Symptoms of conditions needing brain surgery
The symptoms of conditions requiring brain surgery may vary, depending on the type and severity of the condition. General symptoms include:
Headache
Nausea
Vomiting
Drowsiness
Seizures.
Brain conditions may require brain surgery
The main types of brain conditions that may require brain surgery include:
Alterations of the brain tissue – such as brain cancer, infections and swelling (oedema)
Alterations in brain blood flow – such as subdural haematoma, subarachnoid haemorrhage and intraventricular bleed
Alteration in cerebrospinal fluid – such as infection or hydrocephalus.
Brain cancer
Some of the different types of brain cancer that may require brain surgery include:
Gliomas – glial cells make up the supportive tissue of the brain, and don’t conduct electrical impulses. Glioma is a broad term used to describe brain tumours associated with the three types of glial cell, which include the astrocyte, oligodendrocyte and the ependymal cell.
Pituitary tumour – cancer of the pituitary gland, such as craniopharyngioma.
Acoustic neuroma or schwannoma – a type of benign tumour that grows in the canal connecting the brain to the inner ear.
Medulloblastoma – a type of cancer that originates in the brain and can migrate down the spinal cord.
Dysembryoplastic neuroepithelial tumour (DNET) – an abnormal tissue growth in the brain that may or may not be cancerous.
Primitive neuroectodermal tumour (PNET) – a general term referring to abnormal tissue growths of the brain.
Lymphomas – cancers of the lymphatic system.
Chordomas – tumours that originate in particular parts of the skeleton including the skull.
Metastases or secondary tumours – metastasis means cells (usually cancer), which have moved from one part of the body to another.
Alterations in brain blood flow
Some of the causes of altered blood flow in the brain include:
Subdural haematoma – the build-up of blood beneath the thickest membrane (meninges) that covers the brain, called the dura mater. A subdural haematoma can be classified as acute, acute on chronic or chronic. The most common cause is head injury.
Stroke – occurs when a blood vessel supplying the brain either blocks or bursts. A stroke produces sudden and unexpected brain injury and can sometimes be fatal.
Subarachnoid haemorrhage – bleeding between the arachnoid membrane and the delicate membrane that covers the brain (pia mater). Common causes include head injury and aneurysms.
Intraventricular bleed – an increase in blood flow may cause the small blood vessels of the brain (periventricular capillary network) to burst. Premature babies are at increased risk.
Alteration in cerebrospinal fluid
Some of the causes of alteration in cerebrospinal fluid include:
Hydrocephalus – the abnormal build-up of cerebrospinal fluid within the skull. In babies, this can cause the head to enlarge.
Infection – various infections of the brain can cause alterations to cerebrospinal fluid.
Urgent medical treatment is vital
If left untreated, any condition requiring brain surgery can cause further damage to the brain. Pressure on the brain can be harmful as it forces the brain against the skull, causing damage to the brain and hampering the brain’s ability to function properly. This drop in function can lead to long-lasting brain damage and, if left untreated, death.
A craniotomy is an operation to open the skull in order to access the brain for surgical repair. The patient is put under general anaesthesia. The hair on the scalp is shaved. A neurosurgeon performs the craniotomy by first cutting through the scalp over the area where the brain injury is thought to lie. A hole is then cut into the skull in order to access the brain. This is needed to repair any ruptured blood vessels and to remove the blood clot or growth.
After the operation is finished, the piece of bone that was removed is replaced, the muscle and skin are stitched up and a drain is placed inside the brain to remove any excess blood left from the surgery. Some of the possible complications following craniotomy include allergic reaction to the anaesthetic, bleeding, infection, brain damage, brain swelling, stroke and seizures.
Conditions that require brain surgery include brain cancer, stroke and hydrocephalus.
If left untreated, any condition requiring brain surgery can cause further damage to the brain.
A craniotomy is an operation to open the skull in order to access the brain for surgical repair.
Disclaimer: This article has been taken from https://www.betterhealth.vic.gov.au/ as it is. Click here to read the original article.
Starting the IVF pregnancy treatment process can be an exciting and nerve-wracking experience. Usually, IVF is pursued only after other fertility treatments have failed. You may have been trying to conceive for months or, more likely, for years and years.
But this is not always the case. Sometimes, IVF is the very first treatment tried.
Still, even in these cases, IVF may come after years of trying to get pregnant and several fertility tests.1
Just looking over the schedule of ultrasounds, blood work, and injections can have you feeling fragile. (And that’s before the drugs can mess with your moods!) Add to that the cost of IVF, especially if you’re paying out-of-pocket, and it’s no surprise if you’re feeling worried.
However, the more you understand about what’s coming next, the more in control you’ll feel. While every clinic’s protocol will be slightly different and treatments are adjusted for a couple’s individual needs, here is a step-by-step breakdown of what generally takes place during in vitro fertilization, as well as information on the risks, costs, and what’s next if your IVF treatment cycle fails.
In Vitro Fertilization Basics
IVF stands for in vitro fertilization. In vitro means “in the lab” and fertilization refers to conception. Usually, IVF involves taking many eggs (retrieved via a transvaginal ultrasound-guided needle) and placing them in a petri dish with specially washed sperm cells (retrieved via masturbation.)
If all goes well, some of the retrieved eggs will become fertilized by the sperm cells and become embryos. One or two of those healthy embryos will be transferred to your uterus.
In some cases, the sperm cells need extra help with the fertilization process. ICSI, or intracytoplasmic sperm injection, may be used, which is an assisted reproductive technology that involves injecting a single sperm cell into an egg.
This may be done in cases of severe male infertility, previously cryopreserved eggs, preimplantation genetic testing of embryos (PGT), or if past IVF cycles have failed at the fertilization stage.2
But before eggs can be retrieved, the ovaries must be stimulated. Without the help of fertility drugs, your body will typically only mature one (or maybe two) eggs each month. For conventional IVF, you need lots of eggs. Injectable fertility drugs are used to stimulate the ovaries to mature a dozen or more eggs for retrieval.3
This isn’t always the case, however. With minimal stimulation IVF (aka mini IVF), oral fertility drugs or very low dose injectable drugs may be used to stimulate just a few eggs.
Your best odds for success may come from repeated treatment cycles. This same study found that after six IVF cycles, the cumulative live-birth rate was 65.3%. These six cycles usually took place over 2 years.
Age does play an important role in your success, as does the reason for your infertility. Using an egg donor will also affect your success.
Be sure to discuss your personal odds for success with your doctor before starting treatment. While your doctor can’t tell you for certain whether treatment will work for you, she should have an idea of your odds in relation to the average and in relation to other patients like yourself.
IVF Costs and Risks
IVF is expensive. It’s also frequently not covered by insurance, putting the treatment out of reach for many people who need it.5 In fact, studies have found that only one in four couples who need IVF to conceive can actually get the treatment they need.
The average cost of IVF often quoted is between $12,000 and 15,000 per cycle. Some say this estimate is really below the reality, and the out-of-pocket average costs are higher.
One study found that the average couple paid $19,234 for their initial IVF cycle, with an additional $6,955 for each additional cycle. (Why such a difference between the first and subsequent? Partially because some of those second and third cycles are frozen embryo transfers.)6
This is all for conventional, no-frills IVF. If you need any additional technologies—like ICSI, PGT, assisted hatching, an egg donor, or a gestational carrier—costs will be higher. Sometimes much higher.
IVF is generally safe, but as with any medical procedure, there are risks. Your doctor should explain all the possible side effects and risks of each procedure before you begin.
Ovarian hyperstimulation syndrome (OHSS) occurs in 10% of women going through IVF treatment. For most women, symptoms will be mild, and they will recover easily.7 For a small percentage, OHSS can be more serious and may require hospitalization. Less than 1% of women going through egg retrieval will experience blood clots or kidney failure due to OHSS.
The egg retrieval may cause cramping and discomfort during or after the procedure. Rare complications include accidental puncture of the bladder, bowel, or blood vessels; pelvic infection; or bleeding from the ovary or pelvic vessels.8
If pelvic infection does occur, you’ll be treated with intravenous antibiotics. In rare cases of severe infection, the uterus, ovaries or fallopian tubes may need to be surgically removed.
The embryo transfer may cause mild cramping during the procedure. Rarely, women will also experience cramping, bleeding, or spotting after the transfer. In very rare cases, infection can occur. Infection is typically treated with antibiotics.
There is a risk of multiples, which includes twins, triplets, or more. Multiple pregnancies can be risky for both the babies and the mother. It’s important to discuss with your doctor how many embryos to transfer, as transferring more than necessary will increase your risk of conceiving twins or more. When embryos have been tested with PGT, typically only a single embryo is transferred.
Some research has found that IVF may raise the risk of some very rare birth defects, but the risk is still relatively low.9 Research has also found that the use of ICSI with IVF, in certain cases of male infertility, may increase the risk of infertility and some sexual birth defects for male children. This risk, however, is very low (less than 1%).10
The Cycle Before Treatment
The cycle before your IVF treatment is scheduled, you may be put on birth control pills. This may seem backward—aren’t you trying to get pregnant?
Using birth control pills before a treatment cycle has been shown to potentially improve your odds of success. Also, it may decrease your risk of ovarian hyperstimulation syndrome and ovarian cysts.11
But not every doctor uses birth control pills the cycle before. Another possibility is that your doctor will ask you to track ovulation the cycle before. Most likely, she will recommend using an ovulation predictor kit. However, she may also suggest basal body temperature charting, especially if you have experience charting your cycles.
Then, you will need to let your doctor know as soon as you detect ovulation. Sometime after ovulation, the fertility clinic may then have you start taking a GnRH antagonist (like Ganirelix) or a GnRH agonist (like Lupron). These are injectable drugs, but some are available as a nasal spray or implant.
These medications allow your doctor to have complete control over ovulation once your treatment cycle begins. If you don’t get your cycles on your own, your doctor may take yet another approach. In this case, he may prescribe progesterone in the form of Provera. This would bring on your period.
In this case, your doctor will probably ask that you start taking the GnRH agonist or antagonist about 6 days or more after your first Provera pill. Again, though, this may vary. Always follow your doctor’s instructions.
When You Get Your Period
The first official day of your treatment cycle is the day you get your period. (Even though it may feel like you’ve already begun with the medications you started before in step one.)
On the second day of your period, your doctor will likely order blood work and an ultrasound. This will be a transvaginal ultrasound. An ultrasound during your period isn’t exactly pleasant, but try to remember this is the same for every woman going through IVF.
These first-day ultrasounds and blood work are referred to as your baseline blood work and your baseline ultrasound. In your blood work, your doctor will be looking at your estrogen levels, specifically your E2 or estradiol. This is to make sure your ovaries are “sleeping.” That’s the intended effect of the Lupron shots or GnRH antagonist.
The ultrasound is to check the size of your ovaries. Your doctor will also look for ovarian cysts. If there are cysts, your doctor will decide how to deal with them. Sometimes your doctor will just delay treatment for a week. Most cysts resolve on their own with time. In other cases, your doctor may aspirate the cyst (suck out the fluid) with a needle.
Usually, these tests will be fine. If everything looks OK, treatment moves on.
Ovarian Stimulation and Monitoring
Ovarian stimulation with fertility drugs is the next step. Depending on your treatment protocol, this may mean anywhere from one to four shots every day for about a week to 10 days.12
You are probably a pro at self-injection by now, since Lupron and other GnRH agonists are also injectables. Your clinic should teach you how to give yourself the injections before treatment begins. Some clinics offer classes with tips and instruction.
You can read more about the fertility drugs you may take during IVF here:
During ovarian stimulation, your doctor will monitor the growth and development of the follicles.
At first, this may include blood work and ultrasounds every few days. Your doctor will be monitoring your estradiol levels. During the ultrasounds, your doctor will monitor the oocyte growth. (Oocytes are the eggs in your ovaries.)
Monitoring the cycle is very important. This is how your doctor will decide how to adjust your medications.
You may need to increase or decrease dosages. Once your largest follicle is 16 to 18 mm in size, your clinic will probably want to see you daily.
Final Oocyte Maturation
The next step in your IVF treatment is triggering the oocytes to go through the last stage of maturation. The eggs must complete their growth and development before they can be retrieved.
This last growth is triggered with human chorionic gonadotropin (hCG). Brand names for this include Ovidrel, Novarel, and Pregnyl. Timing this shot is vital. If it’s given too early, the eggs will not have matured enough. If given too late, the eggs may be “too old” and won’t fertilize properly.13
The daily ultrasounds at the end of the last step are meant to time this trigger shot just right. Usually, the hCG injection is given when four or more follicles have grown to be 18 to 20 mm in size and your estradiol levels are greater than 2,000 pg/ML.14
This shot is typically a one-time injection. Your doctor will likely give you an exact hour to do this shot. Be sure to follow these instructions!
IVM vs. IVF
During conventional IVF, eggs must complete their development and growth before being retrieved. IVM treatment is slightly different. IVM stands for in vitro maturation. It’s a relatively new technology that is similar to IVF but significantly differs at this point in the process.
During IVM, the eggs are retrieved before they go through all stages of maturity. You will not have a “trigger shot” during IVM. The eggs retrieved will be matured in the lab environment. Once the eggs are matured, the rest of the steps follow the IVF process.15
What If the Follicles Don’t Grow
We’ve assumed to this point that the ovarian stimulation drugs have worked properly. But that isn’t always how it goes. Sometimes the follicles don’t grow. Your doctor may increase the medications, but if your ovaries still don’t respond, the cycle will likely be canceled.
This doesn’t mean another cycle won’t work. You may just need different medications. However, if this occurs repeatedly, your doctor may suggest using an egg or embryo donor. You may want to get a second opinion before moving forward at this point.
What If You’re at Risk for OHSS
Another possible problem is your ovaries respond too well. If your doctor thinks you’re at risk of developing severe ovarian hyperstimulation syndrome (OHSS), your trigger shot will be canceled and the cycle will be stopped at this point.
Another possibility is your doctor will retrieve the eggs, fertilize them, but delay the embryo transfer. This is because pregnancy can worsen and extend recovery from OHSS.16 Once your body recovers, you can try a frozen embryo transfer.
During your next cycle, your doctor may suggest lower doses of medications, try different medications before your cycle starts, or even suggest IVM instead of IVF (explained above.)
What If You Ovulate Prematurely
While not common, a cycle may also be canceled if ovulation occurs before retrieval can take place. Once the eggs ovulate on their own, they can’t be retrieved. Your doctor will likely tell you to refrain from sexual intercourse.
It’s important you follow these instructions! It’s possible you’ve ovulated up to a dozen eggs. Maybe even more. There is danger to both the mother and children if you got pregnant naturally with even half of those eggs.17
How Often Are IVF Cycles Canceled?
Cancellation happens in 10% to 20% of IVF treatment cycles.18 The chance of cancellation rises with age, with those older than age 35 more likely to experience treatment cancellation.
Egg Retrieval
About 34 to 36 hours after you receive the hCG shot, the egg retrieval will take place.19 It’s normal to be nervous about the procedure, but most women go through it without much trouble or pain.
Before the retrieval, an anesthesiologist will give you some medication intravenously to help you feel relaxed and pain-free. Usually, a light sedative is used, which will make you “sleep” through the procedure. This isn’t the same as general anesthesia, which is used during surgery. Side effects and complications are less common.20
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.
The number of oocytes retrieved varies but can usually be estimated before retrieval via ultrasound. The average number of oocytes is 8 to 15, with more than 95% of patients having at least one oocyte retrieved.21
After the retrieval procedure, you’ll be kept for a few hours to make sure all is well. Light spotting is common, as well as lower abdominal cramping, but most feel better in a day or so after the procedure. You’ll also be told to watch for signs of ovarian hyperstimulation syndrome, a side effect from fertility drug use during IVF treatment in 10% of patients.19
Egg Fertilization
While you’re at home recovering from the retrieval, the follicles that were aspirated will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.
Once the oocytes are found, they’ll be evaluated by the embryologist. If the eggs are overly mature, fertilization may not be successful. If they are not mature enough, the embryology lab may be able to stimulate them to maturity in the lab.
Fertilization of the oocytes must happen with 12 to 24 hours.22 Your partner will likely provide a semen sample the same morning you have the retrieval. The stress of the day can make it difficult for some, and so just in case, your partner may provide a semen sample for backup earlier in the cycle, which can be frozen until the day of the retrieval.
Once the semen sample is ready, it’ll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best-looking sperm,” placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.
With the exception of severe male infertility, 70% of the oocytes will become fertilized.23
In the case of severe male infertility, ICSI (pronounced ick-see) may be used to fertilize the eggs, instead of simply placing them in a culture dish. With ICSI, the embryologist will choose a healthy-looking sperm and inseminate the oocyte with the sperm using a special thin needle.
Embryo Transfer
About three to five days after the retrieval, an embryologist will identify the healthiest looking embryos. This is typically done visually (with a microscope), but in some cases, genetic screening is performed. This is known as preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS.)24
Sometimes, with PGD/PGS, the embryos are cryopreserved and transfer is delayed until the next cycle. Otherwise, a “fresh” transfer takes place. The procedure for embryo transfer is just like IUI treatment. You won’t need anesthesia.
During the embryo transfer, a thin tube, or catheter, will be passed through your cervix. You may experience very light cramping but nothing more than that. Through the catheter, they will transfer the embryos, along with a small amount of fluid.25
The number of embryos transferred will depend on the quality of the embryos and discussion with your doctor. Depending on your age, anywhere from one to five embryos may be transferred. Transferring two embryos is the most common option.
More doctors are suggesting having just one embryo transferred and then freezing the rest. This is known as elective single embryo transfer (eSET), and it can reduce your risk of a multiple pregnancy. When you get pregnant with just one healthy baby, you reduce your risks for pregnancy complications.26 Speak to your doctor to find out if elective single embryo transfer is best for you.
After the transfer, you’ll stay lying down for a couple hours (bring a book) and then head home. If there are “extra” high-quality embryos left over, you may be able to freeze them. This is called embryo cryopreservation. They can be used later if this cycle isn’t successful in a frozen embryo transfer, or they can be donated.
Progesterone Support and the 2-Week Wait
On or after the day of your retrieval, and before the embryo transfer, you’ll start giving yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots!) Sometimes, though, progesterone supplementation can be taken as a pill, vaginal gel, or vaginal suppository.
Besides the progesterone, there really isn’t much going on for the next 2 weeks. In some ways, the two weeks after the transfer may be more difficult emotionally than the 2 weeks of treatment. During the previous steps, you will have visited your doctor perhaps every other day. Now, after transfer, there will be a sudden lull in activity.
You may have lots of questions about the two-week wait. Can you have sex? What if you have cramps? Of course, your doctor is the number one source for any of your concerns.
All you can do is wait the 2 weeks and see if pregnancy takes place. It can help to keep busy with your life during this wait time and avoid sitting and thinking about whether or not treatment will be successful.
Pregnancy Test and Follow-Up
About 9 to 12 days after the embryo transfer, a pregnancy test is ordered.27 This is usually a serum pregnancy test (more blood work) and also will include progesterone levels testing. The test may be repeated every few days.
If the test is positive, you may need to keep taking the progesterone supplementation for another several weeks. Your doctor will also follow up with occasional blood work and ultrasounds to monitor the pregnancy and watch for miscarriages or ectopic pregnancies.
Possible IVF Pregnancy Risks
Your doctor will also monitor whether or not the treatment led to a multiple pregnancy. IVF has a higher risk of conceiving multiples, and a multiple pregnancy carries risks for both the mother and the babies.28Risks of a multiple pregnancy include premature labor and delivery, maternal hemorrhage, C-section delivery, pregnancy induced high blood pressure, and gestational diabetes.29
If it’s a high-order pregnancy (4 or more), your doctor may discuss the option of reducing the number of fetuses in a procedure called a “multifetal pregnancy reduction.” This is sometimes done to increase the chances of having a healthy and successful pregnancy.
Women who conceive with IVF are more likely to experience spotting in early pregnancy, though it’s more likely for their spotting to resolve without harm to the pregnancy.30
The risk of miscarriage is about the same for women who conceive naturally, with the risk going up with age. For young women in their 20s, the rate of miscarriage is as low as 15%, while for women over 40, the rate of miscarriage may be over 50%.31
There is a 2% to 4% risk of ectopic pregnancy with IVF conception.32 If you developed OHSS from the fertility drugs, and you get pregnant, recovery may take longer.
When IVF Treatment Fails
If the pregnancy test is still negative 12 to 14 days post-transfer, your doctor will ask you to stop taking the progesterone. Then, you’ll wait for your period to start.
The next step will be decided by you, your partner, and your doctor. If this was your first cycle, another cycle may be recommended. Remember that your best chances for success are after doing several cycles.
Having a treatment cycle fail is never easy. It’s heartbreaking. It’s important, however, to keep in mind that having one cycle fail doesn’t mean you won’t be successful if you try again. There are many steps you can take after a treatment cycle fail.
Disclaimer: This article has been taken from https://www.verywellfamily.com/ as it is. Click here to read the original article.
Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as “test-tube babies.” Louise Brown, born in England in 1978, was the first such baby to be conceived outside her mother’s womb.Unlike the simpler process of artificial insemination — in which sperm is placed in the uterus and conception happens otherwise normally — IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.
What Causes of Infertility Can IVF Treat?
When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:
IVF is never the first step in the treatment of infertility except in cases of complete tubal blockage. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.
If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:
What is your pregnancy rate for couples in our age group and with our fertility problem?
What is the live birth rate for all couples who undergo this procedure each year at your facility?
How many of those deliveries are twins or other multiple births?
How much will the procedure cost, including the cost of the hormone treatments?
How much does it cost to store embryos and how long can we store them?
Do you participate in an egg donation program?
What Can I Expect From IVF?
The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one.You will then be tested to determine whether you’re ready for egg retrieval.
Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.
During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.
Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner’s sperm, which they will have donated on the same day.While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.
Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.
Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.In cases where the man’s sperm count is extremely low or there is poor motility (movement of the sperm), doctors may combine IVF with a procedure called intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen — or in some cases right from the testicles — and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.
What Are the Success Rates for IVF?
Success rates for IVF depend on a number of factors, including the reason for infertility, where you’re having the procedure done, and your age. The CDC compiles national statistics for all assisted reproductive technology (ART) procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures. The most recent report from 2016 found:
Pregnancy was achieved in an average of 27.3% of all cycles (higher or lower depending on the age of the woman).
The percentage of cycles that resulted in live births was 22.2% on average (higher or lower depending on the age of the woman).
Are There Other Issues With IVF to Consider?
Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.
A woman’s age is a major factor in the success of IVF for any couple. For instance, a woman who is under age 35 and undergoes IVF has a 39.6% chance of having a baby, while a woman over age 40 has an 11.5% chance. However, the CDC recently found that the success rate is increasing in every age group as the techniques are refined and doctors become more experienced.
What Are The Costs of IVF?
The average cost of an IVF cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine. This price will vary depending on where you live, the amount of medications you’re required to take, the number of IVF cycles you undergo, and the amount your insurance company will pay toward the procedure. You should thoroughly investigate your insurance company’s coverage of IVF and ask for a written statement of your benefits. Although some states have enacted laws requiring insurance companies to cover at least some of the costs of infertility treatment, many states haven’t.
Also be aware that some carriers will pay for infertility drugs and monitoring, but not for the cost of IVF or other artificial reproductive technology. Resolve: The National Infertility Association publishes a booklet called the “Infertility Insurance Advisor,” which provides tips on reviewing your insurance benefits contract.
Disclaimer: This article has been taken from https://www.webmd.com/ as it is. Click here to read the original article.
Bone marrow is the spongy tissue inside some of the bones in the body, including the hip and thigh bones. Bone marrow contains immature cells called stem cells.
Many people with blood cancers, such as leukemia and lymphoma, sickle cell anemia, and other life threatening conditions rely on bone marrow or cord blood transplants to survive.
People need healthy bone marrow and blood cells to live. When a condition or disease affects bone marrow so that it can no longer function effectively, a marrow or cord blood transplant could be the best treatment option. For some people, it may be the only option.
This article looks at everything there is to know about bone marrow.
What is bone marrow?
Bone marrow is soft, gelatinous tissue that fills the medullary cavities, or the centers of bones. The two types of bone marrow are red bone marrow, known as myeloid tissue, and yellow bone marrow, known as fatty tissue.
Both types of bone marrow are enriched with blood vessels and capillaries.
Bone marrow makes more than 220 billion new blood cells every day. Most blood cells in the body develop from cells in the bone marrow.
Bone marrow stem cells
Bone marrow contains two types of stem cells: mesenchymal and hematopoietic.
Red bone marrow consists of a delicate, highly vascular fibrous tissue containing hematopoietic stem cells. These are blood-forming stem cells.
Yellow bone marrow contains mesenchymal stem cells, or marrow stromal cells. These produce fat, cartilage, and bone.
Stem cells are immature cells that can turn into a number of different types of cells.
Hematopoietic stem cells in the bone marrow give rise to two main types of cells: myeloid and lymphoid lineages. These include monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes, dendritic cells, and megakaryocytes, or platelets, as well as T cells, B cells, and natural killer (NK) cells.
The different types of hematopoietic stem cells vary in their regenerative capacity and potency. They can be multipotent, oligopotent, or unipotent, depending on how many types of cells they can create.
Pluripotent hematopoietic stem cells have renewal and differentiation properties. They can reproduce another cell identical to themselves, and they can generate one or more subsets of more mature cells.
The process of developing different blood cells from these pluripotent stem cells is known as hematopoiesis. It is these stem cells that are needed in bone marrow transplants.
Stem cells constantly divide and produce new cells. Some new cells remain as stem cells, while others go through a series of maturing stages, as precursor or blast cells, before becoming formed, or mature, blood cells. Stem cells rapidly multiply to make millions of blood cells each day.
Blood cells have a limited life span. This is around 120 days for red blood cells. The body is constantly replacing them. The production of healthy stem cells is vital.
The blood vessels act as a barrier to prevent immature blood cells from leaving bone marrow.
Only mature blood cells contain the membrane proteins required to attach to and pass through the blood vessel endothelium. Hematopoietic stem cells can cross the bone marrow barrier, however. Healthcare professionals may harvest these from peripheral, or circulating, blood.
The blood-forming stem cells in red bone marrow can multiply and mature into three significant types of blood cells, each with its own job:
Red blood cells (erythrocytes): These transport oxygen around the body.
White blood cells (leukocytes): These help fight infection and disease. White blood cells include lymphocytes, which make up the cornerstone of the immune system, and myeloid cells, which include granulocytes, neutrophils, monocytes, eosinophils, and basophils.
Platelets (thrombocytes): These help with blood clotting after injury. Platelets are fragments of the cytoplasm of megakaryocytes, which are another type of bone marrow cell.
Once mature, these blood cells move from bone marrow into the bloodstream, where they perform important functionsTrusted Source that keep the body alive and healthy.
Mesenchymal stem cells are present in the bone marrow cavity. They can differentiate into a number of stromal lineages, such as:
Red bone marrow produces all red blood cells and platelets and around 60–70% of lymphocytes in human adults. Other lymphocytes begin life in red bone marrow and become fully formed in the lymphatic tissues, including the thymus, spleen, and lymph nodes.
Together with the liver and spleen, red bone marrow also plays a role in getting rid of old red blood cells.
Yellow bone marrow
Yellow bone marrow mainly acts as a store for fats. It helps provide sustenance and maintain the correct environment for the bone to function. However, under particular conditions — such as with severe blood loss or during a fever — yellow bone marrow may revert to red bone marrow.
Yellow bone marrow tends to be located in the central cavities of long bones and is generally surrounded by a layer of red bone marrow with long trabeculae (beam-like structures) within a sponge-like reticular framework.
Bone marrow timeline
Before birth but toward the end of fetal development, bone marrow first develops in the clavicle. It becomes active about 3 weeks later. Bone marrow takes over from the liver as the major hematopoietic organ at 32–36 weeks’ gestation.
Bone marrow remains red until around the age of 7 years, as the need for new continuous blood formation is high. As the body ages, it gradually replaces the red bone marrow with yellow fat tissue. Adults have an average of about 2.6 kilograms (kg) (5.7 pounds) of bone marrow, about half of which is red.
In adults, the highest concentration of red bone marrow is in the bones of the vertebrae, hips (ilium), breastbone (sternum), ribs, and skull, as well as at the metaphyseal and epiphyseal ends of the long bones of the arm (humerus) and leg (femur and tibia).
All other cancellous, or spongy, bones and central cavities of the long bones are filled with yellow bone marrow.
Function
Most red blood cells, platelets, and most white blood cells form in the red bone marrow. Yellow bone marrow produces fat, cartilage, and bone.
White blood cells survive from a few hours to a few days, platelets for about 10 days, and red blood cells for about 120 days. Bone marrow needs to replace these cells constantly, as each blood cell has a set life expectancy.
Certain conditions may trigger additional production of blood cells. This may happen when the oxygen content of body tissues is low, if there is loss of blood or anemia, or if the number of red blood cells decreases. If these things happen, the kidneys produce and release erythropoietin, which is a hormone that stimulates bone marrow to produce more red blood cells.
Bone marrow also produces and releases more white blood cells in response to infections and more platelets in response to bleeding. If a person experiences serious blood loss, yellow bone marrow can activate and transform into red bone marrow.
Healthy bone marrow is important for a range of systems and activities.
Circulatory system
The circulatory system touches every organ and system in the body. It involves a number of different cells with a variety of functions. Red blood cells transport oxygen to cells and tissues, platelets travel in the blood to help clotting after injury, and white blood cells travel to sites of infection or injury.
Hemoglobin
Hemoglobin is the protein in red blood cells that gives them their color. It collects oxygen in the lungs, transports it in the red blood cells, and releases oxygen to tissues such as the heart, muscles, and brain. Hemoglobin also removes carbon dioxide (CO2), which is a waste product of respiration, and sends it back to the lungs for exhalation.
Iron
Iron is an important nutrient for human physiology. It combines with protein to make the hemoglobin in red blood cells and is essential for producing red blood cells (erythropoiesis). The body stores iron in the liver, spleen, and bone marrow. Most of the iron a person needs each day for making hemoglobin comes from the recycling of old red blood cells.
Red blood cells
The production of red blood cells is called erythropoiesis. It takes about 7 days for a committed stem cell to mature into a fully functional red blood cell. As red blood cells age, they become less active and more fragile.
White blood cells called macrophages remove aging red cells in a process known as phagocytosis. The contents of these cells are released into the blood. The iron released in this process travels either to bone marrow for the production of new red blood cells or to the liver or other tissues for storage.
Typically, the body replaces around 1% of its total red blood cell count every day. In a healthy person, this means that the body produces around 200 billion red blood cells each day.
White blood cells
Bone marrow produces many types of white blood cells. These are necessary for a healthy immune system. They prevent and fight infections.
The main types of white blood cells, or leukocytes, are as follows.
Lymphocytes
Lymphocytes are produced in bone marrow. They make natural antibodies to fight infection due to viruses that enter the body through the nose, mouth, or another mucous membrane or through cuts and grazes. Specific cells recognize the presence of invaders (antigens) that enter the body and send a signal to other cells to attack them.
The number of lymphocytes increases in response to these invasions. There are two major types of lymphocytes: B and T lymphocytes.
Monocytes
Monocytes are produced in bone marrow. Mature monocytes have a life expectancy in the blood of only 3–8 hours, but when they move into the tissues, they mature into larger cells called macrophages.
Macrophages can survive in the tissues for long periods of time, where they engulf and destroy bacteria, some fungi, dead cells, and other material that is foreign to the body.
Granulocytes
“Granulocytes” is the collective name given to three types of white blood cells: neutrophils, eosinophils, and basophils. The development of a granulocyte may take 2 weeks, but this time reduces when there is an increased threat, such as a bacterial infection.
Bone marrow stores a large reserve of mature granulocytes. For every granulocyte circulating in the blood, there may be 50–100 cells waiting in the bone marrow to be released into the bloodstream. As a result, half the granulocytes in the bloodstream can be available to actively fight an infection in the body within 7 hours of it detecting one.
Once a granulocyte has left the blood, it does not usually return. A granulocyte may survive in the tissues for up to 4–5 days, depending on the conditions, but it can only survive for a few hours in circulating blood.
Neutrophils
Neutrophils are the most common type of granulocyte. They can attack and destroy bacteria and viruses.
Eosinophils
Eosinophils are involved in the fight against many types of parasitic infections and against the larvae of parasitic worms and other organisms. They are also involved in some allergic reactions.
Basophils
Basophils are the least common of the white blood cells. They respond to various allergens that cause the release of histamines, heparin, and other substances.
Heparin is an anticoagulant. It prevents blood from clotting. Histamines are vasodilators that cause irritation and inflammation. Releasing these substances makes a pathogen more permeable and allows for white blood cells and proteins to enter the tissues to engage the pathogen.
The irritation and inflammation in tissues that allergens affect are parts of the reaction associated with hay fever, some forms of asthma, hives, and, in its most serious form, anaphylactic shock.
Platelets
Bone marrow produces platelets in a process known as thrombopoiesis. Platelets are necessary for blood to coagulate and for clots to form in order to stop bleeding.
Sudden blood loss triggers platelet activity at the site of an injury or wound. Here, the platelets clump together and combine with other substances to form fibrin. Fibrin has a thread-like structure and forms an external scab or clot.
Platelet deficiency causes the body to bruise and bleed more easily. Blood may not clot well at an open wound, and there may be a higher risk of internal bleeding if the platelet count is very low.
Lymphatic system
The lymphatic system consists of lymphatic organs such as bone marrow, the tonsils, the thymus, the spleen, and lymph nodes.
All lymphocytes develop in bone marrow from immature cells called stem cells. Lymphocytes that mature in the thymus gland (behind the breastbone) are called T cells. Those that mature in bone marrow or the lymphatic organs are called B cells.
Immune system
The immune system protects the body from disease. It kills unwanted microorganisms such as bacteria and viruses that may invade the body.
How does the immune system fight infection?
Small glands called lymph nodes are located throughout the body. Once lymphocytes are made in bone marrow, they travel to the lymph nodes. The lymphocytes can then travel between each node through lymphatic channels that meet at large drainage ducts that empty into a blood vessel. Lymphocytes enter the blood through these ducts.
Three major types of lymphocytes play an important part in the immune system: B lymphocytes, T lymphocytes, and NK cells.
B lymphocytes (B cells)
These cells originate from hematopoietic stem cells in bone marrow in mammals.
B cells express B cell receptors on their surface. These allow the cell to attach to an antigen on the surface of an invading microbe or another antigenic agent.
For this reason, B cells are known as antigen-presenting cells, as they alert other cells of the immune system to the presence of an invading microbe.
B cells also secrete antibodies that attach to the surface of infection-causing microbes. These antibodies are Y-shaped, and each one is akin to a specialized “lock” into which a matching antigen “key” fits. Because of this, each Y-shaped antibody reacts to a different microbe, triggering a larger immune system response to fight infection.
In some circumstances, B cells erroneously identify healthy cells as being antigens that require an immune system response. This is the mechanism behind the development of autoimmune conditions such as multiple sclerosis, scleroderma, and type 1 diabetes.
T lymphocytes (T cells)
These cells are so-called because they mature in the thymus, which is a small organ in the upper chest, just behind the sternum. (Some T cells mature in the tonsils.)
There are many different types of T cells, and they perform a range of functions as part of adaptive cell-mediated immunity. T cells help B cells make antibodies against invading bacteria, viruses, or other microbes.
Unlike B cells, some T cells engulf and destroy pathogens directly after binding to the antigen on the surface of the microbe.
NK T cells, not to be confused with NK cells of the innate immune system, bridge the adaptive and innate immune systems. NK T cells recognize antigens presented in a different way from many other antigens, and they can perform the functions of T helper cells and cytotoxic T cells. They can also recognize and eliminate some tumor cells.
NK cells
These are a type of lymphocyte that directly attack cells that a virus has infected.
Transplants
A bone marrow transplant is useful for various reasons. For example:
It can replace diseased, nonfunctioning bone marrow with healthy functioning bone marrow. This is useful in conditions such as leukemia, aplastic anemia, and sickle cell anemia.
It can regenerate a new immune system that fights existing or residual leukemia or other cancers that chemotherapy or radiation therapy has not killed.
It can replace bone marrow and restore its usual function after a person receives high doses of chemotherapy or radiation therapy to treat a malignancy.
It can replace bone marrow with genetically healthy, functioning bone marrow to prevent further damage from a genetic disease process, such as Hurler’s syndrome or adrenoleukodystrophy.
Stem cells mainly occur in four places:
an embryo
bone marrow
peripheral blood, which is present in blood vessels throughout the body
cord blood, which is present in the umbilical cord and collectible after birth
Stem cells for transplantation are obtainable from any of these except the fetus.
Worldwide, more than 50,000 first HSCT procedures, 28,000 autologous transplantation procedures, and 21,000 allogeneic transplantation procedures take place every year. This is according to a 2015 reportTrusted Source by the Worldwide Network for Blood and Marrow Transplantation.
This number continues to increase by over 7% annually. Reductions in organ damage, infection, and severe, acute graft-versus-host disease (GVHD) seem to be contributing to improved outcomes.
In a study of 854 people who survived at least 2 years after autologous HSCT for hematologic malignancy, 68.8% were still alive 10 years after transplantation.
Bone marrow transplants are the leading treatment option for conditions that threaten bone marrow’s ability to function, such as leukemia.
A transplant can help rebuild the body’s capacity to produce blood cells and bring their numbers to acceptable levels. Conditions that may be treatable with a bone marrow transplant include both cancerous and noncancerous diseases.
Cancerous diseases may or may not specifically involve blood cells, but cancer treatment can destroy the body’s ability to manufacture new blood cells.
A person with cancer usually undergoes chemotherapy before transplantation. This eliminates the compromised marrow.
A healthcare professional then harvests the bone marrow of a matching donor — which, in many cases, is a close family member — and ready it for transplant.
Types of bone marrow transplant
Types of bone marrow transplant include:
Autologous transplant: People receive their own stem cells from their peripheral or cord blood to replenish bone marrow.
Syngeneic transplant: People receive stem cells from their identical twin.
Allogeneic transplant: People receive matching stem cells from a sibling, parent, or unrelated donor.
Haploidentical transplantation: This is a treatment option for the approximately 70%Trusted Source of people who do not have a human leukocyte antigen (HLA)-identical matching donor.
Umbilical cord blood (a type of allogeneic transplant): A healthcare professional removes stem cells from a newborn baby’s umbilical cord right after birth. They freeze and store the stem cells until they are needed for a transplant. Umbilical cord blood cells are very immature, so there is less of a need for matching, but blood counts take much longer to recover.
Tissue type
A person’s tissue type is defined as the type of HLA they have on the surface of most of the cells in their body. HLA is a protein, or marker, that the body uses to help it determine whether or not the cell belongs to the body.
To check if the tissue type is compatible, doctors assess how many proteins match on the surface of the donor’s and recipient’s blood cells. There are millions of different tissue types, but some are more common than others.
Tissue type is inherited, and types pass on from each parent. This means that a relative is more likely to have a matching tissue type.
However, if it is not possible to find a suitable bone marrow donor among family members, healthcare professionals try to find someone with a compatible tissue type on the bone marrow donor register.
Pre-transplant tests
Healthcare professionals perform several tests before a bone marrow transplant to identify any potential problems.
heart function tests, including an electrocardiogram and echocardiogram (ECG)
bone marrow biopsy
skeletal survey
In addition, a person needs a complete dental exam before a bone marrow transplant to reduce the risk of infection. Other precautions to lower the risk of infection are also necessary before the transplant.
Harvesting bone marrow
Bone marrow is obtainable for examination by bone marrow biopsy and bone marrow aspiration.
Bone marrow harvesting has become a relatively routine procedureTrusted Source. Healthcare professionals generally aspirate it from the posterior iliac crests while the donor is under either regional or general anesthesia.
Healthcare professionals can also take it from the sternum or from the upper tibia in children, as it still contains a substantial amount of red bone marrow.
To do so, they insert a needle into the bone, usually in the hip, and withdraw some bone marrow. They then freeze and store this bone marrow.
National Marrow Donor Program (NMDP) guidelines limit the volume of removable bone marrow to 20 milliliters (ml) per kg of donor weight. A dose of 1 x 103 and 2 x 108 marrow mononuclear cells per kg is necessary to establish engraftment in autologous and allogeneic marrow transplants, respectively.
Complications related to bone marrow harvesting are rare. When they do occur, they typically involve problems related to anesthetics, infection, and bleeding.
Another way to evaluate bone marrow function is to give a person certain drugs that stimulate the release of stem cells from bone marrow into circulating blood.
A healthcare professional then obtains a blood sample and isolates stem cells for microscopic examination. In newborns, they may retrieve stem cells from the umbilical cord.
How do healthcare professionals transplant bone marrow?
Before the transplant, the person may receive chemotherapy, radiation therapy, or both. There are two ways of doing this: ablative (myeloablative) treatment and reduced intensity treatment, or a mini-transplant.
In ablative (myeloablative) treatment, a person receives high dose chemotherapy, radiation therapy, or both to kill any cancer cells. This also kills all healthy bone marrow that remains and allows new stem cells to grow in the bone marrow.
In reduced intensity treatment, or a mini-transplant, a person receives lower doses of chemotherapy and radiation therapy before a transplant. This allows older adults and those with other health problems to have a transplant.
A stem cell transplant usually takes place after chemotherapy and radiation therapy are complete.
The infusion of either bone marrow or peripheral blood is a relatively simple process that a healthcare professional performs at the bedside. They infuse the bone marrow product through a central vein through an IV tube over a period of several hours.
Autologous products are almost always cryopreservedTrusted Source. They thaw at the bedside and infuse rapidly over a period of several minutes.
After entering the bloodstream, the hematopoietic stem cells travel to the bone marrow. There, they begin to produce new white blood cells, red blood cells, and platelets in a process known as engraftment. This usually occurs 30 days after transplantation.
In most cases, there appears to be minimal toxicity. ABO-mismatched bone marrow infusions can sometimes lead to hemolytic reactions.
Dimethyl sulfoxide (DMSO) — which healthcare professionals use for the cryopreservation of stem cells — may give rise to facial flushing, a tickling sensation in the throat, and a strong taste of garlic in the mouth. Rarely, DMSO can cause bradycardia, abdominal pain, encephalopathy or seizures, and renal failure.
To lower the risk of encephalopathy, which is a brain condition that may occur with doses above 2 grams per kg per day of DMSO, healthcare professionals infuse stem cell infusions that exceed 500 ml over 2 days, and they limit the rate of infusion to 20 ml per minute.
Healthcare professionals regularly check blood counts. Complete recovery of immune function can take several months for autologous transplant recipients and 1–2 years for people receiving allogeneic or syngeneic transplants.
Blood tests will confirm that the body is producing new blood cells and that any cancer has not returned. Bone marrow aspiration can also help healthcare professionals determine how well the new bone marrow is working.
Significant risks include increased susceptibility to infection, anemia, graft failure, respiratory distress, and excess fluid, which can lead to pneumonia and liver dysfunction.
A mismatch between donor and recipient tissues can lead to an immune reaction between the cells of the host and the cells of the graft.
When graft cells attack host cells, the result is a dangerous condition called GVHD. This can be acute or chronic and may manifest as a rash, a gastrointestinal illness, or liver disease. It is possible to lower the risk of GVHD through careful tissue matching.
Even when a donor antigen match is identical, 20–50% of recipients still develop GVHD, rising to 60–80% when only a single antigen is mismatched. Because of the danger of this complication, autologous transplants are more common.
Past studies suggest that people aged over 50 yearsTrusted Source have a higher risk of complications following bone marrow transplantation. For this reason, experts have typically advised against undergoing transplantation after this age.
However, advances in medical technology have reduced these risks. The authors of a 2013 report conclude that transplantation can be safe for people aged over 70 years,Trusted Source if they meet certain criteria.
There is little risk to those who donate because they generate new bone marrow to replace removed bone marrow. There is, however, a slight risk of infection, and a reaction to anesthetics can occur with any surgical procedure.
Conditions
As bone marrow affects many bodily systems, a problem can result in a wide range of conditions, including cancers that affect the blood.
A number of conditions pose a threat to bone marrow because they prevent it from turning stem cells into essential cells.
Leukemia, Hodgkin disease, and other lymphoma cancers can damage bone marrow’s productive ability and destroy stem cells.
Doctors are treating a growing number of conditions using HSCT.
About every 3 minutes in the United States, someone receives a diagnosis of blood cancer. A bone marrow transplant is often the best chance for survival.
Around 30%Trusted Source of people can find a matching donor in their families, but 70% rely on bone marrow that someone unrelated has donated.
Healthcare professionals currently use autologous HSCT to treat:
some genetic immunologic or hematopoietic conditions
Bone marrow transplants are sometimes necessary after certain treatments, such as high dose chemotherapy and radiation therapy, that treat cancer. These treatments tend to damage healthy stem cells as well as destroy cancer cells.
Bone marrow tests
Bone marrow tests can help diagnose certain conditions, especially those related to blood and blood-forming organs. Testing provides information on iron stores and blood production.
Bone marrow aspiration uses a hollow needle to remove a small sample (about 1 ml) of bone marrow for examination under a microscope.
A healthcare professional usually inserts a needle into the hip or sternum in adults or into the upper part of the tibia (the larger bone of the lower leg) in children. They use suction to extract the sample.
They typically perform bone marrow aspiration when previous blood tests have indicated a need for it. It is particularly useful in providing information on various stages of immature blood cells.
Donation
There are two main types of bone marrow donation.
The first involves the removal of bone marrow from the back of the pelvic bone.
The second method, which is more common, is peripheral blood stem cell (PBSC) donation. This involves filtering stem cells directly from the blood. It is these blood stem cells, rather than bone marrow itself, that are necessary for the treatment of blood cancers and other conditions.
When an individual joins a bone marrow donation registry, they are agreeing to donate using whichever method the healthcare professional deems appropriate.
In terms of costs, the NMDP or a person’s medical insurance usually covers the expense of making a blood marrow donation. Donors never pay for donating, and they are never paid to donate.
The risk to a donor is minimal. Over 98.5% of donors make a full recovery after the procedure. With blood marrow donation, the major risk involves the use of anesthetics during the procedure.
With PBSC donation, the procedure itself — which involves filtering blood through a machine — is not dangerous.
Depending on a person’s ethnicity, the chance of finding a suitable bone marrow donor ranges from 23–77%, according to the NMDP’s Be The Match Registry.
Although 77% of white people in the U.S. can find a match on a donor registry, the same is true for only 23% of Black people. For those of mixed race, the percentage drops to 4%, as the combination of inherited features becomes more complex.
The NMDP has links with registries around the world, but there is an urgent need for more donors. Several researchersTrusted Source are calling for “further efforts” to overcome the barriers involved.
Who can donate bone marrow?
The following are some general guidelines for bone marrow donation as recommended by the NMDP.
The guidelines aim to protect the health and safety of both the donor and the recipient. Donors should contact their local NMDP center for specific details and to discuss donations with a healthcare team.
To be listed in the registry, potential donors must be healthy and aged 18–60 years.
If matched with a person needing a transplant, each donor must pass a medical examination and be infection-free before donating.
People who use medications can usually donate bone marrow, as long as they are healthy and any medical conditions they have are under control at the time of donation.
by those with specific medical conditions, such as most cancers and certain heart conditions
People with Lyme disease, malaria, or recent tattoos or piercings should wait at least a year before donating bone marrow.
How do healthcare professionals determine a bone marrow match?
After registering to donate, the person undergoes an HLA-typing test, which healthcare professionals use to match individuals with potential donors.
The healthcare professional then adds their HLA type to a database of potential donors, and they search the registry to try to find a match.
They compare proteins in the blood cells to see if they are similar to those of the recipient. They then contact the potential donor if there is a match.
The more similar the donor’s tissue type is to the individual’s, the better the chance of the person’s body accepting the transplant.
The World Marrow Donor Association (WMDA) is a collective database of hematopoietic cell donor registries from 55 countries. About 37.9 million potential donors and over 802,600 cord blood units were available as of April 2021. Preliminary searches through the NMDP also explore the WMDA.
What happens when donating bone marrow?
Hematopoietic stem cell donors undergo the following tests:
medical history and physical examination
serum creatinine, electrolyte, and liver function studies
In autologous donations, CMV and VDRL testing are not necessary.
Donating PBSC
Before a person can donate PBSC, they need to undergo daily injections of a medication called filgrastim in the 5 days leading up to the procedure. This medication draws stem cells from the bone marrow, so the donor has more of them circulating in their blood.
Donating PBSC involves a procedure known as apheresis. This is when a healthcare professional takes blood from the body using a catheter inserted into one arm. The blood passes through a machine, which filters out the stem cells, along with platelets and white blood cells. The remaining blood, which consists mainly of plasma and red blood cells, flows back into the body through a vein in the other arm.
The procedure is completely painless and is similar to donating plasma. Most PBSC donations can take place in one apheresis session that may take up to 8 hours. About 10% of PBSC donations require two apheresis sessions, each lasting 4–6 hours.
PBSC donation does not require anesthetics.
The filgrastim injections before donation may cause the following effects for several days:
However, these side effects usually stop soon after donation.
Most PBSC donors experience a full recovery within 7–10 days after the donation.
Donating bone marrow
If a person is donating bone marrow instead of PBSC, there is no need for filgrastim injections. Bone marrow donation is a surgical procedure that takes place in the operating room. It requires anesthetics and is, therefore, completely painless. The entire procedure takes 1–2 hours.
In around 96% of cases, the donor receives general anesthetics, which means that they are unconscious for the entire procedure. In a small number of cases, they receive local anesthetics, which numb the area that the healthcare professional takes bone marrow from. In this situation, the donor is awake throughout the procedure.
The person lies on their stomach. A healthcare professional makes an incision about a quarter of an inch in length on both sides of the pelvic bone. They then insert special, hollow needles into the bone, through which they draw the liquid marrow. The incisions do not usually require stitches.
After the procedure, the donor stays in a recovery room until they regain consciousness. Once they can eat, drink, and walk, they can leave.
Recovery
After bone marrow donation, the average recovery time is 20 days. Bone marrow replaces itself within 4–6 weeks.
A person who donates PBSC is unlikely to experience any side effects following the donation, other than bruising at the needle site. Recovery time is almost immediate.
Outcome
The outcome of a bone marrow transplant depends on:
the type of transplant
how closely the cells match
what type of condition the person has
the person’s age and overall health
the type and dosage of chemotherapy or radiation therapy they received before the transplant
any complications that arise
A person whose condition is stable or in remission has a better chance of a good outcome than someone who has a transplant in a later stage or with relapsed disease. Young age at the time of transplant also improves the chance of success.
Transplants for nonmalignant conditions tend to have more favorable outcomes. For example, for sickle cell anemia, the overall 1-year survival rate is 94–97% if the donor is a relative or matched sibling or 83% if the donor is not related. The overall 3-year survival rate is 89–95% for transplants from related donors or 77% if the donor is unrelated.
Recipients with acute leukemia in remission at the time of transplant have an overall 1-year survival rate of 69–75% if the donor is related or 68% if the donor is unrelated. The overall 3-year survival rate is 49–58% for transplants from related donors or 53% if the donor is unrelated.
In recent years, there has been a decrease in complications such as infections and diseases. This means that the risk of death for recipients of bone marrow transplants dropped over 20% between 2003–2007 and 2013–2017, according to one 2020 analysis.
A bone marrow transplant may completely or partially cure a condition. If the transplant is successful, the person can go back to most regular activities as soon as they feel well enough. Full recovery usually takes up to a year.
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