Bone Marrow Transplant (BMT): Blood Counts & Transfusions

Waiting for engraftment

Engraftment is the term used to describe when your new bone marrow begins to function and produce cells.

The high doses of chemotherapy given before a stem cell transplant cause the bone marrow to stop producing new blood cells. It takes time for the new transplanted stem cells to start functioning. The transplanted cells will travel to the bones, reseed the marrow space and go through a growth process before the mature blood cells are released from the bone marrow into the blood stream. To help the new stem cells mature and grow, you'll receive daily injections of a bone marrow growth factor, called G-CSF. It will take at least 8 to 14 days from the day of transplantation before your blood counts start to recover.

The term "blood counts" refers to the number of blood cells circulating in the blood stream. There are three main types of blood cells: red blood cells, white blood cells and platelets. But until engraftment occurs, no mature cells leave the marrow and enter the blood stream. As a result, your blood counts will show very low values, and you will require careful monitoring by the health care team. Until you start producing adequate numbers of blood cells again, you'll be supported with red blood cell and platelet transfusions.

Types of blood cells

White blood cells (WBCs)

White blood cells fight infection. They include neutrophils and lymphocytes, among others.

Neutrophils, also known as polys or granulocytes, account for the majority of circulating WBCs. They are responsible for fighting primarily bacterial and fungal infections. Bone marrow growth factors are given to make neutrophil counts rise. The neutrophil count should be at least 500 (usually reported on the lab test results as 0.5) by 30 days after transplantation.

Lymphocytes are the backbone of the immune system. These cells are responsible for fighting viruses and for forming antibodies that will attack infectious organisms. Lymphocyte function is generally abnormal for as long as three months after transplantation. This means you may develop severe infections even when the white blood cell count is normal.

Red blood cells (RBCs)

RBCs carry oxygen throughout the body. A hematocrit test measures the percentage of a patient’s blood that contains red cells.

Anemia occurs when there are not enough red blood cells in the body. Symptoms include shortness of breath, weakness, fatigue, dizziness, headache and irritability. A red cell transfusion is given through your catheter over an average of two to three hours. Additional transfusions may be needed if you are an outpatient, or you may be given erythropoietin (EPO), a red blood cell growth factor.

Platelets

Platelets help control bleeding. When you cut yourself, the platelets form a clot or plug to stop the bleeding. Some symptoms of a low platelet count include petechiae (small red dots on the skin), easy bruising and bleeding from the gums or nose.

Transfusions

When your blood counts decrease below safe levels, you will receive red blood cell or platelet transfusions. All persons donating blood are carefully screened for infectious diseases to make sure their blood is safe and the red blood cells and platelets are irradiated and filtered.

Reactions to blood transfusions

You may sometimes experience an uncomfortable reaction to your blood product transfusions. Some of these reactions may include fever, chills, shaking, itching and skin rashes. Infrequent side effects are back pain and shortness of breath. If you have side effects, medications are available to limit the reactions. Medications may be used before the transfusion to minimize any side effects. Your nurse will watch carefully for any of these reactions; you should also report any symptoms to your nurse.

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• Next: After Your Transplant: Outpatient Care

Return to the Autologous Transplant Guide Index:

• Introduction
• The Transplant Team
• Pre-Transplant Evaluation
• Treatment and Side Effects
• Blood Counts and Transfusions
• After Your Transplant: Outpatient Care
• Coping and Recovery