April 2019 digital edition

Bhattad proceeded to plan and collaborate with Drs Stalin
Ramprakash and CP Raghuram, bone marrow transplant
experts at Aster CMI Hospital, to perform this transplant.
Ciara was admitted to the hospital about 2 weeks prior
to the transplantation so that all tests could be carried out
and she could be closely monitored. She was again kept in
the hospital for 2-3 weeks after the transplant to ensure
that there were no adverse effects and she did not get any
infections immediately after the transplantation.
Many factors contribute to the success of transplantation.
HLA donor matching and the underlying condition of the
patient play major roles in success, and the patient must
be closely monitored post the transfer of the bone marrow.
These factors, along with the age and weight of the patient
as well as kidney involvement, contribute to a decision on the
medical treatment that follows transplantation. Due to Ciara’s
kidney and lung involvement, medications were carefully
planned. Complications were also anticipated as preexisting
organ damage increases the risk of complications during and
after the transplant, making the technique complex and one
requiring meticulous planning.
Ciara underwent successful transplantation and is doing
very well so far. She will need to be closely monitored for
the next 3 months and be on immunosuppressants for the
next 6 months. Dr Bhattad calls it the ‘100 day’ period posttransplantation
when there is a high risk of infection and
chances of transplant rejection. However,
after the ‘100 day’ period, the new bone
marrow starts to function completely, and the
immunosuppressant doses can be decreased.
Aster CMI in Bangalore has a dedicated
Immunology and Bone Marrow Transplant
Unit (BMT) which encounters many children
with immune deficiencies, as in Ciara’s case.
Dr Bhattad reiterates that “Primary immune
deficiencies are actually quite common, but
often undiagnosed. It should particularly be
considered in case of repeated infections
and multiple hospitalizations, ideally before
irreversible organ damage occurs. Awareness
of such deficiencies is particularly important,
especially now that the required diagnostics
and therapeutics are available. Eyes see only
what the mind knows.”
Only when doctors start looking for these
conditions in their patients will they be
able to make an early diagnosis. Increasing
awareness of these diseases is the need of
the hour.
DR SHIVANEE SHAH
April 2019 / FUTURE MEDICINE / 51