The question: I'm thinking of becoming a bone marrow donor, but how painful is it and are there any risks involved?
The answer: Let me tell you about a seven-year-old patient of mine. I have been her family doctor since she was four. She was healthy and growing well, but last year, her parents brought her in for a visit because she couldn't keep up with her classmates in gym class and was bruising easily. This usually joyful and energetic little girl was pale, tired and not her interactive self. My heart sank when we received her abnormal blood test results, which was soon confirmed to be a form of leukemia.
Her bone marrow, the soft tissue found in the centre of her bones, was producing too many white blood cells. The stem cells in the bone marrow have the potential to become any type of blood cell: red blood cells that carry oxygen, white blood cells that fight infection and platelets that stop bleeding. In my patient, due to the overproduction of white blood cells, she wasn't making enough red blood cells so she was weak from anemia and bruising due to her low platelet count.
Treatment for diseases of the bone marrow such as leukemia involve replacing the diseased marrow with a donor's healthy stem cells. In order to do this, my patient's specialists sought out a bone marrow donor.
Her family came together to donate their own bone marrow, but no match was found. Finding a bone marrow match is not as straightforward as blood donation, as it goes beyond the A,B,O blood type and depends upon the compatibility of inherited genetic markers on both the donor and patient's blood cells known as HLA antigens. While we may think that most donors come from family members of the patient, it is estimated that only 30 per cent of donors are actually related. For those that do not have a match in their family, the only hope for survival is to find an anonymous donor.
And this is what happened for my young patient.
Her doctors reached out to the Canadian Blood Services' One Match program, a registry of all potential bone marrow donors in Canada. While it is a simple process to register, it is also a commitment that needs to be taken seriously. Once you register, you will only be called if you are a potential match. At this point, you will be asked to go through a physical exam and extra tests to ensure that you are truly compatible. Once this process is complete, the donation occurs, which can take two forms: a bone marrow donation or a peripheral blood donation.
The less invasive peripheral blood donation can be done by a simple blood draw, while the bone marrow donation is a minor surgical procedure. The latter involves removal of bone marrow from the iliac crest (hip bone). It can be painful but it is done under anesthetic to make it more comfortable for the donor. Bone marrow donation is a safe procedure but does carry a low risk of potential pain and infection, and risks associated with anesthesia. Some donors can feel tired after donating their bone marrow which can take days to weeks to resolve. Once your stem cells are donated, your body will replenish your supply within six weeks.
Due to the kindness of a volunteer donor, a match was found for my patient. She successfully had a bone marrow transplant, recovered beautifully and is now entering Grade 2 this fall.
In Canada, there are about 1000 people every day on a wait list for a stem cell or bone marrow transplant. My patient is one example of many that was able to recover from her illness due to the generosity of a stranger. We all have this potential to help, so while there are some risks to consider, I believe it is a worthwhile commitment to make.
Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.
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