3-year-old Iraqi child gives a new lease of life to sickle cell disease affected brother at Manipal Hospitals

South India
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Stem cell transplantation from an adult to a child is common, but it is fraught with high risk in case of a 3-year-old donor. A bone marrow transplant team at Manipal Hospitals achieved the near impossible task.

A bone marrow transplant team at Manipal Hospitals, Bengaluru, brought an 18-year-old boy from Iraq battling with a severe sickle cell disease that doesn’t have any medical cure back to life through a highly complex process of transplanting stem cells from his three-year-old sibling.

Ahmed, who did not get any relief from splenectomy done in his native country, was brought to India after doctors felt that a bone marrow transplantation might help him. They referred Ahmed, who suffered from severe sickle cell disease and severe symptomatic anaemia needing frequent blood transfusions, to the Manipal Hospitals.

The case posed a far more complex challenge for the expert medical team at the Manipal because the donor who could provide the stem cells was the patient’s younger sister, who was a mere 3-year old child, weighed only 18 kg and had a blood volume of only about 1.3 litres.

The doctors needed to process about 8-10 litres of blood to perform the stem cell transplantation. “That was indeed a huge problem for us" said Dr C. Shivaram, Consultant - Transfusion Medicine at Manipal.

The bone marrow transplant team critically evaluated every probable risk that could have occurred to the donor and developed innovative strategies to handle the complications.

"The first challenge was the low volume of blood of donor compared to our large volume requirement. In view of her age the child had to be sedated to elicit co-operation during apheresis (extracting whole blood from and separating the components) in multiple sittings and preserve the stem cells through cryopreservation. We decided to perform this procedure in our pediatric ICU as it is well-equipped to handle any complications," said Dr Shivaram.

"To counter the low volume of blood going into the apheresis machine, we filled the dead spaces with compatible RBC, and to reduce the fluid overload, we determined and monitored the volume of the fluid going into the body of the child. To prevent citrate toxicity, cardiac monitoring, and ECG tracing was implemented. Advanced equipment for cryo-preservation like control rate deep freezer allowed us to preserve the stem cells effectively. Our more than 20-years of experience in bone marrow transplantation came to our rescue while handing such critical case,” added Dr Shivaram while sharing his thoughts on the benefit of clinical experience in handling complicated cases.

Ahmed finally underwent allogeneic bone marrow transplantation successfully and won over his sickle cell disease. He did have few complications post-transplantation like mucositis, febrile neutropenia, viral reactivations, which were successfully managed.

“Ahmed is now several months post Bone Marrow Transplantation and his symptoms have disappeared, he has not needed any blood transfusion, his quality of life has improved significantly and his parents are overjoyed to see their son doing so well after suffering from the illness for several years -and the satisfaction of seeing the joy on the faces of patient and family are unmatched.” said Dr Mallikarjun Kalashetty, Consultant - Haematology, Haemato-Oncology & Bone Marrow Transplantation.

 

 

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