World Marrow Donor Day | Bone Marrow

World Bone Marrow Donor Day is celebrated every year on the 3rd Saturday of September all over the world to thank all the blood stem cell donors worldwide. The main objective of celebrating the day is to thank all the stem cell donors, unknown donors family members, and donors who have enlisted on the global registry and waiting to donate. The secondary objective is to raise awareness among the public on the importance of donating stem cells and how important it could be for a patient. Massive awareness campaigns are done to break the myths and wrong information about donating stem cells and the need for more people to enlist in the registry as many patients are still unable to find a perfect match.

What is Bone Marrow?

This is the soft, spongy tissue inside some of the bones in the body, such as the hip bones and the thigh bones, which makes blood stem cells, i.e., blood-forming cells. It carries immature cells called stem cells. These cells turn into blood cells, including red blood cells, white blood cells, and platelets. The bone marrow makes more than 200 billion blood cells every day. This is vital since blood cells have a limited life span, about 100-120 days in the case of red blood cells. Therefore they need to be replaced continuously, and thus the proper function of the bone marrow is vital for the body.

Marrow Transplant

A bone marrow transplant is a procedure in which the damaged or destroyed bone marrow is replaced by healthy stem cells from the donor. The procedure transplants new stem cells, these cells produce new blood cells and promote the growth of new marrow.

When do you need a transplant?

Bone marrow transplants are required when bone marrow is affected due to some disease, making it unable to function properly. In such cases, a bone marrow transplant is the best option for treatment or cure.

The bone marrow of a person may not function due to several diseases such as:

• Cancers such as leukemia, lymphoma, and multiple myeloma.
• Aplastic anemia, in which the marrow stops making new blood cells.
• Inherited blood disorders, like sickle cell anemia and thalassemia.
• Damaged bone marrow due to chemotherapy.

Marrow Transplant Types

There are two major types of bone transplants:

Autologous Transplants

This is done using the patient's cells. The cells are removed before the patient undergoes any high-dose treatment such as chemotherapy or radiotherapy, and stored in a freezer. After the treatment, the cells are put back into the body. However, this procedure is not always possible as it can be used only when the patient has healthy bone marrow.

Allogeneic Transplants

In this type of transplant, stem cells from the donor are taken to replace the damaged stem cells of the patient. It is imperative that the donor must have a close genetic match, and therefore, most close relatives become donors. Tests are done to check the compatibility between the donor's genes and the patient's genes before the transplant. These transplants have a higher risk of complications, such as Graft versus host disease (GVHD), where the patient's body may see the stem cells as foreign and attack them.

There is another type of transplant, called the umbilical cord blood transplant, which is a type of allogeneic transplant. In this method, stem cells are removed from a newborn baby's umbilical cord right after birth and are stored until they are needed in the future. This method is used since the need for perfect matching is less as umbilical cord blood cells are very immature.

There is another subtype of allogeneic transplant, called a horizontal transplant. This is also called a half-matched or partially matched transplant as the donor is a half-match for the patient. This procedure is followed when the doctors can't find a perfect donor match and decide to use stem cells from donors who are exactly half a match of the patient's DNA. The donors are usually parents or siblings as only they have the chance to half-match the patient's DNA.

Bone Marrow Transplant Donor

The doctors test the blood of the patients to find out the HLA (human leukocyte antigen) type. HLA is a protein, or a marker, based on which doctors look for a prospective donor that matches with the patient's HLA.

Bone marrow cells can be collected in two ways from the donor:

• Bone marrow harvest: This is a minor surgery done under anesthesia, where the bone marrow is removed from the back of both hip bones. The amount of marrow removed usually depends on the weight of the patient receiving it.
• Leukapheresis: In this process, the bone marrow is moved to the blood through several days of shots, and further removed through an IV line. Then, the part of the white blood cells that contain the stem cells is removed through a machine and given to the patient.

Typically, the hospital stay for marrow donation is from early morning to late afternoon, and sometimes overnight observation in rare cases. The median time to full recovery after a bone marrow donation is 20 days, although this may differ from person to person. Most donors will be able to resume work, college, or other activities within a week.

Possible side effects after marrow donation

Some of the possible side effects usually seen after two days of bone marrow transplant according to reports by Be the Match organisation:

• Back or hip pain
• Fatigue
• Throat pain
• Muscle pain
• Insomnia
• Headache
• Dizziness
• Loss of appetite
• Nausea

Debunking myths about bone marrow donation

• Donating bone marrow is painful: This is a popular myth that donating blood marrow is a very painful procedure. This might be due to the exaggerated portrayal of stem cell donation in TV shows and movies, while in reality, it is not so painful. The discomfort varies from person to person but doesn't lead to any serious discomfort.
• Bone marrow is taken from the spine: This is another popular myth, that the marrow is taken from the spine, and is thus very painful and harmful. In truth, 75% of the donation is done by collecting the blood stem cells from the bloodstream, just like collecting plasma. The donors can watch movies or chat with friends while the process takes place and can go back as soon as it is over. Another method is extracting the marrow from the pelvic bone, and not the spine, through a special syringe. This is done under general anesthesia, and while the donor may feel some back pain, it can be treated with medicines. There won't be any permanent side effects, and they will be able to resume normal activities within a week. And while your bone marrow grows back, you would have given a second chance at life to a human being.
• Only a family member can donate: Many people believe that only a family member can donate bone marrow to the patient, but the truth is quite the opposite. Only 30% of patients are lucky enough to find donors with a perfect match from their families, and the rest 70% seek the help of an unknown donor who matches their DNA.
• Bone marrow donation has long-term side effects: This is another myth that discourages people from signing up for marrow donation. Both methods of marrow transplantation are harmless to the body as the body recreates the needed bone marrow levels within a few weeks. All the donors would have to endure would be side effects such as fatigue, back pain, and Nausea for a few days, while they can be glad they saved a life.
• Bone marrow donation is expensive: This is also another false fact doing rounds about bone marrow donation. While a bone marrow donation is slightly expensive, there is no cost to the donor for donating the marrow. Usually, the patient's insurance or the organization collecting the marrow takes care of the travel, hospital, and other clinics.

Need for Awareness of World Marrow Donor Day

People need to get the right idea about bone marrow transplantation. Many people stay away from marrow donation, fearing the side effects and pain, but most of them are nothing but false facts. This is the reason many patients are unable to find a perfect DNA match for their transplant. Thus it is important to build a pool of donors inculcating all the ethnic backgrounds so that we can help them beat the disease. It is especially essential for more donors from racially, and ethnically diverse communities as patients from these communities face a higher risk of finding a perfect match. All it takes is a cheek swab to register as a potential donor and to experience the feeling of saving another life.

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