1. Bone marrow transplant BMT and brain tumors

2. Bone marrow transplant BMT
BMT is especial therapy for patients with cancer or other disease.
BMT involves taking cells that are normally found in the bone marrow (stem cells) filtering those cells and giving them back either to the patient or to another person.
Bone marrow is a soft, spongy tissue found inside the bones as hips, spine, ribs, skull, include RBC (erythrocytes), WBC leukocytes and platelets.
Stem cell: every type of blood cell in the bone marrow begins as stem cell__ which are immature that able to produce other blood cells that mature and function as needed.

3. Bone marrow transplant BMT
Types of BMT: types are depending on who the donor is:
Autologous bone marrow transplant.: the donor is the child himself (bone marrow rescue), taken BM either by harvest or aphaeresis (peripheral blood stem cell) then given back to the child after intensive treatment.
Allogenic bone marrow transplant:
The donor shares same genetic type as the child genetically matched donor usually sister or brother or:
parent__ called half identical to the recipient.
An identical twin__ complete genetic match.
Unrelated bone marrow transplant (URBMT) genetically matched marrow.

4. Bone marrow transplant BMT
3. Umbilical cord blood transplant: stem cells are taken from an umbilical cord immediately after delivery of an infant the stem cell are tested, typed, counted and frozen until they are ready to be transplanted. This type is better because:
Stem cells are (new) they are able to produce more blood cells from each stem cell.
The T- lymphocyte (part of immune system that causes graft versus_ host disease) are not completely functional.

5. Bone marrow transplant BMT
BMT team:
Physicians.
BMT nurse coordinator.
Social workers.
Dietitians.
Physical therapy.
Other team member e.g. pharmacists, respiratory therapists, gastroenterologists, lab technician, infectious disease specialists, dermatologists, and psychologists.

6. Bone marrow transplant BMT
The decision for child to under go BMT will be based on many factors including:
Child age, overall health, medical history.
Extent of the disease.
Availability of a donor .
Child's tolerance for specific medication, procedures.
Parent's opinion or preference.

7. Bone marrow transplant BMT
Preparation for the recipient:
Extensive evaluation is completed by the BMT team and evaluated for risk versus benefits.
Complete physical exam especially for organ function (heart, kidney, liver, lungs).
Child is admitted to hospital 10 days before BMT to: IV hydration, evaluation of placement of the central venous line
A suitable (tissue typed and matched) donor must be available.

8. Bone marrow transplant BMT
Preparation for the donor:
Donor sources available: child himself, parent or relative, non-relative person, or umbilical cord from related or non related persons.
Tests related to their health, exposure to viruses & complete genetic analysis.
Instruction to donor will be given on how bone marrow donation will be made,
Stem cell will be collected by bone marrow harvest or peripheral circulation, cord blood have been collected at the time of birth and stored for later use.

9. Bone marrow transplant BMT
Matching :human leukocyte antigen (HLA) tissue : the antigen on the surface of white blood system( 100 HLA) at least. The more antigen match the better engraftment of the stem cells with the patient and begin produce new blood cell.
collection of stem cell:
Peripheral blood stem cells__ aphaeresis (filtered mashie to stem cells).
Bone marrow cord blood transplant: collect after delivery when the placenta and umbilical cord are separated from the infant. (cleaned procedure and then test the blood for type, or virus or bacterial present, then stored in special freezer.

10. BMT procedure
1. Ablative, myelobltive therapy: in this therapy high doses of chemotherapy and/or radiation given to the child to prevent stem cell production and the marrow becomes empty in order to receive new stem cells to grow and establish a new production system.
2. New stem cell is given through the central venous catheter into blood stream and the stem cells find their way to into the bone marrow and begin reproducing new healthy blood cells.
3. supportive care is given to prevent and treat infection this include frequent blood test, VS,I&O chart, provide sterile environment. :

11. BMT procedure
During infusion of bone marrow the child may experience any or all of the following symptoms: pain, chill, fever.
After infusion: the child spend several weeks in the hospital. Be very susceptible to infection. Experience excessive bleeding.; have blood transfusion. take A.B.
Be confined to a sterile environment. Be given medication to prevent graft__ versus-host disease.
Continuity lab test.
Experience N&V, diarrhea, emotional &psychological distress.
When dose engraftment occur:
When doubted stem cell make their way to the marrow and being reproducing new blood cell.+15 or+30 days. it may taken month to years.

12. Complication of BMT Are vary depend on: Type of marrow transplant.
Type of disease required transplant.
Preparation regimen.
Age 7 OVER ALL HEALTH OF THE RECIPIENT.
VARIANCE OF TISSUE MATCHING BETWEEN DONOR AND RECIEPIENT.
PRESENT OF COMPLICATION.

13. Complication of BMT
Complication infection :bacterial, viral, fungal (life threatening( it cause extended hospital stay, delayed engraftment, permanent organ damage.
Preventive measurement for common resource:
Specially filtered room diet restriction. Isolation requirement.
Restriction of visitors.
Strict hygiene regimen.
Frequent lives changes.
II. Low platelet and low red blood cell__ effect GI bleeding ,lung, blood transfusion,
III. Pain mouth sores and GI irritable.
IV. Diarrhea .N&V__ high IV calories and proteins.
V. Fluid overload_-- pneumonia ,kidneys damage from disease__ wt daily, I&O chart.

14. Complication of BMT
Resp. distress__ fluid over load, graft_ versus_ host disease __ chest x_ rays. Pulse oximetry, supplemental O2.
Organ damage e.g. heart, liver.
Graft failure__ infection recurrent disease, donated stem cell is not insufficient to cause engraftment.
Graft-versus-host disease (GVHD) occur when the don'ts immune system reacts against the recipient tissue specially in GI tract, liver, skin and lungs.

15. Brain tumors
Brain tumors are the most common solid tumors in children and are the second most common childhood cancer
Brain tumors, whether benign or malignant, can arise from any cell within the cranium.
The cranial cells origin provides a histological classification for major tumor .e.g. Astrocytes (cells that form the supportive tissue for neurons) called astrocytoma.
Other classification related to anatomical distribution:
Infratentorial occur in the posterior third of the brain .e.g. medulloblastoma, cerebellar astrocytoma, brain stem glioma.
Supratentorial: within the anterior two third of the brain as hypothalamic tumors, optic pathway tumors.

16. Brain tumors Clinical manifestation: table 28-2. headache: recurrent.
Vomiting: with or without nausea.
Neuromuscular changes: less of balance. Weakness, positive babinski.
Behavioral changes: irritability, decrease appetite, fatigue ,coma.
Cranial nerve neuropathy: head tilt,.
Vital sign disturbance: decrease pulse and Resp. increase BP, decrease or increase temp.
Other signs: seizure, tens pulging fontanel at rest

17. Brain tumors Diagnostic evaluation: Physical exam and history.
LP, MRI, CT. Angiogram, EEG.
Brain tissue specimens during surgery.
Therapeutic management:
- Surgery.
Radiation.
Chemotherapy.
Prognosis: depend on type of tumor, size, child age.
Nursing consideration:
Prepare child and family for diagnosis/operation procedure.
Prevent post operative complication: V/S,POSITION,I&O, ICP.
Support child and family.
Promote return to optimal functioning.