Bone marrow and stem cell:

Bone marrow is a spongy material that is found inside the bones (particularly the pelvic bones). Stem cells are blood cells at the earliest stage of development in the bone marrow. Within the bone marrow, stem cells develop into the different blood cells described below. When the cells are fully mature they are released into the bloodstream.

Bone and bone marrow

Like a factory, bone marrow produces the cells which develop into the three different types of blood cells: red blood cells, which carry oxygen to all cells in the bodywhite blood cells, which are essential for fighting infectionplatelets, which help the blood to clot and prevent bleeding.

Normally, most of the stem cells in the body are in the bone marrow and there are only very small numbers in the bloodstream. However, it is possible to stimulate the stem cells to move into the bloodstream, by using low doses of certain chemotherapy drugs or injections of growth factors. Stem cells can be collected from the bloodstream or from the bone marrow.

A transplant using stem cells collected from the bone marrow is sometimes called a bone marrow transplant, when in fact it is really a transplant of stem cells.

Side effects after a transplant or high-dose treatment with stem cell support:

Anaemia:

The number of red cells in your blood (your haemoglobin level) may go down. This is known as anaemia and will make you feel very tired. You may need regular blood transfusions to counteract this until your body starts to make enough red blood cells again.

Bleeding:

You are likely to need transfusions of platelets to make sure you have enough platelets in your blood, to reduce the risk of bleeding or bruising. Your platelet count will be checked by daily blood tests and your doctor will examine you regularly for bruises or little red spots and rashes on the skin. It is sensible to use a very soft toothbrush when you clean your teeth, to avoid damaging your gums. If you have any bleeding (eg in the mouth or when you pass urine), tell a doctor or nurse immediately.

Eating problems:

You will probably see a dietitian regularly during your treatment, who will make sure that you are eating as well as possible. It is very important that you do not lose too much weight, and the nurses looking after you will encourage you to try to eat small meals and snacks. If you have eating problems, because of lack of appetite, nausea or a sore mouth, you may need to have nutritional drinks. If you find it difficult to drink these, you may need to be given a special fluid through your central line. This will give you all the necessary nutrients. As you start to be able to eat again, the amount of fluid you are given through the line will be gradually reduced.

Your mouth may become very sore while your white blood cell count is low, either from ulcers caused by radiotherapy, or from thrush – a fungal infection. You will be given mouthwashes, and lozenges to suck regularly to try to prevent soreness, and painkillers, if needed. It is important to keep your mouth clean, both for your comfort and to prevent infections developing in your mouth and spreading to other parts of your body.