THE FIRST ALLOGENIC BONE MARROW HARVEST IN KERALA

The history's first successful allogeneic bone marrow transplant was done by Dr E. Donnall Thomas in Cooperstown, New York. He conducted it on a pair of identical twins. He transferred the bone marrow of the healthy twin to the one who was suffering from leukaemia. Bone Marrow transplant is a challenging operation because it needs good cooperation between various medical departments. And, only a few medical institutions in India have the facility to perform it. 

This was a challenging patient, a child from Haripad with Fanconi anaemia with a rare type of genetic disorder that affects the bone marrow resulting in decreased production of all types of blood cells. He was recommended by Alleppey Medical College to go to CMC, Vellore for a bone marrow transplantation. Bone marrow transplantation is the norm cure for kids with Fanconi Anaemia. As Fanconi Anaemia is one of the several situations where a bone marrow transplant is recommended.

Historically, bone marrow is the first source of stem cells. These cells help in reproducing new blood cells and improve one's immunity. Bone marrow harvesting is a procedure done in the OT requiring careful and repeated aspirations from the bone marrow.  

The boy, who had a lot of odds against him, one of them being that he had no money. The family searched for a better option than travelling because they couldn’t take risks due to his fragile health. The family was not financially stable and his health prevented travelling far. After searching for good medical care, they came to Believers Hospital. We explained the importance of Bone Marrow Transplantation. They resigned back to their home to make arrangements. We were lost to follow up as they prepared and contemplated the transplant.

The boy returned to the hospital after five months with a headache. We feared that his conditions would get worse so admitted him here at BCMCH. In the interim, he developed COVID and miraculously despite being neutropenic and heavily immune defective he made it through COVID at Alleppey. 

However, as we feared, upon evaluation, he had an Epidural Haematoma - an accumulation of blood in the head. That was more bad news. But to our relief, it seemed stable. The intensive care was also a risky one. The pediatric intensive care team had to put in an Internal Jugular Vein (IJV) line. However, he started bleeding. When we thought things had stabilized and were working him up for the transplant, one night he developed a severe headache. The scan showed a new bleed with a midline shift in his head. Our neurosurgeon was convinced that he needed a life-saving buzz-hole surgery as soon as possible. It was a high-risk surgery. However, with God’s grace, the surgery was a success, and there was no major bleeding event. 

Surprisingly by then his panchayat members land up and convince us that we should proceed with the transplant and they will arrange the finances whatever be the costs. Thankfully his sister turned out to be a full match. And somehow a panchayat with predominantly daily wage workers contributed bit by bit and arranged funds!

Since the patient was aplastic and he had received multiple transfusions there was a high chance of Graft versus Host Disease (GvHD), a condition where the donor’s cells attack the patient’s cells. We also did not wish to continue his cyclosporine for long since he only has a single kidney. So it was decided to go for a bone marrow harvest for him.

Thankfully, his sister was a very good match. We asked around about an allogeneic bone marrow harvest and it was the first time it was done in Kerala. There are relatively few centres in the country that perform bone marrow harvesting. This is due mainly to the increased logistical and technical challenges in harvesting Bone Marrow. The patient had the operation in the first week of October and the surgery was a success. We thank God for his mighty healing touch on the boy who seemed to have had all odds against him. 

The excellent multi-disciplinary approach between Departments of Anesthesiology, Pediatrics, Neurosurgery, Critical Care, Pathology, Transfusion Medicine, Psychiatry, Haematology and Oncology to get this child home is so inspiring.