by Wood D

Surgical Procedures for Leukemia

Blood Transfusions

Red blood cells, platelets, or other blood components may be transfused to increase the number of red blood cells and platelets in patients who are short of breath, fatigued, or in danger of serious bleeding. During a blood transfusion, blood and blood products are infused into a vein.
Donated blood must be matched to your blood type. Prior to a transfusion, your blood will be drawn to check your blood type. You may receive blood that has been irradiated to prevent the risk of graft vs. host disease. A nurse will monitor you for any signs of an adverse reaction.

Bone Marrow Transplantation

Bone marrow transplantation involves the injection of healthy stem cells from a donor's bone marrow into your vein. The new stem cells travel through the bloodstream to your bone cavities. Stem cells are cells that can produce red blood cells, white blood cells, and platelets.
Bone marrow transplantation allows you to receive high doses of chemotherapy or radiation because it replaces those cells destroyed by the various treatments. Bone marrow transplantation may be done using bone marrow either from a donor (allogeneic transplant) or from you (autologous transplant).
If the transplant is successful, the newly injected cells should be free of cancer and capable of producing healthy cells.
In order for bone marrow transplants to be successful, certain markers (called HLA types) on the donor's and recipient's blood cells and bone marrow cells must match. As the recipient, you will be given medications to suppress your immune system and prevent your body from rejecting the donor bone marrow. In the weeks prior to the bone marrow transplant, you may undergo intense chemotherapy and/or radiation therapy to rid your body of diseased cells and to clear the bone marrow cavities for the new bone marrow. This process is called "conditioning."
Removal of bone marrow from the donor, called "harvesting," takes place in an operating room. A hollow needle and syringe is used to remove bone marrow from the donor's hipbone. Several punctures are made in order to harvest an adequate amount of bone marrow for transplantation. The puncture wounds are then covered with bandages.
The donated marrow is filtered and then administered through a small, flexible catheter into a large vein in your chest. You receive the bone marrow in an isolation room, where you will need to stay to avoid infection until the new marrow begins to produce infection-fighting cells. It may take about a month for the donor bone marrow to begin functioning fully.

Splenectomy

Some patients with leukemia develop complications as a result of the spleen being congested with leukemia cells. In these cases, it may be necessary to remove the spleen as part of treatment. Removal of the spleen can often be done laparoscopically. The main side effect of splenectomy, other than the possibility of infection or anesthesia complications, is the fact that the patient may be left susceptible to certain types of infections, particularly pneumonia. In most cases, vaccination against common bacteria that cause pneumonia can prevent this from occurring. An alternative to removing the spleen, in some circumstances, is to irradiate it with external beam radiation.

Special Considerations

Discuss the benefits and risks of the various treatments with your doctor.

When to Contact Your Doctor

Call the doctor if you develop:
  • Any signs of infection, such as fever, cough, runny nose, red, or swollen skin
  • Any signs of abnormal bleeding

References

American Cancer Society website. Available at: http://www.cancer.org.

Cecil Textbook of Medicine. 21st ed. W.B. Saunders Company; 2000.

Conn's Current Therapy 2001. 53rd ed. W.B. Saunders Company; 2001.

The Leukemia & Lymphoma Society website. Available at: http://www.lls.org.

National Cancer Institute website. Available at: http://www.cancer.gov.

Textbook of Primary Care Medicine. 3rd ed. Mosby, Inc.; 2001.

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