Research And Observation Of The Security Of BMT Donors Less Than 3 Years Old And The Effects On Their Growth And Development

Background1960s-70s of last century, many specialists at home and aboard had already find some ways to cure malignant hematologic diseases and genopathy such as Allogeneic Bone Marrow Transplantation.As the techonology develops fast, Bone Marrow Transplantation technique is becoming more and more mature and it is more frequently used in clinic, which demands more donors. Thus inevitably, children are also considered, so do small children.A lot of studies have already done amount of researches on older chilren and about the effect on their health. The previous studies have proved that donating BM does not affect their health generallly. But reseraches on small children are rare.Up to date, peripheral blood stem cell collection(C-PBSC) have a big developed because its superiority and have a tendency of replacing bone marrow stem cell collection(C-BMSC).But the use of C-PBSC was limited on children,because their poor cooperation and thin vena and not much blood-volume, stem cell was not got easily.The hypotension come out easily at early phase of C-PBSC and hypocalcemia happen because much anticoagulant administrated.The blood cell separator is good for more then 7 years old and adults and there was not report on less than 3 years old.It's a continuous process and donors mostly need to be injected with recombinant human granu-locyte colony stim-mulat-ing factor(rhG-CSF)before donating BM.Small children are light in weight and do not have enough BM to donate, so they need to be injected with rhG-CSF.They have bad coordination, so anaesthetization should be used pior tothe operation, which will increase the risk of BM donation.In condition of no other choice, samll children are considered. However, some parents are parodox, they worry about the health of the small children. As a worker who specialize in hematology, we have the duty to verify that there's no damage to small children's health.PurposeTo investigate the clinic reactions and the mobilize effects after rhG-CSF administrated and security during BM collecting and weight/height increase after BM collecting on children donors less than 3 years old,afforing a reference of security and effectiveness of BM collection and founding another safety method for the children who can not adopt C-PBSC.MethodsIn this study, we chose 20 cases of children donor under 3 years old from the year of 2007-8 to 2009-9,(the youngest donor-12moths, the oldest-36moths, with the average 24 months),average weight is 11.25kg (lightest-8.5,heavest-13.5kg).Before administration, the 20 donors all accepted body check, such as blood routine test, blood type,liver function,kiney function, heart function, chest X-ray, UCG, ECG, bleeding time and coagulation time as well as Virology check..These donors were administrated 5 days before the BM collection and they were skin-pop injected rhG-CSF 10ug/Kg/d every day. We observed every day their spirit condition, sleeping time and paid attention to symptoms occurrence such as fever, vomit, anorexia, bad tempere, pains, fatigue and other conditions such as allergy and arrhythmia. We monitored the routine blood every other day. We tested the classification of the PB after using the fifth dose of rhG-CSF.BM collection should be operated after general anesthesia by anesthetist and the operation was performanced by pediatrician. To observe the donors'vital signs rigorously during the operation.The chlidren should be input suspension of red blood cells and fresh freezing plasma which by 25Gy ray irradiation.The second day after the operation, we tested their cardiac enzyme levels and blood routine, as the result showed hemoglobin>95g/L but cardiac enzyme levels were as usual.They were allowed to discharge as everything was normal.But they were asked to return to test blood routine one week after the collection. We also sent them questionnaire or called them 1 month,3 months and 6 months after their discharge to do the follow up.ResultNo allergy or arrhythmia or bone pain in these 20 children during 5 days of rhG-CSF were administered, of which, one child had the symptoms of fatigue, bad sleeping(5%),anorexia(5%);2 children(10%) had moderate fever.The monocyte counts in peripheral blood(PB) of the 20 healthy donors were 3743±2205×109/L. The counts of CD34+ cells per microliter and quantities of total CD34±cells in the bone marrow graftswere is 276.5±125.83and(117.222±62.930)×106, respectively. The correlation analysis indicated that the counts of monocyte in the PB correlated significantly with the counts of CD34+ cells per microliter(r=0.506,P<0.05) and quantities of total CD34+ cells (r=0.62,P< 0.01)in the bone marrow collection.Luekocyte and write count in PB had no relation with CD34+ count per microliter in bone marrowa or quantities of total CD34+cells (r =0.391,P>0.05;r=0.249,P>0.05)(r=0.06,P>0.05;r=0.039,P> 0.05)respectively.None of the 20 children suffered from anesthesia accident. Hb of blood rountine postoperation(115.05±13.09g/L)did not show big difference with that of administration(124.55±15.37)P>0.05.The collection volume(431.8±108.39) ml/ (39.28±9.196) ml/Kg)of BM had no relation with postoperation Hb (r=0.04, P>0.05).The average hospitalization day is 36 hrs (12 hs-120hs).The CK-MB between before and after the operation did not show big difference.The count of WBC and LYM and MONO after rhG-CSF administrated was significant increased(P=0.000).Follow up of WBC and Hb one mouth postperation had no significant different with that of preoperation P>0.05.90% children'body height and weight were in the range of normal children of the same age. Conclusion1,rhG-CSF is effective in prolifering stem cells for small donors.2,Monocyte count of PB on the day of bone marrow collected after rhG-CSF administrated is a simple and workable indication for forecasting CD34+count in bone marrow collection volume.3,Obviously, rhG-CSF do not have bad effect in short term for small children. Small children are suitable for collecting large volume of bone marrow and would not bring about anemia because of the collection.4,The little children can tolerance the BM collection operation and donating large volume of bone marrow in short time.We found the donors'weigh and height development were not affected after donating large volume of bone marrow.5,Afforing a reference of security and effectiveness of BM collection and founding another safety method for the children who can not adopt C-PBSC.