To prepare for your child’s blood and marrow transplant (BMT), doctors will first run tests to assess how well your child’s organs are working. Usually, children who need a BMT have already had significant problems from their main disease. These complications along with treatment (chemotherapy) can harm important organs in the body.
Tests
While your child prepares for BMT, their previous disease or treatment may have damaged some of their organs. Along with the potential complications of chemotherapy, doctors need to give your child a thorough medical evaluation.
This medical evaluation is usually done two to three weeks prior to being admitted into the hospital for the transplant.
Many of the tests depend on what type of condition your child has prior to their blood and marrow transplant (BMT). For example, if your child has leukemia, doctors will need to take samples of their bone marrow.
For more information, please see the page on Bone Marrow Aspirate and Biopsy in the Leukemia Resource Centre.The doctor will check many different organs in your child’s body.
Heart
One way to check your child’s heart function is to record the echoes of sounds sent through the heart. This is called an echocardiogram. This test also shows the size of the four heart chambers, as well as how the heart muscle works. It is a painless procedure. Your child may need to remove clothing above the waist. Occasionally, a test that measures the electrical activity of your child’s heart may also be requested. This type of test is called an electrocardiogram.
Lungs
To measure the strength of your child’s lungs, your child’s doctor will ask your child to perform a test called pulmonary function testing (PFT). During PFT, your child will breathe through a tube attached to a machine that records how quickly and deeply your child can breathe. Children under six or seven years of age cannot do this very well. Instead, doctors will check how well a young child’s lungs are working through a physical exam.
Hearing
To test your child’s hearing, headphones and speakers are used to assess how your child responds to sound. The test usually takes about one hour, but it may vary depending on the age of your child. You can stay in the room during your child’s hearing test.
Teeth
Your child will need to see a dentist for a dental exam before the conditioning treatment starts. The purpose of the dental exam is to remove any existing sources of infections such as cavities or pull out any teeth, if necessary. All of your child’s dental work should be completed before they are admitted into the hospital.
Kidney and liver
Blood tests will be taken to assess your child’s liver and kidney function. To check how well your child’s kidneys are working, doctors may need to measure the rate at which the kidneys filter. This is called a glomerular filtration rate (GFR). To do the GFR test, doctors need several samples of your child’s blood. The nurse draws blood from your child’s vein, and the sample is sent to a lab for further testing
Blood tests also help your doctor check for viruses that can cause infections during the blood and marrow transplant (BMT), such cytomegalovirus (CMV).
Gynecology
Teenage girls may be referred to the gynecology service. If your child is menstruating, she may need to take an injection of a synthetic hormone called leuprolide (lupron®), which temporarily suppresses your child’s menstrual period during treatment. She will be given lupron one month before she starts preparing for the transplant. Since bleeding is one of the many complications that can occur after the transplant, we need to stop menstruation as a potential source of blood loss.