National Anemia Day: When should anemia patients consider a bone marrow transplant?

Anemia remains a pressing public health issue in India mainly due to iron deficiency which hampers cognitive and motor development in children and reduces work capacity in adults.

Pregnant women with anemia face increased risks of complications such as perinatal loss, prematurity and low birth weight infants. While dietary adjustments and supplements can help manage mild to moderate cases, severe forms of anemia may require advanced treatments including a bone marrow transplant (BMT).

In this article, Dr Rahul Bhargava, Principal Director and Chief BMT, Fortis Memorial Research Institute (Gurugram) will explain various aspects of the disease.

Anemia and role of bone marrow transplants

Anemia is a common disorder characterised by insufficient production or dysfunctional red blood cells. While many cases can be addressed through lifestyle changes, dietary modifications, supplements, or medication, severe forms may necessitate more advanced treatments. In certain situations, a bone marrow transplant (BMT) may be the best or only option. However, determining when to consider BMT depends on the underlying cause and severity of the condition.

Conditions that may require BMT

Bone marrow transplants are typically reserved for individuals with severe, life-threatening conditions that impair the bone marrow’s ability to produce healthy blood cells. Key conditions include:

Aplastic Anemia: It is a rare disorder where the bone marrow fails to produce enough blood cells, leading to extreme fatigue, frequent infections, and uncontrolled bleeding. If traditional treatments like immunosuppressive therapy or blood transfusions fail, BMT may be necessary.

Sickle Cell Anemia: A genetic disorder causing misshapen and sticky red blood cells, leading to blood vessel blockages, severe pain, and organ damage. While medications and transfusions can manage symptoms, BMT is the only known cure, often recommended for children or young adults with severe complications.

Thalassemia Major: An inherited condition causing defective hemoglobin production, leading to severe anemia and requiring regular blood transfusions. Over time, transfusions can cause iron overload and organ damage. BMT, ideally performed at a young age, can offer a permanent cure.

Myelodysplastic Syndromes (MDS): A group of disorders where the bone marrow produces abnormal blood cells, which can progress to leukemia. For high-risk MDS patients unresponsive to other treatments, BMT may be the best option to prevent disease progression.

Risks, considerations and way forward

The decision to undergo a bone marrow transplant depends on several factors, including the severity of the condition, the patient’s overall health, the availability of a suitable donor, and potential risks. The procedure involves high-dose chemotherapy or radiation to destroy the diseased bone marrow, followed by the transplantation of healthy stem cells from a donor. While BMT can be life-saving, it carries significant risks, such as infections, graft-versus-host disease (GVHD), and complications from pre-transplant treatments.

Ultimately, the decision to pursue BMT should be made in consultation with a hematologist or transplant specialist, who will evaluate the risks and benefits based on the patient’s medical history and the progression of their anemia. For individuals with severe, treatment-resistant anemia caused by conditions like aplastic anemia, sickle cell disease, or thalassemia, BMT offers hope for a healthier future.