Medicine

Patient information for Translation

Pre-Stem Cell Transplant tests and investigations

A guide for patients with leukaemia, myelodysplasia, myelofibrosis or aplastic anaemia.
 

Leukaemia Team, Department of Haemato-Oncology

Introduction

You have been given this booklet as you are either considering a stem cell transplant or have already consented to this procedure.

We have prepared this booklet to help you understand why we undertake a number of medical tests as part of what we call ‘pre transplant work up (or evaluation)’.

In total, these tests and investigations are undertaken in an attempt to quantify your general well-being and activities of daily life prior to undergoing high dose chemotherapy (and radiotherapy where applicable).

In other words, the work up investigations are assessing your overall general fitness for a transplant.

This booklet does not replace the face-to-face discussion with your Clinical Nurse Specialist (CNS) - (also known as your ‘key worker’). Rather it serves as a handy reminder to all that has been discussed with you as you approach this stage of treatment.

During the pre-transplant discussion with your key worker, you are encouraged to ask as many questions as you like. Please do not think that any questions are silly. This is a significant time for you, and we understand that with this can cause some anxiety. It is in your best interests to ask us to explain anything which is not entirely clear.

Note: Please read this Barts Health NHS Trust booklet, alongside the booklet provided by your Clinical Nurse Specialist e.g. ‘The Seven Steps’ published by Anthony Nolan (for donor transplants)

What tests and investigations will I need?

Tests and Investigations are as follows:

Blood Tests

The baseline blood tests are an essential part of your assessment. We perform many tests on your blood, but for you this involves one episode of having blood taken. Some of the tests will have been done many times throughout your earlier treatment but it is important that we assess your current status following therapy.

Your blood is tested to assess:

(If you would like any further explanation regarding these blood tests and their significance please do ask.)

• Full blood count (haemoglobin, white cells, platelets etc.)
• Blood Group
• Kidney function
• Liver function
• Thyroid Function
• Clotting factors
• Glucose
• Infectious disease such as HIV, Hepatitis B and C and herpes
• Evidence of prior exposure to viruses e.g., chicken pox
• Current infection or prior exposure to syphilis
• Foreign travel associated viruses or bacterial/parasitic infections (dependent on regions visited)

Additional blood tests may include:

Confirmatory tissue typing (for patients undergoing allogeneic transplant to confirm the compatibility or closeness of tissue match between you and your donor)

Any specific tests which need to be added for your individual circumstances are written below together with the reasons for these tests.

Lung Function Tests

These are undertaken by a respiratory physiologist located next to the Bronchoscopy Department on the Fourth Floor of the King George V Wing at St Bartholomew’s Hospital These tests are non-invasive (do not involve making a break in the skin), require no preparation and take just thirty minutes to complete.

Spirometry

Spirometry is a test that shows how well you breathe in and out. The device that is used to make the measurements is called a spirometer. You will be asked to breathe in fully and to blow out as hard and fast as you can into the mouthpiece of the spirometer. 

Lung volumes

Measuring lung volumes (the total size of your lungs) can give us more detailed results. This test involves wearing a clip on your nose to make sure that no air escapes from your nose. You will be asked to breathe into a mouthpiece similar to that of the spirometer. The test is not painful, and we will be able to talk to you while it takes place.

Gas transfer

This test measures the amount of oxygen that passes from your lungs into your blood. We will ask you to breathe in a harmless gas (a mixture of carbon monoxide, helium, oxygen and nitrogen) through a mouthpiece. Once your lungs are full, we will ask you to hold your breath for about 10 seconds and then breathe out the gas. The gas will be tested to see how much oxygen comes from your lungs.

The respiratory physiologist will explain each step of the test before you are asked to do it.

Cardiac (Heart) Function Tests

These are undertaken by a doctor or cardiac physiologist in the Cardiology Department, also on the Ground Floor of the King George V Wing at St Bartholomew’s Hospital. These are also non-invasive and take just thirty minutes to complete. Again, there is no preparation required for these tests.

Echocardiogram (ECHO)

An echocardiogram uses sound waves to build up a moving picture of the heart. It is similar to the ultrasound scan used in pregnancy and is extremely safe. Ultrasound waves reflect against structures in the heart to measure the size and function of your heart thereby assessing how well your heart is working. The echo can also show the direction and velocity of blood flowing through your heart and across your heart valves.

You will be asked to open or remove your clothes from the waist up and to lie on an echocardiogram bed on your back. You may also be asked to roll over onto your left-hand side during the test to assist in gaining sufficient images for the assessment.

Three small sticky pads, called electrodes, will be stuck to your chest and connected to the echo machine. A small hand-held transducer (echo recorder) is placed on your chest. This will have a lubricating jelly on it. Images of your heart will then be taken from different positions on the chest. The recorder sends high-frequency sound waves to the heart and records the echoes of sound waves reflected back from your heart. The echocardiography machine receives these echoes as electrical impulses and converts them into moving pictures of the heart.

An echo report is generated and reviewed by the haematology team prior to transplant. You will be informed if there are any concerns.

Bone Marrow Biopsy

You will almost certainly have undergone this procedure previously and know all about it. A repeat bone marrow biopsy is not required in all cases pre transplant.

Bone marrow samples at this time serve to evaluate your marrow’s function and to assess the degree of residual disease post chemotherapy treatment.

You do / do not (please circle) require a repeat bone marrow biopsy.

Dental Assessment

It is essential that we assess the condition of your teeth and gums prior to your undergoing a stem cell transplant. This is to ensure that any potential or current problems are identified and addressed prior to commencing high dose therapy. Your ability to fight infection will be significantly reduced throughout your transplant period and any dental problems pose a wholly avoidable risk.

Many patients will have undergone a dental examination already but the period since this checkup varies. It is our standard requirement that a dental examination, and any interventions resulting from its outcome, should be completed within one month of your transplant admission.

Your CNS will provide you with a dental checkup form to take to your dentist. If you do not have a dentist, or your dentist is unwilling to undertake any necessary intervention, please inform your key worker at the earliest opportunity in order that alternative arrangements may be made, and your transplant is not disrupted.

Will I be told the outcome of the pre transplant tests?

Yes. Your CNS will inform you of your results when you next meet. This will be a verbal discussion rather than provision of a written report.

If there are any issues with your results, you will be informed by the CNS or doctor. Try not to worry as in many cases, this just means that a test was inconclusive (neither positive nor negative) or may need to be repeated. Similarly, it may mean that we need to assess your condition via another means.

For example, it is sometimes difficult to assess heart function by echocardiogram (ECHO) alone. If this is the case, you may be informed that you need a Cardiac Magnetic Resonance Imaging (MRI) Scan. This does not automatically mean that there is a problem with your heart but rather, in order to perform a comprehensive assessment, we should re-assess.

What next?

As soon as your pre transplant evaluation is complete you will be informed of the outcome.

If you are fit to proceed to transplant, your CNS will provide you with your transplant schedule.

If you require more time, or further treatment, this will be discussed with you fully in consultation with your consultant at clinic.

USEFUL CONTACTS

ST BARTHOLOMEW’S HOSPITAL

7A (South) Day Unit

Tel: 020 3465 6780 / 6789 / 6786

Monday to Friday: 9am–8pm; Weekends: 9am–5pm

HAEMATO-ONCOLOGY EMERGENCY HOTLINE: 07909 002671

This is a mobile phone serviced by a member of the team
24 hours a day for urgent out of hours medical matters

Leukaemia and Stem Cell Transplant Clinical Nurse Specialists (CNSs)

Your CNSs remain your key workers throughout your post-transplant phase. Please feel free to contact us during normal working hours Monday to Friday 9am–5pm.
Please note that we may not always be immediately free to talk,
but will get back to you as soon as is possible.

Clinical Research Nurse (if applicable)

Name: _____________________________________________

Contact Number: ____________________________________

Large print and other languages
This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.
 

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

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Reference: BH/PIN/1149

Publication date: September 2022

All our patient information leaflets are reviewed every three years.

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