Bone Marrow Failure In Children

WHAT YOU SHOULD KNOW:

• Bone marrow failure happens when your child's bone marrow does not produce blood cells. Bone marrow is the spongy red tissue inside your child's bones. It makes red blood cells (RBC), white blood cells (WBC) and platelets. Red blood cells carry oxygen to all the organs and tissues of your child's body. White blood cells help your child's body fight infection by attacking and killing germs. Platelets stop the bleeding when your child is cut or injured. Bone marrow failure may be inherited (something your child is born with). It may also be acquired (something that happens after birth). The aquired type may be caused by chemicals, infections, medicines, radiation, or problems with the immune system. Both types of bone marrow failure may lead to anemia (low RBC count).
  
  
• The signs and symptoms of bone marrow failure vary, but bleeding is the most common symptom. Your child may bruise or bleed easily, have nosebleeds, or have blood in his urine or bowel movements. He may have birth defects, such as heart, kidney, bone, or skin problems. He may have growth problems and may appear short, have a small head, or have deformed nails. He may often have infections, fevers, shortness of breath and tiredness. He may have pale skin, or skin that has coffee-colored spots. Blood tests, genetic tests, and a bone marrow biopsy are used to diagnose bone marrow failure. Blood transfusions, doner bone marrow transplants, doner blood stem cell transplants, and medicines, such as hematopoietic growth factors and immunosuppressants may be given. Diagnosing and treating bone marrow failure as soon as possible may decrease or relieve your child's symptoms, and prevent more medical problems.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• Treatment of bone marrow failure may make it necessary for your child to stay in the hospital for a time. Medicines may damage your child's organs or bones, or cause growth problems. A bone marrow transplant and medicines may increase your child's risk of cancer, such as liver cancer or leukemia. He may have bleeding and infections that may even lead to death. An allergic reaction to medicines or blood transfusions may happen that may lead to death.
  
  
• If left untreated, your child's condition may worsen. He may be weak and get tired easily. He may have delayed physical and mental growth. Your child may bleed too much and if he is not treated, this may lead to hypotension (low blood pressure), and even death. Your child may develop aplastic anemia, which is a life-threatening anemia. Your child may also be prone to getting a disease called myelodysplastic syndrome, which may progress to leukemia over time. Children who have received transfusions followed by bone marrow transplants have a good chance of living for a long time. Ask your child's caregiver if you have questions about your child's disease, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

Head circumference:

This is the distance around your child's head. Caregivers may put a tape measure around your child's head to measure it.

Reverse isolation:

Your child may be put in reverse isolation if his body is having a hard time fighting infections. Your child will be given a private room to protect him from other people's germs. Caregivers and visitors may wear gloves, a face mask, or a gown to keep their germs away from your child. Everyone should wash their hands when entering and leaving your child's room. Your child may be scared in isolation. Ask caregivers about the best ways to comfort your child while he is in isolation.

IV:

An IV is a small tube placed in your child's vein. Caregivers use the IV to give your child medicine or liquids.

Medicines:

Your child's medicines may include the following:

• Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.
  
  
• Antifungal medicine: This medicine helps kill fungus that can cause illness.
  
  
• Antiviral medicine: This medicine may be given to fight an infection caused by a germ called a virus. Antiviral medicine may help to decrease the number of days your child is sick.
  
  
• Hematopoietic growth factors: These medicines are used to help your child's bone marrow produce more blood cells. They may include androgens, erythropoietin, G-CSF, and GM-CSF.
  
  
• Immunosuppressives: Immunosuppressive medicines help prevent the body from attacking its own bone marrow. This may allow the bone marrow to make more blood cells.
  
  
• Steroids: Steroid medicine may be given to help prevent the body from attacking its own bone marrow. This may allow the bone marrow to make more blood cells.
  
  
• Oxygen: Your child may need oxygen if his blood oxygen level is lower than it should be. Oxygen will help your child breathe easier. Your child may get oxygen through small tubes placed in his nostrils, or through a mask. He may instead be placed in an oxygen tent. Never take off your child's oxygen tubes or mask or remove him from the tent without asking his caregiver first.

Monitoring:

• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your child's skin record the electrical activity of his heart.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your child's oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.

Tests:

• Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.
  
  
• Bone marrow biopsy: A small sample of your child's bone marrow is taken out and sent to a lab for tests.
  
  
• Genetic tests: These tests show if a hereditary disease is causing your child's bone marrow failure.

Treatment options:

• Blood transfusion: During a blood transfusion, your child will get whole blood, or parts of blood through an IV. You may be worried that your child will get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus.
  
  
  • You may be asked to help find blood donors. A close family member may be able to donate blood or bone marrow. Family members may not be able to donate blood if there is the possibility your child may need a bone marrow transplant. Ask your caregiver for more information about finding donors.
    
    
  • Platelets are donated by hemapheresis. Blood is taken from the donor's vein through an IV tube and put into a blood-separating machine. The platelets are removed and the rest of the blood is given back to the donor through the IV. The donor's body makes new platelets within one to two days. Your child is given the donor's platelets through an IV.
  
  
• Transplantation:
  
  
  • Doner bone marrow transplant (BMT): A bone marrow transplant is where your child's damaged bone marrow is replaced with healthy marrow. Your child is usually given bone marrow from someone who is not a family member. The bone marrow transplant is given to your child in an IV while he is in the hospital. Ask your child's caregiver for more information about BMT.
    
    
  • Doner peripheral blood stem cell transplant (PBSCT): Bone marrow has many stem cells in it. Stem cells are the part of the bone marrow that make or change into blood cells. During a PBSCT, stem cells are put into your child's body. To do this, blood is given by a person who has blood that is similar to your child's blood. This may include a parent, brother, or sister who does not have your child's disease. The blood is then put through a process called apheresis. During apheresis, stem cells are taken out of the blood. The stem cells are then put into your child's body through an IV. The stem cells go into your child's bone marrow, where they grow and become blood cells.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Bone Marrow Failure In Children (Inpatient Care)