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Successful bone marrow harvest during pregnancy

Bone Marrow Transplantation volume 35, pages 631–632 (2005)Cite this article

Bone marrow transplantation (BMT) is an established therapeutic modality that may be life saving.1, 2 However, risks and benefits to the recipient as well as risks to the donor must be considered. While bone marrow harvest rarely results in life-threatening complications or death in the donor,1 little is known about bone marrow harvest during pregnancy. In some cases, alternative donors may not be available, and the recipient's condition may necessitate urgent BMT before a pregnant donor has delivered. To our knowledge, there are no reports of bone marrow harvest during pregnancy. Between June 1992 and April 2004, three HLA-matched related donors (Table 1) underwent successful bone marrow harvest during pregnancy at Vanderbilt University Medical Center.

Table 1 Donors characteristics
Full size table

Case #1: A 9-month-old girl with severe combined immunodeficiency syndrome presented with persistent polymicrobial pneumonia despite appropriate medical therapy. Urgent BMT was considered to treat her underlying immunodeficiency. HLA typing demonstrated that her 21-year-old mother, pregnant early in her first trimester, was HLA matched. Obstetric and anesthetic consultations were obtained. Risks to donor and fetus, including pregnancy loss, were carefully considered and explained at length to the mother. Owing to the urgent nature of the situation, a decision was made to proceed with harvest. Bone marrow harvest was performed at approximately 8 weeks gestation under epidural anesthesia with the donor in the prone position. No fetal monitoring was employed. Approximately 125 ml of bone marrow was obtained without difficulty via multiple bilateral iliac crest aspirations, and the donor received 1600 ml of intraoperative intravenous fluid. The donor tolerated the procedure well, was discharged later that day, and ultimately delivered a healthy baby boy at term. The recipient engrafted and is now 2 years post transplant off immune suppression.

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Authors and Affiliations

  1. Pediatric Stem Cell Transplant Program, Departments of Anesthesiology and Pediatrics, Vanderbilt Children's Hospital, Nashville, TN, USA

    C Calder, S R Hays, B Manes, V A Lavin, R H Ho & H Frangoul

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  1. C Calder
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  2. S R Hays
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  3. B Manes
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  4. V A Lavin
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  5. R H Ho
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  6. H Frangoul
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Calder, C., Hays, S., Manes, B. et al. Successful bone marrow harvest during pregnancy. Bone Marrow Transplant 35, 631–632 (2005). https://doi.org/10.1038/sj.bmt.1704844

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