Suyash Hospital Private Limited

Hospital Name Address City State Contact Website Department1 Department2 Department3 Department4 Department5 Department6 Timing Hospital/Clinic Contact Person

Suyash Hospital Private Limited 5/1 Residency area, Indore Madhya Pradesh 0731-2493911 / 17 www.suyashhospital.in Emergency General Gynecology Hematology Private Radiology 24 Hours Hospital - Has admission (bed) facility Mr. Rajesh Malpani

Suyash hospital is a Indore based multi specialty hospital founded in the year 1992, situated in the heart of the city over 45000 square feet with ample space for parking and lush green garden. Its just 5 minutes distance from the railway station and bus stand and 20 minutes from the airport. 24 hours Emergency & Trauma services are available. We have special laboratories equipped with state of the art infrastructure using front line technologies for accurate diagnosis. Patient can choose from five categories of accommodation that comes with a wide range of patient friendly facilities.

Suyash Hospital Private Limited information

A.B. Road (opp M.G.M. Medical College), Indore-1, (M.P.) INDIA Ph.: 0731-2493911 to 18, 4064911

Dr. Anil Singhvi in R.N.T. Marg, Indore

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Category: Hematologists Address: #108, Blood Line Clinic, Manas Bhavan R.N.T. Marg Indore -452001 Flag if incorrect Landmark: Tell us if you know Phone:0731-2527081, 0731-4208761 Flag if incorrect Mobile:

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Haematologist

Dr. Manish Nema

MBBS , MD , DM

Hematologist Hemato-Oncologist Registration # MP-0147

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Clinic- Doctors Chamber (6:00 PM - 8:00 PM) 34, Jaora Compound, in front of MY Hospital,Indore (MP) Indore Madhya Pradesh Mobile: 09300004176,
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Leukemias Lymphomas Multiple Myeloma Aplastic Anemias Hemolytic anemias MDS Myeloproliferative disorder Bleeding disorders WBCs disorder Thalassaemia Sickle cell disease BMT

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Bone Marrow Transplant (BMT) - Information from Dr. Mammen Chandy (Head, CMC,Vellore)

hi every1 , this is from my doctor Dr. Mammen Chandy .

CHRISTIAN MEDICAL COLLEGE, VELLORE - 632 004. DEPARTMENT OF HEMATOLOGY BONE MARROW TRANSPLANTATION FOR THALASSAEMIA Patients with beta-thalassaemia major who are transfusion dependent can be considered for bone marrow transplant (BMT) at CMCH. We do not transplant patients with sickle cell anaemia or other forms of thalassaemia (HbE Thalassaemia, Thalassaemia Intermedia, etc) in our department at present. PATIENT We prefer to take up patients who are two years old for bone marrow transplant for thalassaemia. CONTRAINDICATIONS Patients with the following problems cannot be taken for transplant -

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HIV positive Acute Hepatitis Severe cardiac dysfunction related to iron overload DONOR The donor must be a HLA A, B, DR matched brother or sister. In rare cases it is possible to find a match from one of the parents or other relations (cousins). HLA typing is done from blood taken from a vein in the usual way. The donor must at least two, preferably three years old. The donor and patient need not have the same blood group. A sibling who has thalassaemia minor can serve as the donor if HLA matched with the patient HLA typing can be done at any good laboratory in your area but all results have to be rechecked in our Hospital bef ore transplant. HLA typing can be done in CMCH by prior appointment and for this you need to write to us with the name, age and sex of the patient and all available brothers and sisters. We usually do the AB typing first for the patient and all the siblings and then do DR typing only for the patient and any AB matching brother or sister. If an appointment is given for HLA typing on a particular date, we expect you to keep the appointment and come as scheduled. If for any reason you are not able to come you must inform us by email/fax/telegram at least 7 days in advance. COLLECTION OF BLOOD FOR AUTOLOGOUS TRANSFUSION In general we would like to avoid transfusion of blood obtained from a third party to the donor during the bone marrow harvest. Hence we collect blood from the donor on two or three occasions 2 - 3 weeks prior to the harvest and keep this for transfusion to the donor during the harvest. ADMISSION The donor is admitted at the time of starting the conditioning for the patient (one week before transplant). We are usually able to discharge the donor 2 to 3 days after the bone marrow harvest.

BONE MARROW HARVEST This is the term used for the procedure of taking the marrow from the donor for the transplant. This is done under general anaesthesia. The marrow is sucked out of the hip bones using a needle and there is no 'operation' or incision. The risk to the donor is minimal and related to the general anaesthesia (1 in 25,000). There is no long term problem or side effect to the donor and the harvest is similar to donating blood. PATIENT The patient and the donor will first have a full evaluation by the

transplant doctors in Vellore. If we are satisfied that the transplant can be done and that the HLA is matching and that the donor and patient are fit then we will discuss all the problems relating to the transplant with the parents. We will then give you a tentative date for the transplant and correspond with you regarding the actual date and time for transplantation. The patient is usually admitted 2 weeks prior to the actual date of transplant into a single room in the private ward. HICKMAN CATHETER INSERTION Under general or local anaesthesia a silicone rubber catheter (tube) is inserted into a vein in the neck and positioned near the right atrium of the heart. This tube will be used through out the transplant period for giving all medicines and blood products. Nutrition is also given through this tube when the patient is not able to eat. The tube is removed after the transplant when all the problems are over (2 months). ADMISSION TO THE TRANSPLANT UNIT The patient is admitted to the transplant unit 7 to 10 days prior to the transplant. The unit has HEPA filtered air to keep it sterile and the patient remains in this room till the donor's cells have started to grow and the blood count is satisfactory (usually 3 to 4 weeks). There is a nurse in constant attendance for each patient. Pressure cooked food is given and can be prepared by the family under supervision by the nurse. VISITORS We allow one family member to go into the transplant room and be with the patient for as long as is necessary depending on the age of the patient. There is a protocol for entry into the unit which is supervised by nursing staff. CONDITIONING This is term used for the treatment given to destroy the patient's own bone marrow. A drug called Busulphan is given by mouth for four days and cyclophosphamide by injection for four days. Some patients may have vomiting during this treatment. BONE MARROW TRANSPLANT The marrow that is taken from the donor is put into a special plastic bag (it looks just like blood) and this is given to the patient through the Hickman catheter like an ordinary blood transfusion. ENGRAFTMENT In two to three weeks time the mother cells (stem cells) from the donor will, after settling in the bone marrow of the patient, start to produce blood cells and the blood count of the patient begins to rise. This is known as engraftment. The patient can be transferred out of the transplant unit when the white cell count is satisfactory.

COMPLICATIONS 1. INFECTION : During the period after giving conditioning and before engraftment, the patient's white cells count is very low and the patient is prone to bacterial and fungal infections. There is also a high risk of viral infections like herpes and CMV for about one year post transplant. 2. GRAFT FAILURE-REJECTION : In about 10 to 20% of patients, the donors bone marrow may fail to engraft or be rejected some time later. Graft rejection can occur many months after transplant and will result in the patient becoming transfusion dependant again with relapse of the thalassaemia. 3. GRAFT VERSUS HOST DISEASE : Despite adequate HLA matching in some patients the donor's cells detect minor differences between the donor and patient and can attack the patient. This manifests as skin rash, jaundice, diarrhoea and fever. This is controlled with cyclosporine and steroids. If it is mild it does not cause significant problems but severe graft versus host disease can be fatal. This complication is seen in 20 % of children. Haemorrhagic cystitis, veno occlusive disease and interstitial pneumonia are some of the other complications seen in the post transplant period. DISCHARGE When the blood counts are normal and if there are no complications the patient is discharged from the ward and stays in Vellore for 3 - 4 weeks during which regular follow up is done in the out-patient clinic every week. It is possible to rent a house near the hospital for Rs.500/- to Rs.1,000/- per month for the whole family to stay. POST TRANSPLANT CARE The total duration of stay for an uncomplicated transplant will be about three months and for a patient who has complications the family may need to stay in Vellore for 6 months. For one year post transplant the patient needs to be careful regarding infection and it may be preferable not to send the child to school. Cyclosporine is continued for 6 months and then tapered. If there is no graft versus host disease or other complication, children who have had a successful transplant for thalassaemia may lead a normal life. COST

We do not have a package cost for BMT in Vellore and patients are charged individually according to what is required. So far the cost has ranged from 6 lakhs to 10 lakhs depending on the complications post transplant. We require an advance payment of Rs. 6 lakhs when the patient is admitted and the family should make arrangements for another 1 - 2 lakhs in case there are complications. A weekly statement of costs is provided to the patient and any balance will be refunded at the time of discharge.

RESULTS The maximum number of bone marrow transplants for thalassaemia have been done by Professor Lucarelli at Pesaro in Italy and he has shown that liver enlargement, liver fibrosis and poor chelation are the main factors which effect the outcome of BMT in thalassaemia. In patients who do not have any of these risk factors BMT is successful in 95 % of patients. However in patients who have all three factors transplant is associated with morbidity (failure or death) in 40% of patients. It is reasonable to expect the following results for bone marrow transplantation in thalassaemia 60% - 80% complete cure with good quality of life 10% - 20% relapse of the thalassaemia 10% - 20% death due to transplant related complications. When a family decides on bone marrow transplantation these results have to be kept in mind and compared with what can be achieved with transfusion and chelation. The transplant unit in Vellore till June 2003 has transplanted over 350 patients, more than 150 of whom had thalassaemia major. For any further information regarding bone marrow transplantation you may contact one of the following :

Dr. Mammen Chandy MD, FRACP, FRCPA Address : Professor and Head. Department of Haematology Dr. Alok Srivastava MD, FRACP, FRCPA Christian Medical College Professor. Vellore - 632004, Tamil Nadu, India Dr. Vikram Mathews MD, DM Tel : +91-416-2222102/2223603 Reader. Ext. : 2352/2472/2169/2890/2891 Dr.Biju George MD, DM Fax : +91-416-2232035/2232054 Reader. e-mail : haemat@cmcvellore.ac.in Attached Files
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Last edited by solankyno1; February 13th, 2005 at 03:28 PM.. Reason: Change the title of post.