Before a bone marrow transplant operation, certain tests are required. These include blood tests, a chest X-ray, PET scan, heart tests, and a bone marrow biopsy. Donors are also expected to complete certain tests.
Why do I need to have bone marrow pre-transplant evaluation tests?
Your pre-transplant evaluation includes a variety of medical tests that provide complete information about your overall health. These medical tests help the bone marrow transplant team identify any potential problems before your transplant and avoid potential complications after your transplant.
While each patient does not have the same tests, most of the tests included in this handout are common for all transplant patients. The tests required before the transplant are usually done on an outpatient basis. Your nurse and administrative coordinator will help arrange these for you. Please ask your nurse coordinator any questions you have.
If special instructions are required before any of these tests, you will receive a written form that explains how to prepare. After the tests are completed, your doctor will review the results with you. These results are also required by your insurance company in order to approve the medical necessity of your transplant.
Your health care provider or a technician will take a sample of blood from your arm or central venous catheter (if one is in place). The blood is sent to a lab where the following tests are performed:
Tissue typing (needed for allogeneic patients only)
This was done at or before your initial consultation appointment with your BMT doctor. Tissue typing is a series of blood tests that evaluate the compatibility or closeness of tissue between the organ donor and recipient. From your blood samples, the tissue typing lab can identify and compare information about your antigens (the “markers” in cells that stimulate antibody production) so they can match a bone marrow donor to you. All donors are carefully screened to prevent any transmissible diseases or detect other medical problems that might prevent them from donating bone marrow.
Other blood tests
In the laboratory, a series of tests will be performed to detect certain substances in your blood and to evaluate your general health. These blood tests might include:
Infectious disease screening for:
- HIV (human immunodeficiency virus)
- RPR (syphilis)
- Varicella Zoster
- CMV (cytomegalovirus)
- EBV (Epstein-Barr virus)
- HSV (Herpes Simplex virus)
- West Nile Virus
- HTLV1/11 (Human T-Cell
- lymphotropic virus)
Blood work to check your organ function
- Pregnancy test
- Complete Metabolic Panel
- Hemoglobin solubility
- ABO blood type
- Bleeding times
- CBC, diff, platelets
- Quantitative immunoglobulins
Other possible blood work
- Disease-specific labs for multiple myeloma
- Research samples
A chest X-ray provides a picture of your heart and lungs. This X-ray provides information about the size of your heart and lungs, and might detect the presence of lung disease or infection.
Pulmonary function tests (PFTs, lung tests)
Pulmonary function tests measure the capacity and function of your lungs, as well as your blood’s ability to carry oxygen. During the tests, you will be asked to breathe into a device called a spirometer.
Here are some guidelines to follow before your scheduled pulmonary function tests:
- Be sure to get plenty of sleep the night before.
- Plan to wear loose clothing during the test so you can give your greatest breathing effort.
- Limit your liquids and eat a light meal before the test. Drinking or eating too much before the test might make you feel bloated and unable to breathe deeply.
A CT scan, uses X-rays and computers to produce a detailed image of the body. Depending on the type of scan you need, an oral and/or IV contrast material might be used so the radiologist can see the extent of your disease. CT scans also might reveal the presence of other abnormalities.
If you had a CT scan within 6 months before your pre-transplant evaluation, bring the CT scan films or disc, along with a copy of the report with you. The radiologist will use them as comparison when reading these new scans.
Depending on your illness, your doctor might order additional CT scans.
A PET scan is a unique type of imaging test that helps doctors see how the organs and tissues inside your body are actually functioning.
The test involves injecting a very small dose of radioactive chemical, called a radiotracer, into a vein. The tracer travels through the body and is absorbed by the organs and tissues being studied. Next, you will be asked to lie down on a flat examination table that is moved into the center of a PET scanner -- a doughnut-like shaped machine. This machine detects and records the energy given off by the tracer substance. The PET scan can measure such vital function as glucose metabolism, which helps doctors identify abnormal from normal functioning organs and tissues.
One of the main differences between PET scans and other imaging tests like CT scan or magnetic resonance imaging (MRI) is that the PET scan reveals the cellular level metabolism changes occurring in an organ or tissue, or the activity of cells.
Depending on your illness, your doctor may order a PET scan.
Because prior chemotherapy and/or radiation therapy and the chemotherapy/ radiation therapy you will receive for transplant can affect your heart, you will need heart tests to identify and treat any potential problems before the transplant procedure. The heart tests include:
- Electrocardiogram (EKG): An EKG is used to evaluate your heart rhythm. Before the test, electrodes (small, flat, sticky patches) are placed on your chest. The electrodes are attached to an electrocardiograph monitor that charts your heart’s electrical activity (heart rhythm).
- Echocardiogram: An echocardiogram is a graphic outline of your heart’s movement. During the test, a wand, or transducer, is placed on your chest. The transducer emits ultrasound (high-frequency sound wave) vibrations so the doctor can see the outline of the heart’s movement. The echocardiogram provides pictures of the heart’s valves and chambers so the pumping action of the heart can be evaluated. Echocardiogram is often combined with Doppler ultrasound to evaluate blood flow across the heart’s valves.
Bone marrow biopsy
A bone marrow biopsy is performed to evaluate your marrow’s function and to assess for disease involvement. A needle is placed in your posterior hip bone to remove a sample of bone marrow. The area will be numbed with a local anesthetic, or pain-relieving medicine, to make you feel less discomfort during the procedure. You might be given oral medicine to help you relax prior to the procedure. You should plan to have a driver take you home after this procedure since the medicine can make you drowsy.
This is a series of X-rays of the skull and long bones to assess disease involvement for patients with multiple myeloma.
Other tests may be required by your insurance company or your physician, for example: colonoscopy, PAP smear, dental exam, or mammograms.
After the pre-transplant evaluation appointment, the BMT team may decide if you will need any other tests. Additional tests or consultations will be performed at Cleveland Clinic. Your nurse and administrative coordinator will help you make these arrangements.
After my bone marrow pre-transplant evaluation
At the end of your pre-transplant evaluation and after the test results are complete, the bone marrow transplant doctor will decide whether or not a bone marrow transplant is the appropriate treatment for you.
Your test results will also be sent to your insurance company for the insurance approval process. Usually the insurance company will make a determination in 7 to 10 days after receiving the test results.
Please understand that abnormal test results might require further investigation.
The goal of pre-transplant testing is to ensure that you will be able to undergo the transplant and recover without increased risk of complications.
Bone marrow donor pre-transplant testing
For allogeneic and mini-allogeneic transplant patients, your bone marrow donor will also have a medical evaluation with many of the same tests. The donor must be cleared and determined medically fit to proceed as your donor.