Your bone marrow was destroyed by chemotherapy/radiation. Until your new marrow is able to produce infection-fighting white blood cells, your body won’t be able to defend itself against germs. Infection can be the most serious complication right after your transplant. • You may begin protective isolation if you haven’t already. Your contact with people will be limited to your doctors, nurses, and a few visitors. • Fevers are a sign of infection. They are very common. If you develop one, you’ll be given antibiotics to fight the infection. • Bathe daily to help remove germs from your skin. Hand-washing is still the best way to prevent infection. • Good oral care will keep mouth sores from becoming infected. • Fresh fruits and vegetables will be eliminated from your diet since they may contain bacteria. All your food must be thoroughly cooked.

If you received your own marrow or cells donated by an identical twin, you won’t have to worry about this complication. But if your cells were donated by another person, there’s a chance you’ll experience some form of GVHD, or “graft-versus-host disease.” GVHD occurs when the donated cells attack your body cells because they are different. The donor cells usually target the skin, liver, and intestines. You may develop a rash, stomach pains, vomiting, diarrhea, or jaundice—yellow skin or eyes. • Medications will be given to stop the donated cells’ attack. But these drugs also prevent your body from fighting off other intruders like germs, so your infection risk will be greater.

Since you received high doses of chemotherapy/radiation, your body’s platelet count is low. Until your new marrow is able to produce more platelets, you can bleed easily. • You’ll get platelet transfusions to help your blood clot. • Your nose may feel itchy or dry, but resist the urge to touch it. If you must blow it, do so gently—it will bleed easily and the flow may be hard to stop. • Don’t worry if you see blood in your urine, stool, or vomit. That’s just a sign you need another platelet transfusion.

Most often, stem cells engraft and start to make new blood for you. • If there is a problem and they don’t engraft, you may receive another infusion of cells.

If you need more—or different—care than the BMT unit can provide, you’ll go to the ICU (Intensive Care Unit). It’s in a different area of the hospital with a different team of caregivers. • This move will make you better faster. The ICU and BMT doctors will work together to help you recover and return you to the BMT unit as soon as you’re able.