What tests are required before undergoing a bone marrow transplant?

Generally, before undergoing bone marrow transplantation, several evaluations are required, including bone marrow examination, blood tests, imaging studies, cardiopulmonary function assessments, and infection-related screenings. These tests provide critical information for developing the transplant plan and assessing potential risks. Detailed explanations are as follows:

1. Bone Marrow Examination

Bone marrow examination includes bone marrow aspiration and biopsy, which involve collecting a small sample of bone marrow tissue and cells for analysis. This test helps determine the status of hematopoietic (blood-forming) function in the bone marrow, detect abnormal cells or parasites, and assess the compatibility between donor and recipient bone marrow cells. It is a key factor in determining transplant eligibility and selecting an appropriate donor.

2. Blood Tests

Blood tests cover multiple aspects, including complete blood count (CBC), biochemical indicators, coagulation function, and blood typing. The CBC evaluates the number and morphology of red blood cells, white blood cells, and platelets, helping to identify conditions such as anemia or infection. Biochemical markers reflect liver and kidney function, electrolyte balance, blood glucose, and lipid levels, providing insight into the functional status of major organs. Coagulation testing determines whether the clotting system is functioning properly, reducing the risk of bleeding during transplantation. Blood typing ensures compatibility between donor and recipient to prevent transfusion reactions.

3. Imaging Studies

Common imaging modalities include chest X-ray, abdominal ultrasound, and computed tomography (CT). A chest X-ray helps detect lung infections, tuberculosis, tumors, or other abnormalities, ensuring stable respiratory function post-transplant. Abdominal ultrasound examines the structure and function of abdominal organs such as the liver, gallbladder, pancreas, and spleen, enabling early detection of organ damage or disease. CT scans offer higher resolution and allow more detailed evaluation of vital organs throughout the body.

4. Cardiopulmonary Function Assessment

This assessment primarily includes electrocardiogram (ECG) and pulmonary function testing. The ECG monitors the heart's electrical activity, identifying conditions such as arrhythmias, myocardial ischemia, or hypertrophy, ensuring the heart can withstand the stress of transplantation and subsequent treatments. Pulmonary function tests measure parameters such as vital capacity, ventilation, and gas exchange to evaluate respiratory capacity, minimizing the risk of delayed recovery due to poor lung function after transplant.

5. Infection-Related Screening

Infection screening involves testing for common pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), cytomegalovirus (CMV), and *Treponema pallidum* (syphilis). Bacterial cultures and antimicrobial susceptibility testing may also be performed. These tests help identify active or past infections. If an infection is detected, targeted treatment should be administered prior to transplantation to reduce the risk of severe complications from infection reactivation or dissemination. Susceptibility testing also guides antibiotic selection should infections occur after transplant.

In addition, some patients may require further evaluations such as thyroid function tests or immune function assessments based on individual clinical circumstances. Throughout the evaluation process, it is important to maintain a positive mindset, avoid excessive anxiety, and actively cooperate with healthcare providers to complete all necessary examinations.