Indiana Blood & Marrow TransplantationIndiana Blood & Marrow Transplantation is one of two programs in Indiana offering full-service transplant care. IBMT specializes in the treatment of leukemia, Hodgkins ornon-Hodgkins lymphoma,multiple myeloma and other blood disorders.
8111 S. Emerson Ave.
Cancer Center, Suite 105
Indianapolis, IN 46237
Services offered at Indiana Blood & Marrow Transplantation
Indiana Blood and Marrow Transplantation
Indiana Blood and Marrow Transplantation (IBMT) is a research-oriented organization, providing patients with the best assets of both academic and private practice settings and was the first transplant program for blood cancer in Indiana. Our nationally recognized physicians have performed hundreds of stem cell transplants in outpatient and inpatient settings. IBMT provides you access to the latest research and clinical trials and specialized treatments.
IBMT is one of only two programs in Indiana offering full-service transplant care. IBMT specializes in the treatment of the following conditions:
Indiana Blood and Marrow Transplantation (IBMT) is highly regarded nationally and was one of the first five programs in the nation accredited by the Foundation for Accreditation of Cellular Therapy (FACT). FACT accreditation demonstrates commitment to quality in cellular therapy and blood and marrow transplantation through adherence to rigorous standards, as verified by periodic inspections and peer review.
HLA-Vascular Biology Laboratory
State-of-the-art tissue and bone marrow matching is performed at Franciscan Health through our HLA and Vascular Biology Lab. The laboratory performs the most advanced testing of donor and recipient bone marrow and blood collections to improve the effectiveness of transplant procedures. The laboratory is accredited by the American Society for Histocompatibility and Immunogenetics and the College of American Pathologists.
Indiana Blood and Marrow Transplantation is the name for the Stem Cell Transplant program which was established as a partnership between Cancer Center Associates and SpectraCare Management Services. Since 2006 the hospital partner has been Franciscan Health. The IBMT Outpatient Clinic and Administrative Offices are physically located in the Franciscan Health Cancer Center in Indianapolis. The new inpatient unit opened in 2012.
To have a successful stem cell transplant, you must be healthy enough to undergo the rigors of the transplant procedure.
Your doctor will consider the following factors when determining whether a patient can undergo a stem cell transplant:
- General physical condition
- Stage of the disease
Stem Cell Transplant Research in Indianapolis
All prominent stem cell transplant programs, including Indiana Blood and Marrow Transplantation, are involved with clinical research. The goal of that research is to make stem cell transplantation more effective and safer, to find new indications for the procedure, and to learn more precisely how bone marrow cells (stem cells) work.
You may be asked to participate in some of the cancer research studies currently ongoing within Indiana Blood and Marrow Transplantation. In this page we will try to explain what the different types of study are, and what you should know to make an informed decision.
Why Participate in a Cancer Research Study
All progress made in the field on cancer came from the testing of new drugs that proved more effective than older ones. Further progress will depend on patients willing to be active participants in the evaluation of the new generation of drugs.
Similarly, randomized studies are the only way to select the optimal therapy from among several good therapies. In many instances, randomized clinical trials are the standard of care.
All research studies of IBMT are under the supervision of an Institutional Review Board, a group of physicians and laypersons who review each study to guarantee that the interests of the patients are protected.
Nevertheless, patients should never feel coerced to participate in a cancer research study. If you decide not to participate in studies proposed to you, you will receive the same high standard of care from IBMT physicians and nurses as patients who elect to participate. Patients can receive excellent care without ever being part of a research study.
Before Your Transplant Stay
Medical Tests Needed
Many tests and consultations may be needed before, during and after your stem cell transplant to ensure you are physically capable of undergoing the stem cell transplant.
Tests of your heart, lungs, kidneys and other vital organs are also used to develop a patient baseline against which post-transplant tests can be compared to determine if any body functions have been impaired. The pre-transplant tests are usually done on an outpatient basis.
The transplant coordinator will give you instructions regarding these tests, which may include the following:
- Blood work: About 10 to 15 tubes of blood will be drawn to establish a baseline and to detect any abnormalities that could be a problem for you during or after your stem cell transplant.
- X-rays: A chest X-ray and sinus X-rays will be done to see if you have any active infection or other abnormality. If you have not recently seen a dentist, you will need X-rays of your teeth to check if you have any cavities or an abscess that needs to be taken care before your stem cell transplant.
- Pulmonary function tests (breathing tests): These are performed as a baseline study and to determine if previous chemotherapy or radiation has affected your lungs. Since the transplant preparative therapy may do some damage to your lung function, it is important to know that enough reserve capacity is present.
- Muga scan and EKG (heart tests): These will detect any heart condition or damage to your heart muscle from previous chemotherapy.
- Bone marrow aspirate and biopsy: These may be part of your pre-transplant evaluation or on admission to the hospital just before the start of the transplant process.
- Additional tests (24-hour urine, CT scan, bone scan, Gallium scan, etc.) may be done as needed.
Meeting with other physicians and support staff
If radiation therapy will be a part of your treatment, you will be seen by a radiation therapist before your transplant. Your body will be measured precisely to make sure you will receive the right dose of radiation for your body.
All patients who receive allogeneic stem cell transplants will also be followed by an infectious diseases specialist during the actual transplant episode.
IBMT utilizes consultants in psychology and psychiatry to assess how we may best help you during your transplant to support you. Social workers and chaplains are also available for assistance.
After your initial consult, you will meet the transplant social worker and the care manager. They will be available as a resource to assist you with:
- insurance questions
- financial problems/assistance
- housing concerns
- general support
How we test for donor matches
Special blood tests, called Human Leukocyte Antigen (HLA) typing, determine whether a patient has a suitable donor for stem cell transplant. These tests are performed on several tubes of blood drawn from the arm. The matching for stem cell transplant is much more complicated than matching for red cell blood types. HLA typing is increasingly done using DNA techniques and can take several days to complete.
The most likely place to find a matched donor is within the patient's own family. Brothers or sisters will more likely match than other relatives, such as parents, children or cousins. All humans inherit half of their entire genetic make-up, and thus their HLA type, from their mother and the other half from their father.
For each full sibling, a patient has a one in four (25%) chance of a full match. If you have full siblings, the chances of having a completely matched donor are:
(The chance of having a donor is 1-(3/4)n, where n is the number of full siblings).
Currently only about 30 percent of patients will have an acceptable matched donor within their family. Therefore a search for an unrelated donor may be necessary.
Donor matches outside your family
The National Marrow Donor Program (NMDP) is a federally supported organization that helps locate unrelated donors. This national bone marrow registry has computer access to more than 7 million volunteer donors throughout the United States and in other countries.
Successfully locating an unrelated bone marrow donor is dependent on the patient's HLA type. The more unusual the HLA type, the more difficult it will be to find a sufficiently matched unrelated donor. Patients from mixed ethnic backgrounds may have very uncommon HLA types.
In addition, although the NMDP has made an enormous effort to recruit minority donors, the chances for African-Americans and Asian-Americans of finding a fully matched unrelated donor are still smaller than for Caucasian patients.
Even in cases where the patient's HLA type is quite common, it can take a minimum of four to six weeks to obtain the donor's stem cells.
When a match cannot be found
In some instances, the HLA type of the patient may make finding a matched unrelated donor impossible. If a patient cannot find a fully matched related or unrelated donor, it may be necessary to look at other options, such as using a patient's own bone marrow, matched umbilical cord blood or a partially matched family donor. The results of transplants with umbilical cord cells or with partially matched related have improved considerably over the last few years. Such transplants are feasible, but the risks of rejection are still higher than for HLA-identical sibling transplants or transplants from matched unrelated donors.
Your Stem Cell Transplant
Bone marrow is a spongy tissue inside the bones, responsible for the body's generation of white blood cells, red blood cells and platelets. It is instrumental in a patients' recovery from chemotherapy and radiation treatments which can be very damaging.
During the last five to ten years, stem cells for transplantation are being obtained increasingly from the blood stream instead of from the bone marrow. A blood and marrow stem cell transplant is a procedure that replaces a person's faulty stem cells with healthy ones.
Stem cells develop into the three types of blood cells that the body needs:
- Red blood cells, which carry oxygen throughout the body
- White blood cells, which fight infections
- Platelets, which help the blood clot
IBMT physicians must reach the consensus that bone marrow transplant is the appropriate course of action. Each patient is evaluated based on their general physical condition, disease process, age, co-morbid conditions, and prognostic indicators. Patients participate in Institutional Review Board (IRB) approved treatment protocols.
Transplant treats the following conditions
- Certain cancers, such as leukemia. The high doses of chemotherapy and radiation used to treat some cancers can severely damage or destroy bone marrow.
- Severe blood diseases, such as thalassemias, aplastic anemia and sickle cell anemia. In these diseases, the body doesn't make enough red blood cells, or they don't work well.
- Certain immune-deficiency diseases that prevent the body from making some types of white blood cells.
IBMT considers the following conditions treatable and/or curable with bone marrow transplantation:
- Aplastic anemia
- Acute myeloid leukemia (AML)
- Acute lymphocytic leukemia (ALL)
- Chronic myeloid leukemia (CML)
- Preleukemic syndromes (myelodysplastic syndromes)
- Malignant lymphomas (Hodgkin's and non-Hodgkin's)
- Multiple myeloma
- Other rare diseases for which stem cell transplant has been shown to be effective
Types of stem cell transplants
The two main types of stem cell transplants are autologous (aw-TOL-o-gus) and allogenic (a-LO-jen-ik).
For an autologous stem cell transplant, your own stem cells are collected and stored for use later on. This works best when you still have enough healthy stem cells, even though you're sick. If you have cancer, the cancer cells are removed or destroyed from the collected cells.
For an allogenic stem cell transplant, you get stem cells from a donor. The donor can be a relative (like a brother or sister) or a person who is not related to you.
After Your Transplant
During the first weeks and months after your stem cell transplant, you'll make frequent trips to the Indiana Blood & Marrow Transplantation outpatient clinic. This allows your doctors to track your progress. These visits will happen less often over time. Staff at the clinic will teach you and your caregiver how to care for your central line (which will stay in place for at least 6 months after your transplant), how to watch for and prevent infections, and other ways to care for you. They also will tell you who to call and what to do in case of an emergency.
Your Physical Recovery
Recovering from a stem cell transplant can feel slow. It takes six to 12 months to recover normal blood cell levels and immune function. You may experience a range of physical symptoms while recovering from a bone marrow or stem cell transplant. These can include fatigue and weakness, distorted taste sensations, lingering nausea and diarrhea, hair loss or other changes in appearance, and loss of muscle tone. During this time, take steps to reduce your risk of infections.
Get plenty of rest and follow your doctors' instructions about medicines and checkups.
People who have undergone a stem cell transplant need to be examined regularly by their physicians. The treatment team will closely monitor allogeneic transplant patients for signs of Graft versus Host Disease (GVHD), and will monitor patients who have received either allogeneic or autologous transplants for immune system recovery, late complications arising from the high-dose chemotherapy and radiation therapy given prior to transplantation, and any recurrence of cancer.
Emotional & Social Challenges
The period after a bone marrow or stem cell transplant can be a difficult and stressful time. Because you need to stay away from crowds and from people who are sick to avoid infections, you may feel isolated. Some people find it hard to get back to work, and may not be fully aware of their employment and insurance rights.
Our social workers counsel patients on how to cope with the stresses of illness and how to communicate with family members and children about any concerns.
Absolute Neutrophil Count
The corrected number of neutrophils present in the white blood cell count. Also named Absolute Granulocyte Count. Formula: (% neutrophils + % bands) * WBC = ANC
Acute Lymphoblastic Leukemia
Leukemia of early cells of the lymphocyte series. Occurs more frequently in children
Acute Myeloblastic Leukemia
Leukemia of very early granulocytes (myeloid cells). Occurs more frequently in adults. Several subtypes including acute (myelo-)monocyic leukemia and acute Promyelocytic leukemia
Additional drug or other treatment designed to enhance the effect of the primary therapy.
see Absolute Neutrophil Count
see Anti-thymocyte globulin
see Acute Lymphoblastic Leukemia
Originating from a donor (allo = other; Greek)
Stem cells from a donor to be used for transplant
Loss of hair
see Acute Myeloblastic Leukemia
Drug to prevent or treat fungal and yeast infections. Mostly given by I.V.infusion; sometimes given by mouth
Acute allergic reaction with shortness of breath, rash, wheezing, and/or low blood pressure
see Absolute Neutrophil Count
Too few red cells in the blood, leading to insufficient oxygen being carried to the tissues
Drug used to fight bacterial infections
Protein produced by the body, in response to a foreign substance, to fight the invading organism
Drug to prevent or treat nausea or vomiting
Drugs to prevent or treat fungal infections
Substance that evokes a response from the body's immune system, resulting in the production of antibodies or other defensive action by white blood cells.
Anti-T-lymphocyte agent, used in preparative regimens, or to treat prevent graft-versus-host disease. Also called ATG, or ALG (anti-lymphocyte globulin).
Drug to prevent or treat viral infections
Procedure to withdraw plasma or cells from the patient's/donor's blood with a machine. Can be used to obtain plasma, platelets, or stem cells for transfusion; also to remove diseased plasma or excessive white cells
Empty bone marrow, resulting in very low blood counts
Non-cancerous disease, in which the bone marrow is empty, and the blood counts are very low.
Health care provider (e.g., transplant center) that meets plan requirements to be considered for reimbursement
Accumulation of fluid in the abdomen outside the bowels (in the "peritoneal cavity") Often caused by liver failure
Type of fungus; may cause dangerous infections, primarily of lungs and sinus
Removal by suction, as in bone-marrow aspirate
Assignment of benefits
Option to have the insurance company make its payments directly to the provider (or to you)
see Anti-thymocyte globulin
Bone marrow or blood stem cells removed from the body to be used for autologous transplant
From the patient him/herself; as in autologous stem-cell transplant (autos = self; Greek)
Pigment produced when the liver processes waste products. A high bilirubin level causes jaundice (yellow skin and eyes)
Removal of tissue for examination under a microscope to make the proper diagnosis. May be obtained with a needle or with surgery
Progression of disease in patient with Chronic Myelogenous Leukemia (CML) to an more acute phase which resembles Acute Myeloblastic leukemia (AML) with the appearance of many very immature cells (blast cells) in bone marrow and blood
Specific proteins of red cells that are inherited from the parents, and are important to find compatible (matched) blood. Tested with antisera in the blood bank
Bone marrow transplant
Spongy tissue in the cavities of bones, such as pelvis, vertebrae, ribs, and skull. Produces the cells that circulate in the blood
Chemotherapy drug, often used in preparative regimen. Usually given by mouth; now also available for I.V. infusion (Myleran®)
Most frequent type of yeast in human body (oral cavity and gut). May cause infections
Small, flexible plastic tube inserted into a portion of the body to administer or remove fluids
Complete blood count. Determines numbers of red cells, white cells, and platelets in the blood
see Central venous catheter
Central venous catheter
Small, flexible plastic tube inserted into a large vein, through which drugs and blood products can be given, and blood samples withdrawn painlessly. Mostly inserted into a vein above the heart (subclavian vein), sometimes inserted into a vein in the groin. Different types, such as HICKMAN®, GROSHONG®, etc.
centiGray; unit of irradiation, also called rad
Drugs used to treat cancer by destroying abnormal cells or slowing their growth
View of the chest area which includes the heart, lungs, and ribs
Persisting for a long time
Leukemia of mature lymphocytes. Mostly slowly progressive. Occurs mainly in older adults
Leukemia of the granulocytes. Starts with cells that still mature normally. After a certain period of time may transform into a more acute leukemia (blast crisis), frequently via a transition ("accelerated") phase
Study of the effectiveness of a drug or treatment
see Chronic Lymphocytic Leukemia
see Chronic Myelogenous Leukemia
Central nervous system
Proteins (drugs) that stimulate the production and growth of certain types of blood cell. Examples are Neupogen® and Leukine®
see Preparative regimen
Part of charges the patient is responsible to pay until a certain maximum amount is paid. Usually paid directly to the provider at time of service
Medical services considered eligible for coverage by your insurance plan
Process to preserve by freezing, as in stem cell cryopreservation
see Colony-stimulating factors
Three-dimensional X-ray. Also called CAT-scan
Chemotherapy drug frequently used in preparative regimen (Cytoxan®)
Immuno-suppressive drug used for the prevention of graft-versus-host disease. Called Neoral® when used in oral form
Study of chromosome. Important to establish diagnosis and estimate prognosis in many cases of leukemia. Also used to document engraftment
Virus that may lie dormant for many years in patients who were infected in the past. Frequently causes infection in transplant patients. Probably mostly transferred by oral contact, but can also be transferred by blood products. Drugs to prevent or treat the infection exist
Distribution of various types of white cells in the blood. Used to determine Absolute Neutrophil Count (ANC)
Liquid used to prevent cell damage during cryopreservation. (Di-Methyl SulfOxide)
Change in the size, shape, or organization of cells
Abnormal accumulation of fluid
Electrocardiogram; tracing of the electrical activity of the heart
Minerals found in the blood, such as sodium, potassium, calcium, phosphorus, chloride, and magnesium
Process of recovery of blood cells after transplant. Often expressed as day that ANC > 500/mm3 (0.5 x 109/l) or that white cells > 1,000/mm3. May be confirmed with tests that cells come from donor (allogeneic transplant)
Protein capable of facilitating a chemical reaction
Explanation of benefits; information your insurance company sends to you and to your provider explaining what is paid of billed charges. Also explains denials of payment and your rights to appeal
Terms in your insurance contract describing a possible category of excluded services under the plan. Each plan may have different criteria to define what it considers experimental and investigational. This can be challenged.
Foundation for the Accreditation of Cellular Therapy. Organization that accredites stem-cell programs on the basis of a strict set of criteria.
Foundation for the Accreditation of Hematopoietic Cell Therapy. Old name of FACT.
Flexible plastic tube inserted into the bladder to provide continuous urinary drainage
Organisms that are bigger than bacteria, and are normally present in mouth and gut. Can lead to very serious infections in patients with immune deficiencies. Related to yeasts and molds
Refers to stomach and intestines
Granulocyte colony-stimulating factor (Neupogen®); stimulates the growth and maturation of early granulocytes
Granulocyte-macrophage stimulating factor (Leukine®); stimulates the growth and maturation of early granulocytes and monocytes
Process by which the donated stem cells are rejected by the patient's body
Condition that can occur following an allogeneic stem cell transplant, in which some of the donor's stem cells attack the patient's tissues and organs
Sub-class of white cells, so named because of the presence of granules in the cell. These cells protect the body against bacterial infection. Also called Neutrophils or Polys
see Central venous catheter
see Colony-stimulating factor
Part of the blood made up of red cells (expressed as percentage)
Study and science of blood and blood-forming tissues, and their disorders
Protein in the blood that carries the oxygen (expressed as grams per deciliter)
Bleeding from the urinary bladder because of an inflammation caused by cyclophosphamide or a virus
Inflammation of the liver
see Central venous catheter
see Human Leukocyte Antigens
Human Leukocyte Antigens
Genetic "fingerprint" on human white cells (and platelets), composed of proteins that play a critical role in activating the body's immune system to respond to foreign organisms. Inherited from both parents. Determined by HLA-typing, which can be performed with antisera and with DNA techniques
Class of virus that cause cold sores and other infections
Intravenous feeding that provides patients with all essential nutrients when they are unable to feed themselves. Also called hyperal, TPN or CHA
Hip bone in which a large amount of bone marrow is concentrated and which can be reached with large needles
Body's defense network againts infections and foreign substances
Condition in which the immune system is not functioning normally
Condition in which the patient's immune system is functioning at a lower than normal level. Sometimes done on purpose (e.g., to allow donor stem cells to engraft), often as side effect of transplant or therapy for side effects
Provider (person or facility) that is part of a managed-care provider network
Through (or into) a vein; also called I.V.
Inflammation involving the inter-alveolar areas of the lungs; often caused by viruses (e.g. CMV), but may also be caused by irradiation and drugs.
Yellowing of the skin and eyes. Mostly caused by liver disease
Laminar air-flow room
Isolation room with an air-filtering system in which the entire back-wall of the patient's room is one big filter. The air will come out in a "laminar" :fashion, causing little turbulence
Length of stay (LOS)
Number of days in the hospital
White blood cell
see Liver function tests
Liver function tests
Laboratory tests from a blood specimen that give information about liver function. For example: bilirubin, SGOT, SGPT, GGT, Alkaline phosphatase
Type of white cell that fights infections by producing antibodies and regulating the immune system response
Term to describe various approaches to provide and pay for healthcare in an attempt to limit fees for health services and control or manage those services.
Term relating to an evaluation process used by insurance companies to decide whether requested health care services will be covered.
Spread of disease from the organ or tissue of origin to another part of the body
see Non-Myeloablative Transplant.
Process to increase the number of stem cells in the blood stream. May be accomplished by the daily injections of CSF, or by a combination of chemotherapy and CSF
Antibodies that are all identical, derived from a single "clone". Sometimes used in "purging", a process by which certain cells are removed from bone marrow before infusion into patients
Type of white cell that fight against infection by eating and killing bacteria and fungi
Inflammation, ulceration, and sloughing of the lining cells of the mouth and/or throat Usually side effect of chemotherapy and irradiation; may also be caused by herpes virus.
Magnetic Resonance Imaging; three-dimensional X-ray
Multiple Gated Pool scan; nuclear medicine test to assess the function of the left ventricle of the heart
National Cancer Institute
Low level of granulocytes in the blood. Mostly considered to exist when ANC < 500/mm3
National Marrow Donor Program. Federally supported organization that has the largest registry of volunteer (unrelated) stem cell donors. Located in Minneapolis.
Do not take anything by mouth
Allogeneic stem-cell transplant that uses a less aggressive, less toxic, preparative regimen.
Study of cancer
Packed Red Blood Cell
Red blood cells collected from one individual that are packed into a small volume for transfusion into a patient
Deficiency of all types of blood cells
see Peripheral blood stem cells
Peripheral blood stem cell transplant
Peripheral blood stem cells
Stem cells obtained from the blood stream through an apheresis procedure. Process of "mobilization" increases the number of peripheral blood stem cells that can be collected
Small red spots on the skin (like flea-bites) that usually indicate a low platelet count
Treatment in which white blood cells are exposed to ultraviolet light in the presence of a sensitizing agent. Used for skin lymphomas and for graft-versus-host Disease.
Fluid and protein-containing portion of the blood
Type of blood cell. Important to control bleeding; smallest cell element in the blood.
Pluripotent stem cell
Earliest stem cells; can mature into all cell types in the blood, but also maintain their own numbers
Increase in the total number of red cells in the bloodstream
Requirement to receive prior approval for hospital admission and certain other services. Feature of many managed care health plans
Refers to a clause in your insurance contract which may exclude coverage for certain disease(s) because they were present before the plan went into effect.
Chemotherapy and/or Radiation therapy given prior to a stem cell transplant. Duration varies between 2 and 10 days. Goals are to kill malignant cells, create space for the new stem cells, and break the immune system of the patient (allogeneic transplants only). Also called conditioning regimen
Predicted or likely outcome
Plan of treatment
Process by which certain types of cells are removed from stem cells prior to infusion into the patient. In autologous transplantation, stem cells may be purged to remove lingering cancer cells. In allogeneic transplants, donor stem cells may be purged to remove T-lymphocytes that cause graft-versus-host disease
Assignment of a patient to a treatment protocol that is decided at random. This may be done when a new treatment is being compared to a standard one
see Red blood cells
Red blood cells
Cells in the blood that transport oxygen from the lungs to the tissues. A deficiency of red cells causes anemia
Recurrence of the disease following treatment
Condition in which no cancerous cells can be detected by a microscope, and the patient appears to be disease-free
Means that be all methods used to measure the existence of tumor, there has been at least a 50% regression of the disease following treatment
Presence of micro-organisms in the blood stream leading to clinical symptoms (low blood pressure, fever etc)
Dryness of eyes and mouth; may be caused by graft-versus-host disease
"Mother" cell from which all types of blood cell originate
Class of drugs commonly used to decrease nausea after chemotherapy, and fight graft-versus-host disease. Specific drugs are Solumedrol® given i.v., and prednisone given by mouth
Originating from an identical-twin donor
Immunosuppressive drug used to prevent graft-versus-host disease (Prograf®) . Alternative for cyclosporine
see Total body Irradiation
Sub-class of lymphocytes. Considered to be responsible for graft-versus-host disease
Low level of platelets in the blood; increases risk of bleeding
Total Body Irradiation
Treatment in which the entire body receives irradiation. Mostly given over several days.
Total parenteral nutrition
see Non-Myeloablative Transplant
Size of the tumor or number of abnormal cells in the organ or tissue
Intravenous thrombolytic agent used to restore patency to central venous catheters
Complication of transplant in which the small blood vessels that carry blood through the liver become swollen and clogged. May lead to abdominal pain, jaundice, and ascites
Tiny micro-organism that invades cells, alters their genetic machinery, and turns them into factories for production of more of the virus
see Veno-occlusive disease
White blood cells
Dryness of the mouth caused by malfunctioning salivary glands