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Dr. Shruti Kakkar, Age:37, Paediatrics Haematology Oncologist, Ludhiana, Punjab
Dr. Shruti Kakkar is a paediatrics hematology oncologist. She treats children with blood diseases and cancer. “Examples of blood disorders are anaemia, which require medicines or blood transfusions, bleeding disorders example is haemophilia but most children I see suffer from difficult-to-manage illnesses like malignancy and cancer.” Dr. Shruti mainly works in thalassemia, where children with deficient red blood cells need blood transfusions every fifteen days and cancer.
Dr. Shruti has observed several Blood Stem Cell Transplants throughout her career. As a donor, she is a boon to DATRI, as she understands both sides. She has been indispensable as a counsellor to prospective donors and has been championing stem cell donations for children with thalassemia, urging more people to register.
“I try to counsel donors because I know what happens, and I’ve been on both sides. I know what my parents said, what my husband said, how I dealt with it, and they can’t argue with a doctor! They tend to trust me when I say it’s no harm to the donor. In the past year, I’ve counselled many donors and am happy that I have helped some patient.”
We had an illuminating conversation with Dr. Shruti about her experience as a doctor in treating these diseases and donating via Peripheral Blood Stem Cell Donation with DATRI in 2017
What goes into a doctor’s decision to recommend a patient to undergo a Blood Stem Cell Transplant?
Whenever we are dealing with cancer, sometimes we come across children who are not responding very well to chemotherapy or meet a child who has reacted, but cancer has come back. Then we recommend a transplant. For children with thalassemia, we routinely recommend it because it is a one-stop cure, and it is better to get it at an early age. We don’t recommend it immediately after diagnosis. Though. We’ll send the child for a couple of transfusions, and the child tends to get a little better. That’s when we start talking about transplants.
What are the chances of survival for a patient who undergoes a stem cell transplant?
It differs from patient to patient. It depends on what diseases we are talking about, the patient’s age, and what has been the prior treatment. For a child with thalassemia, the chances of a cure are as high as 95%. I never shy away from recommending a transplant for a thalassemia patient, but when it comes to cancer, things get a little complicated.
And what about leukemia? Diseases like Acute Lymphoblastic Leukaemia (ALL) or Acute Myeloid Leukaemia (AML) can usually be treated without a stem-cell transplant. We recommend the transplant only if the patient relapses or is refractory. Refractory means the patient is not responding at all except patients classified as “Good Risk” everyone else is recommended a transplant.
What does “Good Risk” mean? There are specific tests that we doctors do while making a diagnosis for AML. Based on these tests, we classify a patient as Good Risk, Intermediate Risk, or High Risk. If the patient is at Good Risk, we may opt for chemotherapy. But for Intermediate or High-Risk categories, we have to try for a transplant.
Wel’ve heard that to prepare the patient for a transplant, all the bad cells in their body are removed first, so, to put it crudely, doctors can replace them with new and healthy cells.
See, transplants are not an easy job. That’s why not everybody, not even a hospital does it left and right. Specialists who do transplants are highly trained and it is serious business. So it is there in every doctor’s mind that a transplant is not easy to do, there can be various complications, and patients can even die of severe infections. So, a doctor will only recommend it if the benefits outweigh the risks. And sometimes, we do it because it’s the only way a patient can survive.
If a prospective donor does get the chance to donate, they should decide as fast as possible. For thalassemia, the child can still do blood transfusions for a time, but for cancers, I would say a match should make a choice the very moment they find out.
Tell us a bit about your donation. How did you come to know about DATRI?
I know about DATRI Blood Stem Cell Donors Registry since I’ve been working for thalassemia and cancer patients for a while now. I first heard about it as a fellow in the transplant unit. In our annual International Thalassemia Day celebration, We’d been doing lots of blood donation camps, and we thought we should try to do something more. So we tied up with DATRI to do a registration camp.
There are 250 thalassemia patients in our hospital and, therefore, 500 parents. We urged them to become voluntary donors because nobody would understand the pain of not finding an able and willing match better than them, and we told them at the very least they’d be able to help another child if not their own. So that was my basic idea behind holding the camp.
It was a Sunday, and lots of people had turned up. I wanted to motivate parents who were not from our unit, and I met many of them for the first time. So I registered and announced, “I wish that I’m the first one to be selected as a donor.” I think God just heard me that moment because within a month, I got a call from DATRI’s Gayatri that a child with thalassemia needed me..and we were on cloud nine. She had heard me when I had made my little motivational speech, and I had become quite emotional while I was talking.
What makes you so particularly passionate and emotional about Blood Stem Cell Donation?
I see so many children and so much hope in parents’ eyes that they will find a match for them in the family. It often doesn’t work out, and they keep trying for years and years, and some of them don’t ever find a match.
I recently heard about a fifth-year medical student refusing to donate, despite being fully aware that it was the only fighting chance for a patient. Being an oncologist, I can’t take it when I hear stories like this.
That’s painful and awful.
Yes! There are 1.2 billion people in our country, and I’m not sure what the figure is, but we have hardly ten lakhs registered donors. What are we doing? We keep trying to find our matches in Germany or the US when it’s more likely that we’ll find one in our own country because we have the same genes! That’s what drove me to start collaborating with DATRI…that day at the camp lots of doctors and medical students signed up, which was a real spur.
In speaking to and counselling so many donors over the past year, are there any recurring patterns you notice?
The choice to donate or not is inherent. Nothing is stopping them for people who are motivated enough to give a new lease of life to a whole family. They tend to have little fears here and there; they ask questions like “Will it hurt? Are there side effects?” but it’s clear from the start that they’re going to go ahead. I’ve come across a few donors where I tried so hard, but the inner motivation was not there. I talked to a man of my age who made the excuse that he had a small son so he couldn’t donate. I am a mother! My son is also young, and my husband wasn’t around, and if I can do it, sometimes you can’t say anything to change their views. They tend to be fixed.
What were some of the concerns from your family?
My husband is a doctor too, he’s a radiologist, and he was abroad doing his fellowship in Canada. He didn’t want to stop me from donating, but he was a little worried. He was concerned about managing my day job and my eight-year-old son and everything by me. He just wanted to be around, so he asked me to wait a year till he returned, but we couldn’t do that. On the other hand, my mom was a bit more panicky and did not want me to do it at all. I couldn’t back out; that day, 200 people had registered because I said it’s safe, and if I backed out, knowing that it’s safe, I’ll be creating a bad example, and I can’t do that. So in my mom’s case, my sister, who is also a doctor, helped me out, and she managed to convince mom.
Did you eventually wait a year to donate?
I didn’t have to wait a year, but I did wait about a month. The great thing about being a donor is that all the blood tests are like a master health check-up. I found out that I’m allergic to wheat, and my HB was at 8.5 or 9 because of that. We doctors can explain our own symptoms by other reasoning, and I didn’t know until the tests returned. So, I had to spend one month on a gluten-free diet and treat my HB levels. Apart from that, the donation went by without a hitch.
How do you feel after the donation?
The whole process is safe, and there is nothing to worry about. To understand, the doctors and professionals involved in selecting a match are cautious to only request it of people who are in perfect health and capable of donating. They are conscientious not to put the donor or the patient at risk at any cost, which is why the numerous tests. And I think I’ve been healthier after the donation. After going off gluten, I feel better, and I’m happier, so I’m healthier.
Is there any advice that you’d like to give prospective donors?
I suggest that while trying to find out about stem cell donation, matches avoid going to a next-door physician and try to speak to someone more specialized. It’s such a new procedure that even some doctors are not experienced or aware about. Try and get as much accurate information as possible before you decide. That’s all.
This interview was conducted in 2019 before Dr. Shruti met her recipient. Keep reading to know what were the feelings of Dr. Shruti and her recipient – now living a healthy life!
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DATRI is a Not-for-Profit organization that was founded in 2009 with a mission to save lives of those suffering from life-threatening fatal blood disorders like Blood Cancer, Thalassemia, Leukaemia, Aplastic Anaemia, Sickle Cell Anaemia, etc
DATRI is registered with the Government of India as a Section 8 organization, and all monetary contributions towards DATRI are subject to 80G exemptions
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