​Understanding ​engraftment

The cells you received on transplant day know where they belong in your body. They move through your bloodstream and into the bone marrow. When the cells begin to grow and create new blood cells, it’s called engraftment. This is an important milestone in your recovery after your blood or marrow transplant (BMT).

Have questions about what happens after a blood stem cell transplant?

Your transplant team watches for engraftment by monitoring your lab reports for changes in your blood counts. They may write your blood counts on a white board in your hospital room.

Doctors check the following blood counts when looking for engraftment:

• White blood cells (WBCs) – These cells fight infections.
• Absolute neutrophil count (ANC) – Neutrophils are of the most common type of white blood cell.
• Hemoglobin (Hgb) – This is a protein in red blood cells that helps to carry oxygen from your lungs to all parts of your body.
• Platelets (Plts) – These help your blood clot.

Engraftment usually happens within the first 30 days after your transplant, but sometimes can take longer. Engraftment means your new cells are working properly and are starting to rebuild your immune system. White blood cells are the first cells to engraft, followed by red blood cells and platelets. Engraftment marks the start of your recovery process.

You will be at the highest risk of infection until your new cells engraft. This is because you will have fewer white blood cells than normal. White blood cells power your immune system to prevent or fight infections. Your transplant team will help protect you from infections and treat any infections that develop while waiting for engraftment to happen. 

Tell your doctor right away if you have any symptoms or signs of infection after your BMT, such as: 

• Fever or chills 
• Diarrhea 
• Having to go to the bathroom (urinate) often 
• Having pain with urination or with a bowel movement 
• Blood in your urine or stool 
• Stomach pain 
• Confusion or decreased alertness 
• Severe fatigue (tiredness)
• Bleeding
• Coughing or shortness of breath
• Chest pain
• Severe headaches
• Feeling like your heart is racing
• Feeling lightheaded

It takes time for your body to recover after BMT. Explore tips to help you stay healthy after transplant.

The road to recovery may feel overwhelming for you and your loved ones. Our Patient Support Center offers group support, emotional support, tips for healthy living after transplant and more.