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HEALTH COURSE STUDENTS’ KNOWLEDGE ABOUT HEMATOPOIETIC

STEM CELL DONATION

Dayane Indyara de Sá Silva1

Cristiano Leonardo de Oliveira Dias2

Renata Di Pietro Carvalho3

Anielly Geovanna Santos Leopoldo4

Viviane Dias Souto5

Karoline de Souza Oliveira6

Priscilla Loreddany Santos Queiroz e Silva7

Euvaíra Nunes de Aquino Fonseca8

Romana Aparecida Alves Barbosa9

Suede de Oliveira Neto Silva10

Carla Rodrigues Pereira11

Letícia Lima Silva de Abreu12

Davidson Gonçalves Soares13

Jéssica Najara Aguiar de Oliveira14

1 University Center of Northern Minas Gerais

2 Montes Claros State University

3 Federal University of the Jequitinhonha and Mucuri Valleys

4 Faculty of Health and Humanities Ibituruna

5 Montes Claros State University

6 University Center of Northern Minas Gerais

7 Montes Claros State University

8 Faculty of Health and Humanities Ibituruna

9 Montes Claros State University

10 Faculty of Health and Humanities Ibituruna

11 Montes Claros State University

12 Montes Claros State University

13 Montes Claros State University

14 Montes Claros State University

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Micaela Santos Pereira15

Gabriel Jose de Menezes16

Gizelle Coelho Azevedo17

Abstract: Objective: To analyze the knowledge of health sciences students about bone marrow

transplantation and the National Registry of Voluntary Bone Marrow Donors (REDOME). Methods:

Cross-sectional study conducted with 205 students from higher education institutions located in the

north of Minas Gerais. Students’ knowledge about leukemia, bone marrow donation and REDOME

registration was measured using an online questionnaire. Data were analyzed using descriptive

statistics and Person’s chi-square test was applied to assess the correlation between the studied

estimates. Results: Participants were divided into 155 (75.6%) female students and 50 (24.4%) male

students, with a mean age of 23.6 years. It is noteworthy that most of the assessed group reported

no or poor knowledge about bone marrow donation. Female gender (p=0.018), registered donors

at REDOME (p=<0.005) and students with knowledge about leukemia treatment (p=0.000), were

associated with better knowledge indexes about hematopoietic stem cell donation. Conclusion: The

results of this study attest to the need to educate health students about the bone marrow donation

process and REDOME.

Keywords: Bone Marrow Transplantation, Hematopoietic Stem Cell Transplantation, Knowledge,

Health Sciences Students, Public Health.

15 Faculty of Health and Humanities Ibituruna

16 Faculty of Health and Humanities Ibituruna

17 State University of Santa Cruz

INTRODUCTION

Bone marrow transplantation (BMT), also known as hematopoietic stem cell transplantation

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(HSCT), is a treatment modality indicated for certain pathological conditions, such as malignant

hematological diseases (leukemia, lymphoma, and multiple myeloma), autoimmune hematological

diseases, neoplasms, and immunodeciencies (MAGEDANZ et al., 2022). Technological advances in

biological sciences have contributed to signicant evolutions in BMT, which involves the replacement

of bone marrow cells to restore bone marrow function, with signicantly positive repercussions on

the quality of life of numerous patients and on survival rates (RODRIGUES et al., 2021; BARRETT;

CRADDOCK, 2020; MARQUES et al., 2021).

On the other hand, it should be noted that BMT is a procedure with varying levels of

complexity depending on the frailty of the patients and the need for specialized or intensive care

(MARQUES et al., 2021; IZU et al., 2021; YOUNG et al., 2017). Therefore, it is considered that this

treatment modality, in situations of failure, presents considerable risks of morbidity and mortality –

which should not be ignored – and may culminate in the need for retransplantation, special therapies,

and the risk of serious complications, such as infections, hepatic veno-occlusive disease, pulmonary

complications, graft-versus-host disease, metabolic disorders, mucositis, dehydration caused by

diarrhea, and hematological alterations, especially when linked to a fragile health condition of the

patient (RODRIGUES et al., 2021; THANGAVELU; BLAZAR, 2019; BURT et al., 2019).

HSCT can be allogeneic – the bone marrow precursor cells come from an external donor,

either a family member or from voluntary donor banks and are therefore unrelated – or autologous –

the cells come from the patient themselves, being collected, treated in the laboratory and subsequently

transfused to the patient immediately or after cryopreservation (SARMIENTO et al., 2020).

It is noteworthy that choosing the type of transplant requires knowledge of the characteristics

of the morbidity condition, the patient’s age, general condition, and the presence of concomitant

donors. The transplant is considered successful when the grafted bone marrow is reconstituted with

donor cells and produces sufciently healthy and functional blood cells (MAGEDANZ et al., 2022;

RODRIGUES et al., 2021; AZEVEDO et al., 2022; SIMPSON; DAZZI, 2019).

International studies have recorded that approximately 68,146 hematopoietic stem cell

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transplants (HSCTs) were performed, considering data from 77 countries published in 2012, with

53% being autologous. Researchers highlighted that these indicators represented a 46% growth in

the total number of transplants between 2006 and 2012. Furthermore, it is worth noting that the

procedures were predominantly performed in developed countries in North America, Asia, and

Europe (NIEDERWIESER et al., 2016).

In Brazil, between 2015 and 2020, an estimated 17,210 hematopoietic stem cell transplants

(HSCTs) were performed, with 6,657 being allogeneic and 10,553 autologous. Furthermore, the annual

average of transplants was recorded at 2,868 (SD: 637.43) (DAMBROS et al., 2021). However, it is

important to note that there are still barriers that considerably hinder the growth of the number of

donors in the country – observed in the low donor rates, mainly due to a lack of or inefcient education

of the population. Additionally, as a consequence, healthcare professionals warn that another difculty

in performing the procedure is associated with the complex search for a genetically compatible donor

(CORGOZINHO et al., 2012).

Given this scenario, there is a strong need to publicize and promote the registration of Brazilian

citizens in the National Registry of Voluntary Bone Marrow Donors (REDOME), in order to increase

the possibilities for patients to obtain voluntary donors for hematopoietic stem cell transplantation

(HSCT). REDOME, founded in 1993 in the state of São Paulo and coordinated by the National Cancer

Institute (INCA) since 1998, has become the third largest bone marrow donor bank in the world, with

estimates of more than 300,000 new registrations per year (INCA, 2022).NASCIMENTO et al., 2021).

It is understood that healthcare professionals and students in the eld – future professionals –

have a primary role in educating and raising awareness among the population regarding bone marrow

donation. In light of this, this study aimed to analyze the knowledge of students in health-related

courses, afliated with higher education institutions, about bone marrow transplantation and the

National Registry of Voluntary Bone Marrow Donors (REDOME).

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METHODS

This cross-sectional, descriptive study with a quantitative approach was conducted with

students from health-related courses afliated with higher education institutions located in northern

Minas Gerais. Students enrolled in undergraduate courses in biomedicine, physical education, nursing,

pharmacy, physiotherapy, speech therapy, medicine, nutrition, dentistry, and psychology were invited

to participate in this investigation. Individuals under eighteen (18) years of age were excluded.

Data collection took place between April and June 2022. Dissemination of information

and invitations to participate in the research were conducted at higher education institutions and

through announcements on social media. It is noteworthy that the announcements presented general

information about the research, such as its objective, inclusion/exclusion criteria, and means of

contacting the researchers; in addition, they included links directing to the informed consent form

and, subsequently, to the online questionnaire.

Participants were asked to complete an online questionnaire with socioeconomic and

demographic information, with the following variables considered for evaluation: sex, age, marital

status, family income, religion, and registered donor status in REDOME. Additionally, students’

knowledge about leukemia, bone marrow donation, and registration in REDOME was measured

using a six (6) item questionnaire congured as a Likert-type scale. Responses regarding knowledge

on the subject were structured from one (1) to ve (5), where: 1 – none; 2 – poor; 3 – fair; 4 – good;

5 – excellent.

The questionnaires were sent via email or software of the participant’s preference, preceded

by the Informed Consent Form. Students who indicated their agreement with the research were

promptly directed to the questionnaires. For data analysis, descriptive, absolute, and relative statistics

were synthesized to characterize the investigated variables. In addition, Pearson’s chi-square test was

applied to assess the correlation between student characteristics and estimates of knowledge about

bone marrow donation, considering a signicance level of 5% (p<0.05). It is worth noting that the study

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followed the guidelines and standards of resolution 466/2012 of the National Health Council (CNS)

(BRAZIL, 2012), and has the approval of a Research Ethics Committee (CEP), with a substantiated

opinion integrated into the Brazil platform under number 4.293.242 (CAAE: 36741820.4.0000.5141).

RESULTS

The study included 205 students from health science courses afliated with higher

education institutions. Participants were subdivided into 155 (75.6%) females and 50 (24.4%) males.

The predominant age group was 18 to 25 years, with 173 (84.4%) respondents; the average age was

23.6 years (SD: 3.21). Regarding marital status, 184 (89.8%) students declared themselves single.

Concerning family income, 104 (50.7%) participants reported that their family income was up to one

minimum wage.

The students’ knowledge about bone marrow donation, REDOME (Brazilian Bone Marrow

Donor Registry), leukemia, and its clinical-social aspects was measured. Notably, the majority of the

evaluated group reported no or poor knowledge about: bone marrow donation (42%), donor registration

in REDOME (52.7%), and the National Registry of Voluntary Bone Marrow Donors (60.5%). On

the other hand, 42.9% of the students declared fair knowledge about leukemia and 39.5% about the

treatment of the disease. Finally, 41.5% of the participants reported no or poor knowledge about the

types of leukemia. This and other information related to the assessment of students’ knowledge is

presented in [reference to document/section].Table 1.

Table 1 -Assessment of students’ knowledge about REDOME, leukemia and its clinical-social aspects

(n = 205), 2022, Minas Gerais, Brazil.

Variables

Knowledge: n (%)

None (1) Spacious

(2)

Regular (3) Good (4) Great (5)

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Leukemia 7 (3,4) 22 (10,7) 88 (42,9) 68 (33,2) 20 (9,8)

Types of leukemia 40 (19,5) 45 (22,0) 65 (31,7) 40 (19,5) 15 (7,3)

Leukemia treatment 16 (7,8) 34 (16,6) 81 (39,5) 52 (25,4) 22 (10,7)

Bone marrow donation 34 (16,6) 52 (25,4) 59 (28,8) 35 (17,1) 25 (12,2)

Registration in REDOME 59 (28,8) 49 (23,9) 57 (27,8) 27 (13,2) 13 (6,3)

THE REDOME 75 (36,6) 49 (23,9) 47 (22,9) 21 10,2) 13 (6,3)

Source: study data.

ThatTable 2The characteristics of the students regarding socioeconomic and demographic

variables are presented, according to their knowledge or lack thereof about bone marrow donation. This

study revealed that only 6.8% of the evaluated group are registered bone marrow donors in REDOME

(Brazilian Bone Marrow Donor Registry). The results demonstrate signicant differences between

men and women in relation to knowledge about bone marrow donation, with a higher proportion of

female individuals having some knowledge about the donation process (p=0.018). Furthermore, being

a registered donor in REDOME (p=<0.005) and possessing knowledge about leukemia treatment

(p=0.000) were associated with better levels of knowledge about hematopoietic stem cell donation.

Table 2 -Socioeconomic and demographic factors associated with students’ knowledge about bone

marrow donation (n = 205), 2022, Minas Gerais, Brazil.

Variables

Knowledge about bone marrow donation

No Try Total p-value

n % n % n (%)

Sex 0,018

Feminine 46 29,7 109 70,3 155 (75,6)

Masculine 24 48,0 26 52,0 50 (24,4)

Age 0,171

18-25 years old 57 32,9 116 67,1 173 (84,4)

26-35 years old 9 33,3 18 66,7 27 (13,2)

36-45 years old 3 75,0 125,0 4 (1,9)

46-55 years old 1 100,0 00,0 1 (0,5)

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Marital status 0,786

Married 637,5 10 62,5 16 (7,8)

Divorced 00,0 1100,0 1 (0,5)

Single 62 33,7 122 66,3 184 (89,8)

Other 250,0 250,0 4 (1,9)

Family income 0,252

Up to 1 minimum wage 40 38,5 64 61,5 104 (50,7)

≥ 1 to ≤ 2.9 minimum wages 19 31,8 35 68,2 54 (26,4)

≥ 3 to ≤ 4.9 minimum wages 10 34,5 19 65,5 29 (14,1)

Earning ≥ 5 minimum wages 211,1 16 88,9 18 (8,8)

Religion 0,141

Catholic 35 28,7 87 122 122 (59,5)

Spiritist 325,5 975,0 12 (5,9)

Evangelical 16 47,5 19 54,3 35 (17,1)

None 12 48,0 13 52,0 25 (12,2)

Other 430,0 770,0 11 (5,3)

Donor registered with REDOME <0,005

No 70 36,6 121 63,4 191 (93,2)

Try 00,0 14 100,0 14 (6,8)

Knowledge about leukemia treatment 0,000

1 - none 12 75,0 425,0 16 (7,8)

2 – spacious 22 64,7 12 36,3 34 (16,6)

3 – regular 20 24,7 61 75,3 81 (39,5)

4 - good 12 23,1 40 76,9 52 (25,4)

5 - excellent 4 18,2 18 81,8 22 (10,7)

Source: study data.

DISCUSSION

This study made it possible to evaluate the knowledge of students in health-related courses

about bone marrow donation, the National Registry of Voluntary Bone Marrow Donors (REDOME),

leukemia, and its clinical-social aspects. The group evaluated is relatively homogeneous in terms

of socioeconomic and demographic characteristics; however, this investigation recorded statistically

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signicant differences between male and female students regarding knowledge about hematopoietic

stem cell donation. Furthermore, being a registered donor in REDOME and having greater information

about leukemia treatment were associated with knowledge about bone marrow donation.

A higher proportion of female students were observed to have knowledge about bone marrow

donation when compared to male individuals. Another investigation carried out with university

students in Poland also found that women showed higher levels of knowledge related to donation and

transplantation of hematopoietic stem cells (HREŃCZUK et al., 2021).

Analysis of the students’ knowledge prole revealed that a signicant percentage of participants

either lacked knowledge or rated their knowledge of bone marrow donation and REDOME as poor.

Similarly, another cross-sectional study conducted with nursing students from a higher education

institution in northern Brazil showed that the majority (71%) of students lacked knowledge related to

hematopoietic stem cell donation, and 86% of participants were unaware of REDOME (NOGUEIRA

et al., 2017).

It is noteworthy that only a very small percentage of the students evaluated reported being

registered donors in RENOME. The ndings are consistent with international literature, since a

study conducted in Greece, when exploring the attitudes of nursing students towards bone marrow

donation, found that only 6.4% of the group of students were registered as donors in the country

(SYMVOULAKIS et al., 2022).

REDOME was created in 1993, therefore it is considered inadequate that society still

has little information on the subject, especially students of health courses or already graduated

professionals, who together have the essential function of educating and sensitizing the population

about the importance/necessity of bone marrow donation. Although records show that there are more

than 5 million citizens registered in REDOME, these numbers are not sufcient given the complex

possibilities of genetic compatibility – estimated at 64% according to INCA – and the high demand

in the country (INCA, 2022;NASCIMENTO et al., 2021;NOGUEIRA et al., 2017; AZEVEDO et al.,

2022).

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It should also be noted that the scenario created by the 2019 coronavirus pandemic limited the

possibilities for action in the public health sector and, consequently, created signicant barriers that

hindered the achievement of objectives related to the recruitment of new potential donors.JANOWIAK-

MAJERANOWSKA et al., 2022Furthermore, studies highlight that the donation process is often

questioned by the population due to misinformation and lack of education, and is hampered by false

common-sense beliefs, fears, and stigmatizing factors (DAMBROS et al., 2021;NASCIMENTO et al.,

2021; HRENCZUK et al., 2021; NOGUEIRA et al., 2017).

This study is not without limitations. It is a cross-sectional study, which makes causal

inferences impossible. Additionally, recall and selection biases must be considered, since this research

used an online self-report questionnaire for participants.

CONCLUSION

The students investigated in this study presented a limited knowledge prole regarding

REDOME (Brazilian Bone Marrow Donor Registry) and the bone marrow donation process. The

ndings of this study reinforce the need for special focus on the bone marrow donation process,

as well as reiterate the paramount importance of educating society and professionals/students about

REDOME, hematopoietic stem cell donation, and hematological neoplasms.

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