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The cells you received on transplant day know where they belong in your body. They move through your bloodstream into your bone marrow. When these cells begin to grow and make new blood cells, it’s called engraftment.

Your transplant team will watch for engraftment by monitoring your lab reports. They may write your blood counts on a white board in your hospital room. Or, if you are an outpatient, they may write your blood counts in a notebook for you.

They will check the following blood counts:

  • 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 starting to rebuild your immune system. Engraftment marks the start of your recovery process. White blood cells are the first cells to engraft, followed by red blood cells and platelets.

Risk of infection

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 are the part of the immune system that help prevent or fight infections. Your transplant team will help protect you from infections and treat any infections that develop.

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

  • Fever or chils
  • 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