Typically, blood progenitor cells (BPCs) obtained through collection of your peripheral blood stem cells are used for an autologous BMT. Less often, your bone marrow will be harvested. You may recover your blood counts more quickly if you do not have anesthesia when your peripheral blood stem cells are collected.

Peripheral Blood Stem Cell Collection
As you read earlier, blood progenitor cells (BPCs) circulate in your bloodstream. They appear to be just like the stem cells found in your bone marrow, and they are capable of repopulating damaged bone marrow and restoring the process of blood cell growth and development (hematopoiesis).

The BPC procedure is not painful, but takes three to four hours and will need to be done for one to five days on an outpatient basis. The registered nurse who will care for you during the process will explain the collection procedure to you.

How to Prepare. Prior to the collection procedure, you will be given a medication called growth factor, which causes your bone marrow to increase its production of BPCs. These cells will be collected, preserved and given back to you after your conditioning regimen of chemotherapy and/or radiation.
 
To prepare for your BPC collection, it’s important that you maintain good nutrition. Calcium-containing foods, such as milk or milk products, are good choices, unless you have been told otherwise. Avoid fatty and high-cholesterol foods.

What to Expect
On the day of your BPC collection, you will report to Admissions, just as you have for your previous visits. You may be asked to go to the Hematology Neuro-Oncology Center first or you may be asked to go directly to the Apheresis Unit.
Wear comfortable clothing that allows easy access to your long-term IV catheter. You are welcome to bring a friend or family member with you for company. You will be free to read, write, knit, etc. The Apheresis Unit has a TV, computer and CD player. You may wish to bring your favorite CDs. Lunch will be provided, but if you prefer to do so, you may bring your own food.

BPCs are collected through your long-term IV catheter. First, the nurse will help you get comfortable in a bed or chair. Then, your catheter will be connected to the tubing of a leukapheresis machine, which draws blood from one tube of the catheter and returns it to your body through the other. The machine has a special feature called a centrifuge that spins the blood to separate and collect your BPCs as it passes through.

Because the procedure returns your blood at the same rate that it is drawn, it is unlikely that your vital signs will change. However, your blood pressure may become low and you may feel lightheaded; if so, tell the nurse. You will be monitored closely and should this occur, it can be readily relieved.

A small amount of an anticoagulant is added to your blood as it is drawn into the machine to keep it from clotting. The anticoagulant removes calcium from your blood and you may feel a tingling sensation in your fingers, toes or around your mouth. This is harmless, but the tingling may continue for a few hours after the collection. A few Tums® usually provide relief.

If you have any questions regarding this procedure, please discuss them with your attending physician.

Bone Marrow Harvest
Your bone marrow will be harvested when it is disease free, or as minimally involved with disease as possible. After harvest and any necessary preparation, your bone marrow will be frozen and stored in special bags until you are ready for your BMT. During the freezing process, dimethylsulfoxide (DMSO) is added to the bone marrow to prevent ice crystals from forming inside cells and causing them to burst. Bone marrow can be stored in this state for many years.

How to Prepare
Before you are admitted to RPCI, you will meet with an anesthesiologist to discuss which type of anesthesia, if any, you will receive. When you are admitted, you will be asked to sign an informed consent for bone marrow harvest.
Do not take aspirin or any aspirin-containing compounds for 10 days, and do not take ibuprofen or ibuprofen-containing compounds for three days before your marrow is harvested. Shower or bathe the evening before the procedure, and do not eat or drink after midnight so that your stomach is empty when you are given anesthesia. This helps prevent vomiting during the procedure and promotes your safety. If you eat or drink, your procedure may be delayed or canceled.

What to Expect
Before being taken to the operating room on the morning of your marrow harvest, you must:

• Dress in the hospital gown provided. 
• Empty your bladder.
• Remove jewelry, hairpins or hairpieces.
• Remove dentures or partial plates.
• Remove make-up and nail polish.
• Remove eyeglasses or contact lenses. 

An IV line will be inserted in your arm or hand, or through your long-term IV catheter to give fluids during and following the procedure. The IV will be removed when you are able to drink fluids again. Just before being taken to the operating room, you may be given a shot to make you feel sleepy.

In the operating room, all doctors and nurses will be wearing gowns and masks. The doctors from the BMT program will perform your bone marrow harvest procedure.

After you are asleep, bone marrow will be collected by inserting a needle through the skin into the inner cavity of the back of your pelvic bone. If enough bone marrow cannot be obtained from the back, the remainder will be collected from the front of your pelvic bone. Blood progenitor cells (BPCs) and some blood will be withdrawn through the needle. The needle will be inserted into the skin two to four times on each side of the back (and possibly also the front) of your pelvic bone. When the procedure is completed, a pressure dressing will be placed over the collection sites to help prevent bleeding.

The bone marrow harvest procedure takes two to three hours. Generally, three to five percent of your bone marrow cells are collected, along with some blood. The filtered bone marrow is processed for freezing and kept frozen until it is time for your autologous BMT.

The harvest procedure affects only your red blood cell count. Red cells can be replaced through blood transfusions if your doctor determines that it is necessary. You may receive a unit of your own blood that was removed from the harvested bone marrow. However, if your doctor determines that additional blood transfusions are needed, you will receive matched blood from the RPCI Blood Bank.

When the harvest is completed, you will be taken to the recovery room. The nurse in the recovery room will check your blood pressure, pulse and breathing pattern about every 15 minutes. The pressure dressing on your lower back will be checked to be sure there is no bleeding. You will stay in the recovery room for one to two hours. You will probably hear several noises, such as the beeping of monitors and the nurses speaking.

When fully awake, you will be taken to your room.  You may feel tired and want to rest for a few hours. Your throat may be dry and sore from the tube used during anesthesia, but do not drink anything until your nurse or doctor approves. Tell the nurse if nausea develops.

After receiving anesthesia, it is a good idea to change your position in bed, breathe deeply and cough frequently to expand your lungs and help prevent infection. You should continue to do this until you are discharged.

The harvest sites will be sore and you might have pain; if so, tell your nurse. Your doctor will have ordered pain medication for you.

You may be discharged from RPCI on the day of your procedure (later in the afternoon) or the next morning. A family member or friend must be available to take you home. You will be given a prescription for pain medication and possibly a prescription for a 30-day supply of iron supplements.

The pressure dressing should be removed the day after your marrow was harvested. Keep the collection sites clean and covered for about one day after the pressure dressing is removed. If Steri-Strips® were used, leave them on until they come off by themselves. You may shower, but avoid tub baths for 48 hours. Check the collection sites each day for redness, increased tenderness, swelling or drainage. If any of these symptoms develop, please call the Outpatient BMT Center. After hours, call the RPCI switchboard and ask to speak with the physician on call.

You can resume normal activities when you are comfortable. If you have questions, please ask your nurse or doctor.