Being a donor for a blood or marrow transplant is a very generous thing to do, whether donating for a loved one or as an anonymous donor for someone you don’t know.
Stem cells for transplant patients can be obtained in two ways:
- Bone marrow harvest
- Collection of peripheral blood stem cells(also called blood progenitor cells, or BPCs).
Currently, peripheral blood stem cell collection is preferred for adults because the transplant procedure is easier for the recipient and the transplanted stem cells seem to recover more quickly. The attending physician can discuss the pros and cons of each procedure.
In pediatric cases, however, bone marrow harvest is the usual choice. Donors are typically pediatric siblings, and the procedure is less invasive for the donor.
Are you a suitable peripheral blood stem cell or bone marrow donor?
Before someone is accepted as a cell donor, safety for both the donor and recipient must be confirmed. To determine your eligibility, pre-evaluation and consultation sessions are conducted on an outpatient basis through RPCI’s Hematology Neuro-Oncology Center.
During your first visit to RPCI as a possible donor, a complete medical history will be taken, including questions about any preexisting medical problems, potential allergies and if you have a history of infectious diseases. A physical examination will be done and tests will be given to ensure you are physically able to endure the donation of BPCs or bone marrow. You’ll have an electrocardiogram (EKG) and a chest x-ray. Blood samples will be taken to check for infectious disease and to perform tissue typing (also called HLA or human leukocyte antigen testing). HLA tests show if your BPCs or marrow are a match for the person who needs a transplant.
When cleared to become a stem cell donor, you will meet with the transplant team to learn how to proceed. You will need to sign an informed consent form prior to the collection or harvest.
Peripheral Blood Stem Cell Collection
BPCs, which circulate in the bloodstream, appear to be the same as the stem cells found in bone marrow and are capable of repopulating the bone marrow and restoring the process of blood cell growth and development called hematopoiesis. If you will be donating BPCs, this will give you an idea of the possible steps:
- To help drive your BPCs from your bone marrow into the bloodstream so they can be collected, we will arrange for you to receive shots of colony stimulating factors (G-CSF/Neupogen® or GM-CSF/ Leukine®) just under your skin (subcutaneous injections).
- You will meet with the pheresis nurse to determine whether it is best to have the BPCs collected through your veins or through a special catheter. If a catheter is chosen, you will be taken to the operating room, receive local anesthesia, and a small incision will be made in your neck or upper chest. The catheter will be tunneled under your skin and placed in one of your major veins, where it will stay until the donation is complete.
How to Prepare
- Maintain good nutritional habits as you prepare for BPC collection. Calcium-containing foods such as milk or milk products are good choices, unless advised otherwise by a doctor. Avoid fatty and high-cholesterol foods.
- Do not take aspirin or any aspirin-containing products for 10 days and do not take ibuprofen or ibuprofen-containing products for three days before the collection procedure.
What to Expect
BPC collection is done as an outpatient, takes approximately three to four hours, and generally requires between one and five daily sessions. The collection procedure is not painful, but you may notice that your bones are aching from the G-CSF/GM-CSF shots. The area around the catheter may be tender. These side effects usually go away in a few days.
Wear comfortable clothing when you come to have your BPCs collected. You are welcome to bring a friend or family member for company, and will be free to read, write, knit, etc. The Apheresis Unit has a TV, radio and tape player. Lunch will be provided, but you may bring additional snacks.
To begin the collection, first, the nurse will help you get comfortable in a bed or chair. If you have a catheter, it will be connected to the tubing of a leukapheresis machine, which draws blood from your body through one tube and returns it into another. If you do not have a catheter, the nurse will put a needle into your vein, and intravenous tubing will connect you to the machine, whicn is also called a cell separator. It has a centrifuge that spins the blood as it passes through, to separate and collect the BPCs. Because the procedure returns blood at the same rate as it is drawn, there rarely are any changes in how you feel. Occasionally, your blood pressure may drop and you might feel lightheaded. The nurse should be informed as this can be remedied. You will be monitored closely throughout the procedure.
A small amount of anticoagulant is added to your blood to keep it from clotting as it is drawn into the machine. The anticoagulant removes calcium from your blood so 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 supplements such as Tums, which contain calcium, usually provide relief.
You can resume normal activities each day, but if you have a catheter, you should avoid vigorous physical exercise and activities such as weight lifting until the catheter has been removed.
Bone Marrow Harvest
Harvesting bone marrow is usually the preferred method of collection for pediatric donors.
Donating bone marrow poses virtually no danger to you as the donor, however, bone marrow collection is done under general or spinal anesthesia, and any anesthesia poses some risk.
Before you are admitted to RPCI, you will meet with an anesthesiologist to discuss which type of anesthesia you will receive. The procedure will be explained to you in detail, and you will be required to sign an informed consent form for anesthesia.
How to Prepare
- In preparing for the harvest procedure, do not take aspirin or any aspirin-containing products for three days before the collection procedure.
- Shower or bathe the evening before the procedure and do not eat or drink after midnight to ensure an empty stomach when the anesthesia is given. This helps prevent vomiting during the procedure and is for your safety. If you eat or drink after midnight, the procedure may be delayed.
What to Expect
When you are admitted, you will be asked to sign an informed consent for bone marrow harvest. Before being taken to the operating room on the morning of your marrow donation, you must:
- Dress in the hospital gown provided.
- Empty your bladder.
- Remove jewelry, hairpins and hairpieces.
- Remove dentures or partial plates.
- Remove makeup and nail polish.
- Remove eyeglasses or contact lenses.
An intravenous (IV) line will be inserted into your arm or hand 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 perform the bone marrow harvest procedure.
After you are asleep, bone marrow will be harvested by inserting a needle through the skininto the inner cavity of the back of your pelvic (hip) bone. BPCs and some blood will be withdrawn through the needle. The needle will be inserted into the skin once or twice on each side your pelvic bone. When the procedure is completed, a pressure dressing will be placed over the harvest sites to help prevent bleeding.
The bone marrow harvest procedure usually takes two to three hours. Generally, three to five percent of a donor’s bone marrow cells are collected, along with some blood. The bone marrow is filtered and will be used in the allogeneic BMT within 24 to 48 hours of collection.
The harvest procedure affects only your red blood cell count. Red cells can be replaced through blood transfusions if your doctor determines this is necessary. If you are an adult donor, you may receive a unit of your own blood that was removed from the harvested bone marrow. If the doctor determines you need additional blood transfusions, you will receive matched blood from the RPCI Blood Bank. This is rarely necessary.
Pediatric donors usually are given iron supplements for one month after harvest.
When the harvest procedure is completed, you will be taken to the recovery room for approximately one to two hours. The nurse in the recovery room will check your blood pressure, pulse and breathing patterns approximately every 15 minutes. The pressure dressing will be checked to be sure there is no bleeding. 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 the 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 later in the afternoon if your medical condition is stable. A family member or friend must be available to take you home. You will be given a prescription for pain medicine to use at home.
The pressure dressing should be removed the day after the procedure. Harvest sites should be kept clean and covered with a bandage for about one day after the pressure dressing is removed. If Steri-Strips® were applied, they should be left on until they come off by themselves.
You may shower, but avoid tub baths for 48 hours. Check the harvest sites each day for redness, increased tenderness, swelling and 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 based on your comfort level. The nurses and doctors are available to answer any questions.