Peripheral blood stem cell donation
Peripheral blood stem cells (PBSC) circulate in the blood stream all the time. Their formal name is hematopoietic [hee-mat-oh-poi-ET-ik] stem cells or hemocytoblasts [hee-moe-SIGH-toe-blasts]; these cells generate all other blood cells. By transplanting them into a patient whose immune system has been completely eliminated, they can grow an entirely new immune system for that person – free of cancer or the condition that caused the need.
While PBSC are found in great concentration in the bone marrow, they also circulate in the blood and can be encouraged with medication to flock to the blood stream, making them easier to collect and ensuring that the collection center can draw sufficient quantities for the patient.
Preparation with Filgrastim/Neupogen
Donors preparing for a PBSC donation will receive injections of Filgrastim (usually in the form of a medication called Neupogen™), a synthetic version of a naturally occurring protein found in the body, to encourage the stem cells to enter the blood stream. The injections last for five days. The first injection will be administered at a lab or clinic, then a home health nurse will visit your workplace or home to administer the others. The fifth injection is given at the collection center on the day of donation.
Filgrastim has been used to prepare donors for 25 years, so the effects are well documented. Many donors report feel achy while taking it, and some report feeling as if they have the flu. These symptoms typically disappear within a day of the final injection, sometimes within a few hours. Every person will have a slightly different experience.
Apheresis collection process
Collection of the stem cells is done while you are fully conscious. A needle is placed in each arm, with blood drawn from one arm, processed through a cell-separating (apheresis) machine that identifies and collects only the needed stem cells, then the remaining blood is returned to your other arm. Collection may take 4 to 6 hours, depending on the amount of cells needed for the patient. This depends on the size of the patient, for example, a child requires fewer cells than an adult.
During the process you are fully awake and able to talk, read, and watch movies. You are not able to get up and walk around.
Once the required amount of cells are collected, the bag of donated stem cells will be turned over to the courier and hand-carried to the transplant center. If the center is overseas, special customs arrangements are in place to prevent delays.
After collection
Most donors find it important to eat soon after collection. You may feel achy or lightheaded after donation, but every person reacts differently. Some donors report they felt perfectly normal a few hours later, and others say it took them a day or two. Most donors can return to work the next day and resume full athletic activities within a few days. Your stem cells will naturally regenerate and return to normal levels on their own.
Bone marrow donation
Preparation for bone marrow donation requires no special injections beforehand. Collection will be done at the same medical facility where the physical examination occurred. This is an outpatient surgical procedure, completed while you are under general anesthesia. The physician will explain the risks of undergoing anesthesia, and your Gift of Life coordinator is always available to answer any questions you might have.
Once you are anaesthetized, aspiration needles are inserted into the pelvic bone at the iliac crest, in the back of the pelvis. You can easily feel the iliac crest by putting your hands on your hip bones, thumbs forward, palms to your back. The large bones you can feel in your back under your fingers are the iliac crest.
A syringe is used to draw out bone marrow. The amount needed is based on the size and condition of the patient, for example, a child requires less than a full-grown adult.
No stitches are needed, and when the collection is completed, the site is bandaged and you are sent to a recovery room until the anesthesia wears off. Most collection centers discharge donors the same day; a few ask donors to remain overnight.
After collection
Bone marrow naturally regenerates during the weeks following donation. Some donors feel backache and/or mild fatigue during this time, while others feel normal after a day or two. Those donors who experience stiffness or backache after collection find it is treatable with acetaminophen or similar over the counter medications. Athletic individuals should be able to gradually resume a normal level of activities over the next two weeks. Each person’s experience will vary.
