Bone marrow is the soft, spongy substance that fills the inner cavities of bones. It is where blood is produced.
Tiny spaces in the bone marrow hold blood and stem cells, the primitive cells that are able to grow into various types of blood cells. Stem cells that have matured leave your bone marrow space and enter your bloodstream. These mature cells can be collected during a process called apheresis.
You will be scheduled to come to Cleveland Clinic for a day filled with appointments within 30 days of the actual stem cell donation day. This time frame is required by our transplant program and by the Food and Drug Administration (FDA). The purpose of your work-up is to ensure:
- You meet medical criteria for stem cell collection
- We will be infusing healthy stem cells to your recipient
Having your appointments completed at Cleveland Clinic ensures that billing will be processed appropriately. All of your bills are the responsibility of your recipient/recipient's insurance company.
Donor work-up: meetings with the BMT Team
Meeting with a transplant doctor
You will meet with a transplant doctor who will discuss the process of collecting your stem cells. The doctor will also discuss the testing that will be performed during that day. The doctor will also review your past medical history and perform a physical exam. After the doctor receives all of the test results from the work-up, he or she will decide if any additional tests need to be scheduled. It can take from 7 to 12 days to receive these results.
If any tests or lab results are abnormal, it is possible that you will be expected to return to Cleveland Clinic for further testing and for possible consultations with other specialists. Again, this is to ensure the safety of the donation and the health of both you and your recipient. The doctor will meet with you a second time to review the test results and discuss any abnormal findings on the tests. You will be able to ask any questions during this time.
Meeting with your bone marrow nurse coordinator
- You will meet with the nurse coordinator to review the process of collecting stem cells.
- You will be asked to complete a donor Health History Survey, as required by the FDA.
- The nurse coordinator will provide and explain the consent form for being a stem cell donor. The coordinator will also answer any questions you might have.
- The nurse coordinator will teach you how to give self-injections of Neupogen®, also called filgrastim or G-CSF. If you are unable to give the injections, a family member or friend might be instructed and should plan to attend for the teaching. This medicine is given to stimulate your bone marrow or stem cells. These are the cells necessary for a successful bone marrow transplant.
- Your nurse coordinator will take you to Apheresis (M12) for an assessment of the veins in your arms. This will help to determine if a central venous catheter will need to be placed for the collection of your stem cells.
Meeting with the financial counselor
You will have the opportunity to meet with the financial counselor to discuss the process of billing and to answer any questions about insurance coverage for the stem cell collection. All of your bills are the responsibility of your recipient or recipient's insurance company.
- donor work-up: tests needed
- chest X-ray (picture of the lungs)
- electrocardiogram (a graph of the electrical impulses traveling through the heart to evaluate heart function)
- urinalysis (urine test)
Samples of blood will be drawn from a vein in your arm and the following laboratory tests will be performed:
- CBC-complete blood count
- CMP-comprehensive metabolic panel
- pregnancy test (all females)
- bleeding times
- ABO blood type
- infectious disease tests — human immunodeficiency virus (HIV), cytomegalovirus (CMV), toxoplasmosis, hepatitis, Epstein-Barr virus (EBV), herpes, HTLV I/II, varicella, and syphilis
After your recipient has been approved for the bone marrow transplant, you will start giving the Neupogen® self-injections. These injections will be started 4 days before the stem cell collection procedure. You will give the self-injections once per day, at the same time each day and for 5 days in a row. If you require more than 1 injection per day, it is very important that you take all injections at the same time.
Stem cell collection procedure
The next step is the peripheral stem cell collection. You will return to Cleveland Clinic in the morning for the placement of a central venous catheter if it is determined your vein size is not adequate. If a central venous catheter is planned, follow the dietary guidelines on your appointment schedule.
A few days prior to the collection of your stem cells, it is recommended that you drink plenty of fluids. If you do not require a central venous catheter, you may eat breakfast in the mornings prior to the collection of your stem cells. After the catheter has been placed, you will be sent directly to Apheresis (M12) so your stem cells can be collected. If a catheter is placed, the dressing must remain dry and intact. You may take a bath, but no shower. The catheter dressing will be changed daily by the apheresis nurses.
The collection procedure takes 3 to 4 hours for 2 to 3 days or until a minimum number of cells has been collected. Depending on the number of cells that are collected, the collection process might last more than 3 days.
A side effect that you might experience during the collection of your stem cells is a decrease in your platelet count. Platelets are a component of your blood that helps with clotting. Due to a potential decrease in your platelet count, each day prior to the collection of your stem cells a CBC (complete blood count) will be drawn to ensure it is safe to collect your stem cells.
Another side effect that can occur is a tingling sensation in your hands or feet, which is due to a fluctuation in your electrolyte levels during the stem cell collection process. This might require you to receive an electrolyte replacement, such as calcium, during the stem cell collection.
Visitors will be able to come in and out of the apheresis area while your cells are being collected but will not be able to stay due to limited space. Visitors may bring in food and drinks for you while you are having your stem cells collected. A driver is not required but is recommended.
Your experience comes to an end with the removal of the central venous catheter if one was placed. The catheter is removed 24 hours after the last day of stem cell collection by the apheresis staff at M12. The apheresis nurse will call you the following day to see how you are feeling. He or she might instruct you on precautions to follow for several days if your platelet count drops below a certain range.
If you have any questions once you are home, please feel free to contact your BMT nurse coordinator.
- Stem cell transplant (peripheral blood, bone marrow and cord blood transplants). American Cancer Society Accessed 2/2/2012
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/15/2011…#13921