What is bone marrow?
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 in for a day filled with appointments within 30 days of the actual stem cell donation day. This time frame is required by the Food and Drug Administration (FDA). The purpose of your work-up is to ensure:
- You meet the medical criteria for stem cell collection.
- We will be infusing healthy stem cells to your recipient.
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).
Blood tests. 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 transplant, you will start giving the filgrastim self-injections. These injections will be started four days before the stem cell collection procedure. You will give the self-injections once per day, at the same time each day and for five days in a row. If you require more than one 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 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 collection procedure takes three to four hours for two to three 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 three 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.
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. 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.
Recovery and Outlook
Your experience comes to an end with the removal of the central venous catheter if one was placed. The catheter is removed by the apheresis staff. 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.
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