Bone marrow collection
Once a donor has had all the matching blood tests performed and the patient’s doctor is satisfied he/she has enough information to choose the best donor for a patient, you may be asked if you are able to donate your blood stem cells. This may be bone marrow from the pelvic (hip) bones (posterior iliac crests) it may be peripheral blood stem cells (PBSCs), in other words cells taken from your circulating blood stream. Usually you will have about a month’s notice, sometimes a bit longer and sometimes, although rarely, you may be asked to donate at fairly short notice (but not usually with less than two weeks notice).
Marrow donation is a surgical procedure performed in a hospital known as the collection centre. This usually means a night in hospital, before or after the operation but some collection centres will schedule a same-day stay. Each collection centre has its own hospital policies and procedures however at all centres you will have a general anaesthetic and the doctors use special, hollow needles to withdraw liquid marrow from your pelvic bones. Some physicians will make several small incisions one or two centimetres through the skin on your lower back. No stitches should be needed. Other physicians simply insert a needle into the skin without making incisions. The amount of bone marrow collected depends on the patient’s need but a maximum of approximately 20 mL per kilogram of donor weight is usually extracted so for example if you are 65 kg approximately 1300 mL may be taken. Your body will replenish the donated bone marrow within about four weeks. Following the collection, the bone marrow stem cells will be filtered to remove any unwanted particles (such as fat and/or bone) and then mixed with an anti-clotting agent. The bone marrow will then be placed in a sterile blood transfusion bag and transported by hand to the transplant centre. The actual transplant is given intravenously to the patient just like a blood transfusion.
After the procedure and once the anaesthetic wears off, you may feel somewhat stiff and sore in the lower back region for a few days. Pain medication such as paracetamol (eg Panadol) is usually sufficient to relieve the discomfort. There may be some colourful bruising at the back of the hips in the week after the donation. Donors have also reported feeling tired and having some difficulty walking. Most donors recover well and are back in their normal routine within several days. However some individuals may take two to three weeks before they feel completely recovered. Donors may receive a transfusion of their own previously donated blood to assist with iron replacement. Serious complications are rare but could include anaesthesia reactions, infection, transfusion reactions, or injury at the needle insertion sites.
On discharge from hospital we recommend that you have a companion drive you home or take a taxi. If you are from the country you may be asked to stay in the vicinity overnight.
After the donation
If you donate to a patient, you will be removed from the registry’s active list for two years. This means that no patient other than the one you donated to can match with you in this time. The patient you donated to may still need additional cell products from you, depending on how their transplant progresses.
At the end of the two years, you will automatically be re-activated for all patients. Around this time, a donor coordinator will contact you and discuss whether you wish to remain on the registry.
If you are a blood donor, you should be deferred from blood donation for six months after bone marrow donation and three months after PBSC donation. After that period you can donate blood provided you are well and meet the blood donation requirements.
Peripheral blood stem cell (PBSC) donation
Most people’s perception is that a traditional bone marrow collection is the only way of collecting blood stem cells, but there are other sources of stem cells that are beneficial to patients. One of these is stimulated or mobilised peripheral blood stem cells (PBSCs) and another is cord blood stem cells or blood stem cells taken from the umbilical cord and placenta after the birth of the baby. In this context “Peripheral” means that the collection is made from veins in your arms. “Stimulated” or “mobilised” means that stem cells are created in higher than normal quantities in the bone marrow and released from the marrow into the blood stream. Under normal circumstances there are too few blood stem cells in the peripheral blood to provide a useful quantity for transplant purposes. However administration of a hormone-like treatment known as G-CSF by a small injection under the skin daily for four days stimulates the bone marrow to produce white cells more quickly and in larger numbers. These are mobilised into the blood stream where they can be collected more easily.
Thousands of healthy donors have received G-CSF worldwide to date. The course of G-CSF you are being asked to consider would be classed as a “short course”; and would usually not extend for longer than four (4) days. If insufficient cells are obtained after the collection you will be asked to receive a fifth injection on day 5 and have a further collection procedure the next day.
In light of the fact that G-CSF causes normal bone marrow cells to multiply and divide and, in some patients with leukaemia or related cancers may cause growth of abnormal or leukaemic cells, a great deal of attention has been paid to establishing the safety of G-CSF in normal donors. Importantly, available data from healthy people who have received G‑CSF suggests that there are no long-term risks associated with the G-CSF. In particular, despite isolated reports suggesting that some donors who have received G-CSF may have developed leukaemia, at the present time there is no statistical evidence that G-CSF increases or decreases a normal individual’s long term risk of developing cancer or leukaemia in any way differently to the normal population who have not received G-CSF.
You may experience varying symptoms including bone or muscle pain, fatigue, headache, low-grade fever, nausea, insomnia, and generally feeling a “bit off”; while receiving injections of G-CSF. The symptoms are usually mild and controlled by paracetamol, but occasionally some donors can feel more unwell and need stronger painkillers. These effects disappear shortly after collection. Severe side effects are rare and will be discussed if you are asked to donate.
The PBSC donation takes place at an Apheresis Centre. Apheresis is a process of collecting blood from a vein in one arm and passing it through a cell separator machine, which collects the cells that are needed for the transplant. The remaining blood is returned to you through a vein in your other arm.
During the collection some donors experience nausea, a tingling feeling or chills. These effects go away shortly after donating. When asked about their discomfort, most donors are quick to point out that it was worth it to help save a life, and they would be willing to do it again. The procedure does not require a general anaesthetic and takes approximately 3-4 hours. After the procedure you may leave if feeling well. If any side effects (eg nausea) have been experienced, you may only leave when your symptoms have been treated and monitored and you are feeling well.
After the donation
As with bone marrow donation, you will be deferred from the registry for 2 years. At the end of this period you will automatically be re-activated in the registry system unless you notify your donor coordinator that you no longer wish to remain on the registry.
If you are a blood donor then you will be deferred from blood donation for three months after a G‑CSF stimulated stem cell donation. You can donate blood after that period if you meet the blood donation requirements and following clearance at physical follow – up.
Follow – up
Naturally after such a procedure, the ABMDR wants to keep in touch and see how you are. You will be contacted within 72 hours of your collection. The donor coordinator will telephone you and ask you to answer a short questionnaire with some simple questions about your well- being.
If you have donated bone marrow your donor centre coordinator will follow – up with you at least weekly until you are able to resume normal activity. You will also receive a phone call at three months and an annual telephone call for up to ten years to check your general condition.
If you have donated PBSCs you will be asked to see your general practitioner (GP) at a designated date after the donation. Bone marrow registries worldwide have collected, and continue to collect, long-term information on people who have received G-CSF. It is particularly important to have this information because donor registries, including the ABMDR, are committed to continue the systematic collection of follow-up data to further clarify if there are any positive or negative long-term effects from receiving G-CSF.
The ABMDR would therefore like to review you medically 3 months and annually for ten years. If any abnormal findings in follow -up testings are identified you will be referred to your GP or a relevant physician.
You will be automatically retired on your 60th birthday when you are no longer eligible to donate or you can ask at any time to be retired by contacting your donor coordinator if you no longer wish to remain on the registry
Donating more than once
If the transplant fails to take or engraft, or only partially engrafts after the first transplant or if the recipient relapses with the original disease, the transplant centre may request a second donation. This may occur within your twelve month retirement period and may involve bone marrow, PBSC or leukapheresis. Leukapheresis is a process in which the donor’s white cells are collected using an apheresis machine but which does not require further G-CSF injections. A medical review panel will review any request for another donation to determine whether it is an appropriate request. If the panel approves the request you will be contacted and asked if you are willing to donate again for the same patient.
Your donation may be a life-changing experience for you. There may be a temporary disruption to your daily physical routine and in addition you may experience some emotional ups and downs, especially if the transplant is not successful and you receive bad news about your recipient. However it is always important to remember the value of your gift. In cases where the recipient does not survive, you can be comforted by the fact that you gave the recipient’s family peace of mind that everything was done to try and save the life of their loved one. This in itself is a true gift.
The main cost to you as a donor will be some of your time. This will include time to provide additional blood samples if they are needed, time to be assessed by the third part haematologist and your time to actually donate your blood stem cells if you are chosen as the donor for a patient. The ABMDR will cover all medical and hospital expenses related to the blood stem cell donation. Incidental expenses associated with the donation such as travel to and from hospital and accommodation if necessary will be paid directly by or reimbursed by your donor centre. All your “out of pocket” will be reimbursed.
Leave from paid employment is a matter between you and your employer.