Bone marrow and peripheral blood stem cell donation - information for donors

Donating your stem cells

The results of the tissue typing have shown that you have the same tissue type as your brother/sister. This means that you could donate stem cells for him/her should he/she need a bone marrow or peripheral blood stem cell transplant.

This information sheet has been designed to give you an overview of the two methods of doing this.

What are stem cells?

Stem cells are the seeds from which blood cells (red cells, white cells and platelets) grow. These can be found in the bone marrow or can be encouraged to enter the blood stream by the use of injections called' growth factors'.

Why may I need to give my brother/sister some of my stem cells?

A transplant may be an option for treating your brother/sister's blood/immune system disorder. This involves him/her receiving large doses of chemotherapy and/or radiotherapy. Chemotherapy and radiotherapy destroys cancer cells. However, as a side effect they also destroy normal blood cells and a person's ability to produce new blood cells.

By taking your stem cells and giving them to your brother/sister after chemotherapy/radiotherapy, we can overcome some of these side effects, as these stem cells will seed and grow to produce new blood cells.

How do I donate my stem cells?

There are two sources of stem cells that we can use. These are from the bone marrow or from the peripheral blood. Each of these will be discussed in turn.

Bone marrow donation

Do I need any tests prior to starting this treatment?

Yes. You will need some blood tests to make sure that you are fit to go ahead with the collection. We also need to assess whether you have viruses such as HIV, hepatitis, HTLV and syphilis before we are able to collect stem cells from you. This is also a blood test. There is a counselling service available to you prior to having the blood test should you wish to use it. Please discuss this with the consultant or the transplant co-coordinator prior to the blood sample being taken. The results of these tests will be available to you if you wish. The implications of any abnormal test results will be discussed with you.

How is bone marrow collected?

Bone marrow is collected whilst you are under a general anaesthetic. It is performed in the same way as a bone marrow aspirate test. You will be lying on your stomach when the harvest is taken from you. Hollow needles are then inserted into the pelvic bones. Approximately one litre of your bone marrow is then extracted, put into bags, processed and stored at very low temperatures.

How long will I be in hospital for?

You will need to be assessed by the day surgery staff.

If you are fit for day surgery you can have a light early breakfast at home before 7 a.m. You cannot have any further food until after the surgery. You may drink water only up until 12 midday.

You will need to arrive at the Haematology Day Unit Addenbrooke’s for a blood test no later than 10 a.m. The results will be reviewed and you will be asked to go to the Day Surgery unit in the Addenbrooke’s Treatment Centre at 12 midday.

Children being harvested will attend PDU at 10am on the day of the harvest and will be admitted on to the children’s ward overnight.

The bone marrow harvest will take place between 2 p.m. and 4 p.m. and you should be ready for discharge no later than 7 p.m.

You will only be able to go home if you have somebody to drive you home.

If you require hospital transport or wish to drive yourself home we can provide a hostel bed on site overnight. If you become unwell and need urgent medical attention whilst in the hostel, you will need to call the emergency services on 999.

If day surgery is not appropriate for you we will need to admit you to a ward at Addenbrooke’s Hospital on the Sunday evening. You will have your bone marrow harvest on the Monday afternoon. You should be ready for discharge on the Tuesday if all is well.

How long will bone marrow collection take?

Bone marrow collection itself usually takes about one hour.

Where will the bone marrow collection take place?

The bone marrow collection takes place in the day surgery theatre and is carried out by members of the Haematology team.

Are there any side effects?

The general anaesthetic may cause nausea and dizziness. As a result of our taking about one litre of bone marrow from you, you may feel weak and tired following the collection. You will be given fluids into a vein following the procedure. You may also require a blood transfusion, this will be determined by a further blood test after the procedure. The bone marrow sites may bleed and bruise. We try to prevent this by putting a tight plaster over the puncture site.

Will the bone marrow harvest be painful?

Following the collection you may experience some discomfort. A long acting painkiller will be inserted into the area from which the bone marrow was withdrawn whilst you are under the anaesthetic. You will also be prescribed pain relief to have on return to the ward should you require it.

The pain may persist for a few days after you have donated your bone marrow. In a very small number of people the discomfort may last a few weeks.

Am I allowed to eat before the collection?

No, as the collection is done under a general anaesthetic, you will not be allowed to eat 6-8 hours prior to the collection. It is recommended that a light breakfast only is consumed before 7 a.m. i.e. toast/cereal.

How long will I need to be off work / school

It is advisable that you take a few days following this off so that you are fully recovered before you return to work/school.

Your GP will be able to give a certificate to cover the few days you take off following the harvest.

If you have any questions in the meantime please do not hesitate to contact the BMT nurse practitioner/coordinator on 01223 217224.

Peripheral blood stem cell donation

Do I need any tests prior to starting this treatment?

Yes. To make sure that you are fit to go ahead with the collection. We also need to assess whether you have viruses such as HIV, hepatitis, HTLV and syphilis before we are able to collect stem cells from you. This is also a blood test. There is a counselling service available to you prior to having the blood test should you wish to use it. Please discuss this with the consultant or the transplant co-coordinator prior to the blood sample being taken.

The results of these tests will be available to you if you wish. The implications of any abnormal test results will be discussed with you.

How do we collect blood stem cells?

This is done in two stages.

First we have to 'mobilise' the stem cells. This means that we encourage them to come out of the bone marrow and into the blood stream. This is called 'mobilisation'. This is achieved by giving you a growth factor called G-CSF. G-CSF is a small injection, which is given under the skin for four or five days. This can be administered by the Haematology Day Unit staff, at your local hospital or at your GP surgery.

When you have the injections we monitor your blood count on the third day. This helps us assess how effective the injections have been so far .On the fifth day, you will attend the day unit on ward E10 Apheresis Unit for you stem cells to be collected. This is called 'harvesting'.

In order to collect the blood stem cells a needle is placed into a large vein in each of your arms. (We will assess your veins when you come for your outpatient appointment). We then connect you to a cell separator machine. This machine spins the blood and separates it in to different parts. The machine can detect the cells that we wish to collect and put them into a bag. The rest will be returned to you. If you wish you can see a cell separator machine when you attend for your out patient appointment.

How long will the stem cell collection take?

The stem cell collection itself takes four hours. We then calculate the numbers of cells we have collected. We aim to collect all we need in one harvest. If we do not have enough cells, we may give you another injection of G-CSF and collect more cells from you the following day. This could be done for three days in total if necessary.

Throughout the stem cell collection, to prevent your blood from clotting, an anticoagulant is added to it. This may cause tingling or pins and needles in your fingertips or around your mouth. If this happens, let the nursing staff know.

Is it possible to collect blood stem cells in everyone?

No. Some people do not 'mobilise' blood stem cells. In cases where this occurs we would plan to remove bone marrow from you on the same day we failed to collect blood stem cells.

Is G-CSF safe?

Although G-CSF is a relatively new drug, it has been used with donors for several years. It is not unusual to get some mild to moderate aches and pains in the bones of your trunk and limbs after these injections. Some people also experience a headache. Taking regular paracetamol can often relieve these pains.

There is also a risk of very small blood vessels becoming blocked whilst you are receiving G-CSF. We monitor your blood count to reduce the risk of this occurring.

It is impossible to say there are no long term effects of G-CSF but if there are any they are thought to be rare.

Do I need to stay in hospital when the stem cells are collected?

No, you do not need to be admitted into hospital for the stem cell collection. This is an outpatient procedure. However for those living some distance from Cambridge, overnight hostel accommodation may be available if prior notice is given.

Where will the stem cell collection take place?

Stem cell collection is done on Ward E10 the Apheresis unit at Addenbrooke’s by nursing staff who have undergone special training.

Am I allowed to eat before the stem cell collection?

Yes, please eat a good meal before the collection.

Can I bring a friend / relative with me when the stem cells are harvested?

Yes, but just one other person, as the space in the day unit is limited.

How long will I need to take off work?

When you are receiving the daily G-CSF injections you will need to have blood taken on day three. This can be done at the Haematology Day Unit or at your local hospital at the same time as the injection. The blood needs to be taken in the morning. Once this is done you will be able to go to work as usual. You will need to take the whole day off work on the day the collection is to take place. We also recommend that you make plans to have the following day off also just in case we need to do a further collection.

What side effects is my brother/sister likely to experience during the transplant?

There are many known risks associated with transplantation. We will discuss these with your brother/sister in great depth prior to the transplant. The risks/side-effects include failure for the donor cells to seed and grow, graft versus host disease, which occurs when the donor cells do not recognise the recipient, infection, bleeding, a painful mouth, tiredness and hair loss.

Where can I park when I come to Addenbrooke’s?

There is special dispensation for oncology patients who attend Addenbrooke’s. Please ask for information about the discount parking scheme for oncology patients.

There are other car parks allocated for patients and visitors. Tickets are issued on a pay and display basis. An appointment slip will permit access into these car parks. Information about car parking and general access to Addenbrooke’s can be found on our website or ask for Trust information leaflet ‘Services for you and your visitors’ or ask for Trust information leaflet ‘Services for you and your visitors’

This information booklet has been designed to give you an overview of donating stem cells should the need arise. If we do need to treat your brother/sister by carrying out a transplant we will arrange to meet with you to discuss the possibility of your donating stem cells.

If you have any questions in the meantime please do not hesitate to contact the BMT nurse practitioner/coordinator on 01223 217224.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and / or specialist one to one care is required.