What Is Bone Marrow collection/Stem cell collection?How bone marrow or stem cells are collected.

Bone marrow harvesting is a procedure in which healthy marrow-containing stem cells are collected from a healthy donor.

What are the sources of stem cell collection?

Stem cells are collected in two ways. One method is peripheral collection, and another method is aspirated from the bone with the help of a largely bored needle.

What are the preferred sites for bone marrow collection?

Most of the sites used to collect marrow are the hip bone; sometimes, it is collected from the sternum bone as well. The procedure is carried out in the Operating Theater, where general anesthesia is given to the donor, so that the donor will not feel the pain of the needle.

Peripheral stem cells are collected by inserting a central line in the chest of the patient or Donor, depending upon the type of transplant.

How much will it take to Collect Bone Marrow?

The time of bone marrow harvesting from the bone depends upon the amount of bone marrow required for the recipient (the patient). Normally, it takes around 45 to one hour once started. On the other hand, peripheral stem cell collection takes around 3-4 hours.

Peripheral Harvesting is used in both autologous and allogenic transplants. Bone marrow harvesting is primarily performed in allogeneic transplants.

Selection of a donor for bone marrow transplant:

A healthy donor is selected by a test called HLA typing. The donor may be from sibling or he or she may be unrelated.

Preparing a patient for peripheral stem cell collection in an autologous transplant:

In an autologous transplant, stem cells are collected from the patient and reinfused into the same patient.

Growth factors Administration: (bone marrow or stem cell mobilization).

Before stem cell collection, the patient is given some injections called growth factors to boost the marrow; moreover, this is done to collect the maximum amount of stem cells.

Central line insertion:

A large-bore central line is placed in the chest or neck of the patient. The central line contained two lumens. One lumen is used to draw blood into the pheresis machine.

At the same time, another lumen is used to return the blood to the body. Moreover, it can also be done through a large-bore cannula inserted into a large vein of the patient.

Preservation of stem cells in Autologous Transplant:

The collected stem cells are saved in the laboratory after adding preservatives. They are frozen at -80 degrees centigrade or 2 – 8 degrees centigrade, depending upon the time for preservation and infusion.

For how long can the cells be preserved?

The stem cells can be stored for years; however, a special laboratory is required, such as liquid nitrogen is required to preserve them for a long period of time.

If the cells have to re-infuse after 72 hours, then they are frozen. If it has to be infused within 72 hours, the cells are kept at 2 to 8 degrees centigrade. Whereas in an allogenic transplant, cells are infused into the patient on the same day of collection.

Bone Marrow Harvesting In the Operating Theater

Donors are not to eat anything from midnight. A blood sample is done in the morning at least 2 -3 hours before the procedure, and a cannula for medications and fluids is in the Operating Theater.

After shifting to the Operating Theater, general anesthesia is given. The donor is placed in a particular position called the prone position.

During the Procedure of Bone Marrow collection

After giving anesthesia, the bone marrow harvesting team, including bone marrow harvesting consultants, operating room technicians, and BMT nurses, will start the procedure of collecting marrow by inserting a special needle called a spinal needle or bone marrow needle.

The amount of bone marrow depends upon the patient’s (Recipient’s) weight as well as the donor’s weight. If in case the donor is an adult and the recipient is pediatric, then very little marrow is needed, vice versa.

 After Bone Marrow Collection/Harvesting:

After the procedure, shift the donor to the post-operative area for monitoring for at least 30 minutes to one hour un till the donor is fully conscious and with stable vital signs, such as normal blood pressure, pulse, respiration, and temperature.

Then transfer to the normal floor with special instructions, such as food restriction/ nothing by oral, again for at least 3-4 hours after the procedure, to avoid any anesthesia complications such as nausea and vomiting. It is necessary to have nothing per oral till the patient is fully awake.

What precautionary test should be carried out after bone marrow harvesting?

Assess bleeding from the puncture site. A complete blood count test is carried out to check hemoglobin levels. If there is a drop in HEMOGLOBIN levels, a packed RBC could be transfused before discharging the donor to home.

What diet should be given after the procedure?

Your diet starts with clear liquids like green tea or juice. Once you tolerate an oral diet, your consultant will discharge you home with some iron supplements and some painkillers.

Are there any side effects of bone marrow donation? OR

Will the donor feel any complications after bone marrow harvesting?

There is no major side effect of donating bone marrow. However, mild pain at the side of the needle puncture may be experienced, for which painkillers are usually advised.

Seek medical attention:

In case of the following symptoms, consult your physician:

•  Fever 101F.This could be a sign of infection due to exposure to any infection-causing organism during the procedure, if sterility is breached.
• Severe pain regardless of oral painkillers.
• Uncontrolled bleeding from the bone marrow aspiration site
• If you have a hematoma/ swelling at the catheter site in peripheral stem cell collection.

 Usually, there is no harm to the donor. The donor can resume his/her daily routine activities just the same day of the transplant.

However, there could be some weakness due to the anesthesia effects for one or two days. Furthermore, there could be some pain related to needle punctures in the area where bone marrow has been collected.