Your stem cells will most likely be collected by a procedure called “apheresis” (a-fair-ee-sis). Two ends of tubing will connect you to a cell separator machine during the collection. Your blood will flow out of one arm, inside the tubing, to the machine where it will spin your blood around at high speed. The spinning separates the different components of the blood into layers based on their weight. The stem cell layer will then be collected and the remaining blood will be returned to you via the other arm. The blood always stays inside the tubing set. The tubing and needles are sterile. They are used only once and then discarded.
You will be attached to the cell separator machine for 4-6 hours for each collection. There will be nurses and technicians present for the entire time. During the procedure it is necessary for you to stay in bed. Each bed area has a television set to help pass the time. You may also have a friend stay with you.
The apheresis procedure is safe. However, there are some side effects you may experience and should be aware of:
If you have an IV (intravenous) needle in the inside elbow region of your arm(s) you will need to keep your arm(s) straight during the procedure. Sometimes this can be uncomfortable. Please let the nurses know so that they can assist you in getting as comfortable as possible.
The flow of blood from your veins can sometimes be slow and variable. In this case, the nurses may ask you to squeeze your hands to increase blood flow, change your arm position, or the nurses may adjust the lines or machine. Occasionally a needle will have to be replaced in order to get good blood flow.
Changes in blood volume may make some people feel dizzy or light-headed. You should tell the nurses immediately if you feel anything like this.
An anticoagulant (anti-clotting) drug is mixed with your blood as it enters the machine to keep it from clotting during the procedure. This may cause a sour taste in your mouth. The anticoagulant can also lower your blood calcium and you may experience light-headedness, nausea, muscle cramping, and/or a tingling feeling around the lips, hands or feet. You should tell the nurses immediately if you feel any of these symptoms. Oral or intravenous calcium will bring quick relief of these side effects.
You may start to feel cold during the procedure. If you feel chilled, please let the nurses know. They can give you extra blankets and heating pads to keep you warm and comfortable.
The goal is to collect enough cells for one or two transplants depending on why the patient is receiving the transplant. The BMT physician will have discussed this with you prior to the collection. The targeted cell collection is usually achieved in 1 to 2 days. Occasionally a third day of collecting is required. The number of stem cell collections needed largely depends on the patient’s weight and the donor's response to the G-CSF and the apheresis procedure.
Immediately after the apheresis procedure is completed, specimens are obtained from the bag of collected stem cells. These are sent as soon as possible to a special lab where the sample will be studied and the actual stem cell count will be determined. Results of this analysis will usually be completed by 4:00 pm that same day. Once the actual count is known and reviewed by the doctor, you will be notified as to whether more stem cell collections are needed on subsequent days.
In some cases, the transplant will not take place right away. In order to preserve the stem cells, they will need to be frozen. This process is called cryopreservation. Shortly after the stem cells are collected, they are sent to a special lab called the Cryogenics Lab. There, the stem cells will be concentrated and a preservative will be added to protect the cells from the freezing process. They will then be stored in a special freezing vault until the time of transplant.
Sometimes, the stem cells will be transplanted shortly after they are collected. In this case, the stem cell will be refrigerated and given within 1 to 2 days of the collection.