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Bone Marrow Donation Instructions

 

1.Autologous blood collection

When extracting the marrow from the marrow cavity, blood cells are also been drawn out. To prevent from losing too much red blood cells that may cause the donor to have anemia or low blood pressure, autologous blood from the donor is been collected before marrow been extracted. The blood collected before marrow donation will be transfused back into the donor to replenish the loss of the red blood cells. (Autologous blood is the safest, and has regeneration function itself, under normal conditions, the marrow produces an appropriate daily amount of blood cells to replenish the balance of different type of blood cells in the blood. When there is a blood loss, like donating blood, the marrow will produce blood cells at a quicker speed and at an increased amount, so that it recovers to the normal status before the donation.)

  Life cycle and daily production (renewal) amount of blood cells:
  ★ Red blood cells – 120 days, the marrow makes 0.8% daily
  ★ White blood cells < 1 day, the marrow makes 230 % daily
  ★ Platelet – 10 days, the marrow makes 10 % daily

During the health check up,”Autologous blood collection Consent” needs to be signed. After confirmed a date taking Autologous blood, Tzu Chi Stem Cell Center will notify the blood donation center to assist with the collection procedure. Tzu Chi Volunteers (Care Unit) will accompany the donor throughout the process.

Around three weeks prior to the marrow donation date, please contact a nearby blood donation center for the Autologous blood collection. The amount collected will be according to the amount of marrow extracted. Each unit is 250 cc, In general, 500 cc is collected. Donor over 60 kg may collect two units of blood (500 cc) each time; under 60 kg may collect one unit of blood (250 cc) each time.

According to blood donation center’s rule, blood donation intervals must be no less than two months. No blood donations within six months after the completion of body check and bone marrow donation shall be preceded.

If you need to ask for leaves at work or school for Autologous blood collection, Tzu Chi Stem Cells Center can issue a formal letter of proof for the donor asking for leaves.

When arrived at a blood center, the center will evaluate if you fall under their blood donation standard. You will be asked to postpone the collection date if your hemoglobin are not high enough, or have high blood pressure or other problems that need to be rechecked by the doctors.

After the collection, according to regulation, the blood center will run the blood test again. Your blood may be presumed not qualified by the blood center due to some tests are not in standard value(e. g. Liver function tests pass the range). At the same time, blood center has the responsibility to report to authority for any notifiable diseases. For example: HIV.

Although it seldom happens, it’s possible that you being notified the cancellation of marrow donation after completion of the collection, which usually is due to the change of condition of the patient. At such situation, your blood will be donated to other patients.

Must Know List prior to Collection

1. All check ups must be completed.
2. Two weeks before collection, avoid going to public places to prevent any infections.
3. Keep good eating, sleeping and excreting habits.
4. Drink milk daily to replenish calcium.

 

2. Hospitalized for Marrow Donation

Tzu Chi Stem Cells Center will arrange transportation to and from the marrow collection hospital (Tzu Chi Hospital) for donor; Tzu Chi Volunteers (Care Unit) will accompany and take care the donor throughout the whole process.
 Day 1: Hospitalized
  After arriving at the Tzu Chi hospital, the medical personnel will introduce the ward environment and sanitary care. No food intake 8 hours before going into the operating room. According to the hospital’s rule, patient has to get permission from the doctor before leaving the ward.
   
 Day 2: Extracting of bone marrow
  Usually, the time of extracting the marrow will be coordinated with marrow courier’s flight schedule.
1.
Extracting of marrow must be done in the operation room with general anesthesia as a surgical operation; therefore, an agreement must be signed with regards to the anesthesia and its risks. An anesthetist will evaluate donor’s physical condition before deciding the type of anesthesia to use.
2.
Extracting of marrow is done after the general anesthesia (inhalation anesthesia), a needle around the size of a pencil lead is inserted into ilium situated on the side of pelvis (figure on the left) to extract the marrow cells.
3.
When extracting bone marrow, the body is lying faced down, in order to ensure smooth breathing; a soft pipe will be inserted into airway for oxygen.
4.
The amount of marrow extracted is according to the weight of the patient and donor’s marrow density of cells, around 1g per 10 ~ 20 cc. After the operating puncture points are set, around 600 ~ 1,500 cc marrow fluid is extracted (including plasma, differentiated and undifferentiated blood cells, and hematopoietic stem cells) which makes up 2%~5% of total marrow supply of the body (human body can replace the extracted amount of marrow within 4 weeks). When extracting the marrow from the bone marrow cavity the blood cells within are also been drawn out. Losing too much red blood cells can cause donor to have anemia or a low blood pressure, therefore, auotlogous blood are been transfused back into the donor to replace the loss of blood cells during the extraction of the marrow. In the same time, a Physiologic Monitor (Bedside Monitor)is used to monitor the donor to ensure the safety of the donor during bone marrow extraction.
5.
Under normal condition, a healthy person’s blood contains 1.5 ~ 2 × 10^6 of nucleated cells. The standards provided by our center for our patient is as calculated: body weight (kg) × 5 × 10^8, which doesn’t exceed the limit what the donor’s body can bear.
6.
During marrow extraction, there is no need of cutting and sewing procedure, only punctured wounds are left on the skin. After the donor has been anesthetized, normally the wounded area will feel uncomfortable but can be controlled by standard pain killers. Under normal condition, one can be discharge after a day or two to resume normal work. Extracted marrow must be kept within 2~8C (under the request of transplant hospital, it can be kept at room temperature). Bone marrow must be transfused into the patient as soon as possible, usually within 36 hours.
7.
10 cc of bone marrow fluid donated by the donor are been kept to provide different types of CDC and infection of microorganism test. Only under written agreement may the bone marrow fluid be used in medical researches.
8.
The whole process takes approximately 3 ~ 4 hours. This includes sterilization before operation, anesthetization, extracting the bone marrow (during bond marrow extraction, auotlogous blood are been transfused back into the donor ) and observation in the recovering ward. Actual bone marrow extraction takes around half an hour.
9.
After ensuring that you are conscious from anesthesia in the recovering ward and that auotlogous blood transfusion had been completed, you will be sent back to your own ward. It’s necessary to lie flat on the bed for 6 ~ 8 hours so that the wound area can be pressed to prevent from bleeding.
10.
After regain conscious, when swallowing reflection is normal and feeling hungry, try to drink a little water first, if there is no feeling of throwing up, then you can eat as normal.
11.
Within 24 hours, take notice whether the wound is permeated with blood, if it is, please notify medical personnel.
12.
8 hours in bed after the wound has stopped bleeding and not permeated with blood, then gradual off bed activities can be permitted.
   
 Third 3: Discharge
  Overall stay in the hospital is 3~5 days (depending on donor’s recovering condition). Depending on the situation, returning to work or school, resuming daily activities in 1~2 days after extracting the marrow is allowed. Some donors will have sore waists, nauseas, sore throats and other symptoms for a few days, but it will be gone within 1~2 week. To avoid affecting recovering, no intense sports or heavy laboring work shall be done within the two weeks after operation.

After marrow donation, intaking ferrum supplement and folic acid to increase the production of blood is encouraged. This must be taken after meal as it reduces irritating the stomach. No tea, coffee, coke or other caffeine drinks after eating ferrum supplement. To prevent absorption of the medication, heart burn control pill and Tetracycline must not be used. During medication period, please eat fiber rich food to prevent constipation. Green or dark colored soft faeces is normal during medication, it will stop after the medication is stopped.

Discomfort and method to ease the syndromes after marrow donation 1. Within 24 hours after the operation, please take caution whether the wound is permeated with blood. The donor’s extraction wound will be applied with elastic bandage or swab on it. Please lie flat for 6 ~ 8 hours in order to add pressure onto the wound for stopping the bleeding. After 8 hours if there is no permeation of blood, gradual off bed activities are allowed. If blood permeates from the wound, please notify the medical personnel immediately.
2. Wound sore – most donors would not feel the wound sore, but if it happens, please notify the doctor to prescribe pain killers or antibiotics and it will be better within 3 ~ 5 days. Most donors feel the pain at the waist. Each person has a different constitution, a minority of people continuously feel the pain for 30 day.
3. Nauseas – If you are sensitive to anesthetic, after it wears off, you might feel nauseas. After gaining consciousness and feeling hungry, try to drink some water first, if there is no feeling of throwing up, then you can eat normally. If there is severe nauseas, please notify medical personnel, normally it will get better after taking medication.
4. Burning throat – During the extraction of marrow after been anesthetized, soft tube is inserted through the throat to assist you to breathe. Some may feel throat burning or pain, but the condition is only slight. Normally no medication needs to be taken to recover, but may notify medical personnel to check if your throat is burning or sore.
5. Fever - While extracting marrow from the bone cavity, red blood cells are been drawn out too. When red blood cells run low, human body’s immune system will set up defenses, therefore, it may show fever symptoms. If the temperature gets over 38.5o, please notify medical personnel immediately.
6. Dizziness (Giddiness) – After marrow donation, temporary dizziness from short of blood can happen due to the loss of red blood cells, but the symptoms are light. Getting out of bed for the first time after marrow donation must be taken step by step slowly to avoid the feeling of discomfort caused by dizziness. This condition will get better after a few hours of rest.
※If there is any discomfort, please contact us. Tel: 886-3-8561825 Ext: 3518/3519/3216
Fax: 886-3-8574324, E-mail: btcscc@tzuchi.org.tw

 

3. Possible risks during the process of marrow donation

Punctured Wound Pain 1.Punctured wounds – During marrow extraction, there is no need of cutting and sewing operation, only few punctured wounds are left on the skin. The wound must be pressed for 6 ~ 8 hours after the extraction of the bone marrow until the body’s immune system starts functioning, and those wounds will start to heal. If blood permeates within 24 hours, please notify medical personnel immediately. To prevent the wound from infection, the doctor will prescribe antibiotics for at least 3 days.
2.After the anesthesia has worn off, some donors feel a slight pain at the waist, in such situation, pain killers may be taken, and the condition may improve in 3 ~ 5 days.
3.Lower back pain – some donors will feel a lower back pain, this may improve by resting or taking pain killers.

Side Effects of Anesthesia 1. Nauseas, vomiting: Doctor will prescribe medicine when necessary.
2. Sore throat: Caused by the inserted pipe during full body anesthesia, mouth wash can be used and it will improve in a day or two.
3. Fever: This is the normal reaction of the body when the body’s defensive system is working. If necessary, you can take the antibiotics or antipyretics prescribed by the doctor.
4. Temporary slight low blood pressure: As each person’s body situation varies, some may feel feverish, nauseas or dizzy.

 

4. Injuries during marrow donation
The risks of severe injuries caused by the medical process during marrow extracting is very low, but if injuries happened, immediate emergency rescues will be implemented by the transplant hospital and our center as well as support for the later medical care.
Possible side effects include 1.Anesthetic accident During health check up, all unsuitable anesthetic conditions are ruled out, but there are also rare allergic reactions to anesthetic, such as causing temporary fever, allergy reaction or difficulty when urinating.
2.Infections During the process of bone marrow donation, infections may be caused by the apparatus, wound not healing well or improper nursing. If the wound continues to be painful or permeates with blood after the operation, please notify the stem cells center immediately, doctors will prescribe antibiotics when necessary.
3.Collection point pain or numb in the foot This happens quite rarely during the extraction of marrow where bone nerve or other tissue cells are been injured. If this happened, please notify the center to arrange further check-ups.
4. Depression and Self-blame Not every patient that goes through bone marrow transplant will be fully recovered. The precious life of the patient may not be saved by the transplantation due to the complication of the process and his own condition may get worse. Because the marrow transplant result is not predictable, therefore, whether the transplant succeeded or not, there is no need to blame yourself.

Although it is very unlikely to risk one’s life due to extracting marrow, but please take note that it is still possible. When feeling not well after the marrow donation and been treated by the doctor without any improvements, please contact our center’s administration unit immediately(Tel: 886-3-8561825 Ext: 3518/3519/3216 Fax: 886-3-8574324, E-mail: btcscc@tzuchi.org.tw

 

5. Attention List on taking ferrum supplement
(1) Take the supplement after meals to reduce irritation to the stomach.
(2) No tea, coffee, coke or caffeine drinks shall be taken.
(3) Cannot take the supplement with heart burn pill or Tetracycline which may prevent absorption.
(4) Eat high fiber food during medication to prevent constipation.
(5) Green or dark colored soft faeces is normal during medication, it will stop after the medication is stopped.

 

6. Caution List after marrow donation
(1) Take plenty rest at the ward, discharge after been checked by the doctor.
(2) Wound left by the catheter must be kept dry and clean.
(3) Daily intake of rich protein and fiber food such as to-fu and milk.
(4) Quality rest and enough sleep.
(5) Avoid intense sports or heavy laboring work within two weeks after the marrow donation.
(6) No blood donation within half a year of marrow donation.
(7) When feeling not well after the marrow donation and been treated by the doctor without any improvements, please contact our center’s administration unit immediately.

 

7. Stem Cells Donating Process

The table below shows all the steps from blood drive activity , successful matching, Confirmatory Typing Test, health checkups, Autologous blood collection , extracting of bone marrow and the followups afterwards:
Steps
Health Screening
Consent form Signed
Blood Testing
1. Attend blood drive activity
Donor consent
2. Preliminary match
Asking for inclination
3. Donor’s Counseling
4. Confirmatory Typing Test(Ensure the only donor)
CT Consent form
5. Health checkups
Stem Cell Donation Consent form
6. Autologous blood collection
Autologous blood collection consent at the blood center (Signed while doing body checkups)
7. Extracting the bone marrow
General Anesthesia and Operation Consent
8. followup after the donation.
Questionnaire
9. followup after the first month.
Questionnaire
10. followup after the third month.
Questionnaire
11. followup after the sixth month.
Questionnaire
12. Annual followup after the donation.(For three years)
Questionnaire

Update: Oct. 2009

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