Peripheral Stem Cell Harvest

The bone marrow contains stem cells which andevelop into all the different types of cells in theblood.

Information for donors of stem cells

What is peripheral stem cell harvest?

The bone marrow contains stem cells which an develop into all the different types of cells in the blood:

  • Red blood cells which transport oxygen around the body
  • White blood cells, also called leukocytes, and hel pdefend the body against infections
  • Platelets which help stop bleeding

Using a simple method, many of the stem cells can be induced to migrate from the bone marrow and into the blood stream where they can be collected directly from a blood vessel. In order to get the stem cells from the bone marrow out into the blood stream, you will need injections of growth factor. See more about growth factor later in this booklet.

Pre-interview before stem cell harvest

Well before the stem cell harvest you will be invited for a preinterview with a physician and a nurse. The interview will take place at the Stem Cell Section at the Blood Bank, Section 2034. During the interview, you will be briefed about the stem cell harvest procedure and treatment with growth factor.

Preliminary examination before stem cell harvest

You need to undergo a preliminary examination, because we want to make sure that you are healthy. The preliminary examination also takesplace at the Stem Cell Section at the Blood Bank, Section 2034, possibly simultaneously with the pre-interview.

There may be health-related reasons why we do not find you suitable to donate stem cells:

  • Previous or current cancer diseases
  • Previous or current blood clots (cardio-vascular diseases)
  • Severe pulmonary diseases

The medical treatment in peripheral stem cell harvest can also exacerbate autoimmune diseases. Therefore, iif you know you suffer from an autoimmune disease, you will not be suitable to donate stem cells. For example

  • Rheumatoid arthritis or systemic lupus erythematosus
  • Certain chronic intestinal diseases (ulcerative colitis or Crohn’s disease)
  • Eye diseases (iritis, episcleritis)

The preliminary examination normally takes about half a day and includes the following:

  • Interview with a physician
  • Setting up medical records
  • A regular medical examination to check your heart, lungs and blood pressure
  • X-ray image of your lungs
  • CT scan of your lungs if you are older than 55 and have smoked for more than 10 years
  • Electrocardiogram (ECG)
  • Blood samples to make sure that your blood values are normal. Note that according to Danish legislation you will be tested for HIV, syphilis and hepatitis
  • A pregnancy test for women under the age of 50
  • A gynaecological examination of women over the age of 55

The nurse will show you the room where the stem cell harvest is to be carried out and go over the procedure with you.

The nurse will assess your blood vessels on both arms. If your blood vessels are very small, it may be necessary to insert a catheter in a blood vessel in your chest under the collar bone or in the neck. This is a safe procedure, and the catheter will be inserted with local anaesthesia by an experienced anaesthesiologist just before the stem cell harvest.

Treatment with growth factor

Growth factor is a naturally-occurring hormone in the body. It stimulates the production of white blood cells and increases the number of stem cells in the blood stream. Growth factor is given as injections under the skin each morning
between 7.00am and 9.00am and each evening between 7.00pm and 9.00pm for five to six days. The fifth day of growth factor injections will be the first day of the stem cell harvest.

If not enough stem cells have been harvested on the first day, you will have to continue with growth factor treatment on a daily basis. We will instruct you in how to inject yourself or arrange the injections to be given to you either by a homecare nurse or by your own GP. The growth factor injections will be handed to you at the preliminary examination.

Discomfort and risks of growth factor treatment

Growth factor is produced in a laboratory and is almost an exact copy of a naturally-occurring hormone that regulates the bone marrow cells. The dosages given to donors create temporary higher concentrations than normal, which can cause the following side effects:

  • Aching bones
  • Headaches
  • Influenza symptoms (aching muscles, fatigue and very rarely a slight fever)
  • Nausea
  • Insomnia

These symptoms, which are caused by a temporary increase in white blood cells in the blood, will go away within two days after the last growth
factor dosage and can be relieved with paracetamol (Panodil/Pinex), two tablets up to 3-4 times a day.
The number of blood platelets (which help the blood clot) may decrease, but never to critical values and the number will be normalised after 1-2 weeks.

There may be an accumulation of fluids in the tissue. Signs of fluids in the tissue may be swelling around the eyes, of fingers and lower legs. Therefore, you will have to weigh yourself during the treatment. Your weight will be registered in a table which you should hand in on the day of harvest.
In very rare cases, accumulation of fluid can occur in the lungs and in the abdominal cavity.

Similarly, and again very rarely, the spleen can rupture due to growth factor treatment. Only two incidents of ruptured spleen have been recorded since the early 1990s when treatment with growth factor commenced. Symptoms of a ruptured spleen are sudden pain in the stomach or in the left shoulder. You should contact the nearest accident and emergency department immediately if you experience these symptoms.

Long-term side effects of growth factor treatment have not been recorded on healthy people for the 20 years this type of treatment has been carried out.

Peripheral stem cell harvest

Stem cells are harvested over 1-3 days depending on how many stem cells you have in your blood.

You will start at around 8.00am (arranged with the nurse at the preliminary examination) and it is important that you have had something to eat and drink before you arrive. If you need painrelieving medicine, it is important that you
only take Panodil/ Pinex (paracetamol), as other painkillers such as Kodimagnyl, Treo, Ipren and similar can affect the blood platelets.

Through a needle in one of your arms, your blood will be led into a centrifuge which separates the blood. The stem cells are collected in a bag, whereas the red blood cells and the blood plasma is returned to you through a needle in your other arm.

A fluid, citrate, is added to your blood to prevent it from clotting. Citrate binds the calcium molecules in the blood stream, and therefore the calcium content in your blood will fall temporarily. The symptoms are a prickly sensation in the lips. You will be given calcium infusion during the entire stem cell harvest in order to relieve these symptoms.

The stem cell harvest procedure takes about five to six hours. It is a good idea to bring something to read and perhaps a smartphone/tablet or similar so you can listen to music. We have a TV.

You are welcome to bring relatives, and you can eat and drink during the stem cell harvest (we have drinks including coffee/tea).

It is not possible to go to the toilet during the procedure, so it is a good idea to use the toilet before we begin the procedure. Urinals/ bedpans are available if needed.

After the stem cell harvest you may feel tired. About 1-2 hours after the stem cell harvest, you will know if there are enough cells. We advise against that you are driving immediately after the stem cell harvest.

Accommodation

If you live close to Rigshospitalet, you can spend the night at home. If not, we can arrange for you to stay at the Patient Hotel.

Coverage of expenses and lost earnings

In connection with pre-interview, feasibility study and (stem cell) harvest, compensation is granted for:

  • Lost earnings: Please note that there must be pay-slips for 3 months, and calculation of the amount from the employer.
  • Expenses related to transport: Remember to save original tickets / receipts

No compensation is granted for:

  • Meals
  • Taxi service, unless medical reasons from the hospital are available.

See more information about refund in the folder: ”Covering expenses and lost earnings”.

Insurance

As a donor, you will be insured according to the Danish Patient Insurance Act.

Follow-up examination

About one month after the stem cell harvest, we will check that your blood values are normal by taking a blood sample. We can take the blood sample at the department, or your own GP can take the sample, if this is more convenient. We will also ask you to complete the questionnaire you have received and return it to us. This will give us feedback on how you have experienced the process.

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