Apheresis for Stem Cell Collection
Apheresis for stem cell collection is a procedure to collect stem cells from blood in the veins (peripheral blood) as part of peripheral blood stem cell (PBSC) collection.
Steps of peripheral blood stem cell collection include:
- Health screening and blood tests
- Medicine to move more stem cells into the blood (mobilization)
- Stem cell collection from blood through a vein (apheresis)
To collect the stem cells, an apheresis machine takes blood from a vein and separates it into components (plasma, platelets, white blood cells, and red blood cells). The stem cells are removed from the blood and stored for later use. The rest of the blood is returned to the body through a vein. Only a small amount of blood is out of the body at any time.
This process may also be called PBSC collection, stem cell donation, or stem cell harvest.
How are stem cells used for transplant?
Stem cells (also called progenitor cells or hematopoietic stem cells) are cells that can develop into other types of cells, such as blood cells. Stem cells for transplant can come from the blood (apheresis) or the bone marrow (bone marrow harvest).
Stem cells can come from the patient or a donor, a person who donates stem cells to a patient who needs a transplant.
Getting ready for stem cell collection
Screening exam and blood tests
Before stem cell collection, the donor – either the patient or another person - will have a physical exam and blood tests to make sure it is safe to proceed. These tests check for overall health and screen for infections. This step is important because transplant patients have weakened immune systems and cannot fight infections well.
Lab tests: Blood tests may be performed to measure different parts of the blood and check blood cell counts. If blood counts are low, a blood transfusion might be needed before apheresis begins.
Tests for infectious disease: Lab tests will also look for certain infectious diseases such as hepatitis B and C virus, human T cell lymphotropic virus (HTLV-I/II), syphilis, West Nile virus, and human immunodeficiency virus (HIV). You will be notified if test results indicate an infectious disease.
Medicine to increase stem cells (mobilization)
A medicine, called a growth factor, is given to help move stem cells from the bone marrow into the blood. This process is called mobilization.
More than one growth factor medicine may be given. It is usually given as an injection (shot) once a day for a few days. Females of childbearing age must have a pregnancy test before taking growth factors.
Growth factor side effects: Most side effects are mild and go away soon after the injections stop. Possible side effects include:
- Fatigue (feeling tired)
- Insomnia (trouble sleeping)
- Headache
- Low-grade fever
- Bone and joint pain
- Chills
- Mild nausea and vomiting
The care team may give acetaminophen (Tylenol®) or other medicines to help with symptoms. In some cases, more serious side effects can occur. Contact your care team or seek medical help if symptoms do not improve, worsen, or are severe.
What to expect during apheresis
Apheresis takes 3 to 8 hours per day. Several sessions may be needed to collect enough of the cells. If more than 1 session is needed, apheresis is usually done once a day. Staff will explain what to expect and answer any questions.
You will be in bed during the apheresis procedure. Wear comfortable, loose-fitting clothing. During the procedure you can rest, watch a movie, read, or do other quiet activities in bed.
Because you will have tubes attached to the apheresis machine, you will not be able to leave the room once the procedure has started. Portable toilet equipment will be provided if needed.
An apheresis nurse will stay at the bedside to monitor for any reactions or problems.
Vein access for apheresis
The procedure is usually done with 2 lines (double needle procedure). The medical team will decide the best way to place the lines based on vein size and the number of treatments needed.
Types of vein access include:
The medical team will take steps to reduce the risk of infection. All tubes that touch the blood are sterile (free from germs) and are only used once.
Stem cell collection
An apheresis machine takes the blood and separates the stem cells from other types of blood cells. The stem cells are collected in a sterile bag. The remainder of the blood is returned to the body.
Citrate is used to keep blood from clotting in the apheresis machine. Calcium is also given to help prevent reactions to citrate.
If red blood cell counts are low or the patient or donor is of a smaller size, staff might need to add donated blood to the apheresis machine’s tubing before starting the procedure. This helps make sure that the red blood cell count does not become too low.
Side effects of apheresis are similar to donating blood. The most common side effects are:
- Nausea
- Dizziness
- Fainting
- Pain or bruising at the site
Some people may have side effects due to the citrate. These include:
- Muscle cramps
- Numbness
- Feeling cold
- Tingling sensations
- Anxiety
- Strange or metallic taste in the mouth
- Seizures (in rare cases)
Medication reminders for stem cell donors
Certain medicines may increase your risk of bleeding. Before and after apheresis, it is important that you avoid certain medicines.
- Aspirin and NSAIDs: Do not take aspirin, medicines that contain aspirin, or pain relievers like ibuprofen (NSAIDs) while receiving growth factor injections and for 2 weeks after stem cell collection unless your health care provider says it’s safe.
- Blood thinners: Discuss any blood thinners or anticoagulants that you currently take with your doctor to know when these medicines may be stopped before stem cell collection.
- Blood pressure medicines: Talk to your health care provider about blood pressure medicines such as angiotensin-converting enzyme (ACE) inhibitors. They may recommend temporarily stopping this medicine to help prevent low blood pressure during the procedure. Examples of ACE inhibitors include:
- Benazepril (Lotensin)
- Captopril (Capoten)
- Enalapril (Vasotec, Epaned)
- Fosinopril (Monopril)
- Lisinopril (Zestril, Prinivil)
- Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
Let your care team know about all medicines you take. Always check with a health care provider before changing any medications during this time.
When to seek emergency help
Talk to your care team about what side effects to expect and ways to help manage them if they occur.
There is always the risk of very rare or unknown side effects before or after stem cell collection. If you notice any severe side effects listed below, unusual feelings, or discomfort during mobilization or apheresis, tell a nurse or a doctor right away.
Get medical help right away if you have any of the following symptoms:
- Fever of 100.4°F (38°C) or higher
- Severe headache or vision changes
- Chest pain or shortness of breath
- Confusion or trouble speaking
- Dizziness or fainting
- Severe pain or pain that does not get better
- Nausea or vomiting that will not stop
- Swelling in one or both legs
- Signs of an allergic reaction, such as facial swelling or trouble breathing
Your care team may give you a patient wallet card with information about the possible side effects of stem cell mobilization and apheresis. Keep this card with you as instructed.
Always follow the instructions given by your care team. Let all health care providers know that you are a stem cell donor. Please talk to your health care provider or apheresis staff if you have questions.
Questions to ask your care team
- How does peripheral blood stem cell collection work?
- What are the risks of stem cell collection and apheresis?
- How should I prepare for donating stem cells?
- What medicines should I avoid before or after apheresis?
- How long does stem cell collection take?
- What side effects should I watch for?
- When can I go back to normal activities after apheresis?
- What symptoms mean I should seek emergency medical care?
Key points about stem cell collection
- Apheresis for stem cell collection is a process to harvest or collect stem cells from blood in the veins (peripheral blood).
- Stem cells for transplant may be collected from the patient or a donor.
- Medicines called growth factors are given to help move more stem cells from the bone marrow into the bloodstream. This is called mobilization.
- Stem cells are collected from the blood using a procedure called apheresis.
- Most side effects of apheresis collection are mild and go away soon after collection.
- Get medical help right away if symptoms are severe or get worse.
- Talk to your care team if you have questions or concerns about stem cell collection.
