The actual PBSC collection!

18 Oct

Today was the day of my stem cell collection!

I arrived at the hospital at 8:30 AM and walked up to the now-familiar infusion center (with my dad, who kindly agreed to sit around and keep me company during the collection). My doctor spotted us on the way in and pointed me to a bed, which looked way cushier than the very hospital-ish (whatever that means) green vinyl chairs which I’d been seated in for all of my Neupogen shots. Since all the action was happening only in my arms, there was no changing into a hospital gown, which I appreciated. We got the last Neupogen injection taken care of, and I was ready to go! Well, almost. They kindly reminded me that I’d be attached to the apheresis machine for about four hours, so unless I wanted the full bedpan experience, I’d better make sure to stop by the restroom.

How it goes:

Before they stuck any needles in me, my doctor and the infusion center nurses explained how the whole procedure worked. I would have a larger, rigid needle in one arm, attached to the “out” tube taking my blood to the apheresis machine, and a smaller flexible one in my right arm, putting the blood back in once the machine had taken out some stem cells. In between the in and out, my blood would be mixed with anticoagulant so it didn’t clot outside my body, it would be spun by the apheresis machine so that the different cells and plasma would separate into layers, the white cell/stem cell layer would be collected by the machine (at about 50% efficiency, so I’d still have plenty), and then everything would be mixed back together to go to the “in” tube, supplemented with a little calcium to counteract calcium deficiency caused by the anticoagulant. This would happen continuously for about four hours, cycling all the blood in me through the machine more than twice!

For the purposes of preserving the anonymity of my recipient and myself, I couldn’t take pictures of myself hooked up to my apheresis machine, but the machine looked like this.

apheresis machine!

All that tubing is actually one closed unit, so that my blood never comes into contact with the machine. Thank goodness for smart nurses and the helpful color-coded diagram for linking up the tubes! The bags hanging at the top would include one for the anticoagulant, which is what you can see in the picture, plus one for my stem cells, and one for a little plasma they collect to freeze the cells in if they need to store some for later (most will not be frozen and will be given to my recipient within a day or two).

How it went:

Having learned all I ever needed to know about apheresis, it was time for the jabs. The smaller “in” needle went in first. Normally they can put this one in the forearm so that this arm has a little mobility, but they couldn’t find an easily-visible vein in my forearm, so it had to go into the crook of my elbow. It felt about like all of the blood draws I’d done so far. The pain continued after the needle was in, but faded away in about half a minute. The “out” needle hurt enough that I gasped involuntarily, but this pain also faded away fairly quickly. The tubes were all taped down to my arms and, after a little blood was drawn off to check my cell levels, the machine was switched on. The tubes in the machine start out filled with what I imagine is some sort of saline solution so that there is no air in the system. As the machine starts, the harmless solutions goes through the system into the “in” tube, while the blood from the “out” tube takes its place. I watched the tubes slowly turn from clear to red, and eventually the stem cell bag started to fill. My doctor said the machine could filter out about 1 cc (cubic centimeter) of stem cells every minute, and we were shooting for a little over 200 ccs, so it would be about four hours.

The first hour was actually a lot of fun, since so much was going on. My doctor, nurse, and observing medical student were gathered around while the results of my day-of blood cell counts came in. My white blood cell count had increased eightfold since before I started Neupogen, and my stem cell levels were good (yay!). I was offered warm blankets (since the blood isn’t heated before it comes back in) and briefly experienced the slight tingling in my nose and lips that is caused by the anticoagulant before the calcium counteracts it. My contact at the NMDP was also there to wrap up my final Neupogen side effects survey, and remind me that she would keep in touch to make sure I was in good shape a couple days, a week, a month, and six months after the Neupogen experience.

The second hour was a little more relaxed, and I mostly talked with my dad about the news of the day and watched the stem cell volume readout on the machine slowly increase. Around the two hour mark, my “out” vein decided to start misbehaving, which in the context of apheresis means that it started to spasm around the needle. This didn’t hurt at all (it’s sort of a fluttering feeling just at the needle site), but it decreased the pressure of the blood going into the tube, so the machine beeped at me and paused its pumping. This is a pretty typical occurrence when the donor’s veins are small, so it was nothing to worry about, but it would prevent the apheresis from continuing. We tried a number of things to keep the pressure in that vein up, including squeezing a stress ball every now and then, moving the needle in the vein a bit, and putting a rubber tourniquet on, but these only helped temporarily, so the needle had to be put in a new vein. Obviously, I wasn’t thrilled, but it was a quick change, and it would be worth it if that machine would stop beeping and stopping.

After the needle move, the apheresis went smoothly, without even one more beep. The hours felt longer without all the excitement, but I talked to my dad, watched some of a movie, and filled my mom in on all the events of the day when they switched shifts sitting with me. Let me say it now, stem cell donation is totally possible on your own — the doctors are great and everyone is really kind — but it is infinitely nicer to have someone who actually knows you to talk to and to watch out for you during the process. A good friend or family member or two are highly recommended by peripheralblogstemcells for an ideal PBSC donation experience.

By the last twenty minutes or so of apheresis, I was well ready to be done. I had read in another donor’s blog that it was advisable not to drink too much fluid morning-of, advice that I followed, but that didn’t stop the half-liter of anticoagulant from taxing my bladder after four hours. On top of that, my “out” arm, which had had to stay straight the whole time was starting to ache in a way that was tolerable, but made the minutes creep. The minutes did eventually pass, and I felt liberated when the nurse came to take my needles out.

The “out” line could be removed immediately, and it hurt a bit, but it felt so good to be able to move my arm, it really didn’t matter. The “in” line had to stay in a while, because the machine still had a bunch of my blood in it, and I needed that stuff back. The machine returns the blood by running clean fluid through to push the blood back into my “in” arm without taking any more out of my “out” arm. This only took a few minutes, then the last needle was out and I was free! Since I didn’t actually lose any blood, I didn’t have any lightheadedness from trying to get up, but I took it slowly and sat up drinking a kindly-offered and enthusiastically-received cup of chocolate milk before I tried walking around.  Once I was pretty sure my legs still worked after being still for so long, I used them to get to the bathroom speedily, so I could actually focus on the wrap-up my doctor was giving me.

After a little explanation of how the cells would be given to my recipient, and a thanks for my good deed, I was all set to go. I headed home, took a little nap, and wrote this. As far as the donation goes, my work is done. The NMDP will follow up with me for a little while to make sure the Neupogen wears off well, and will contact me in a month to a month and a half to let me know how my recipient does. At the same time, I will follow up with you! In the next few days, I’ll keep track of when the Neupogen side effects disappear and any feelings I have about the donation process from the other side of it. Hopefully in a little while, I’ll be able to pass on some good news about my recipient, though I know the chances for people who have reached the stem cell transplant stage are not great.

I can say right now, there was not one moment that I regretted deciding to be a PBSC donor. The little discomfort during the tests and the collection felt like nothing compared to the good I know I’m doing by giving my recipient hope, even if the transplant doesn’t work out. If you are healthy and able, please think about becoming a potential donor, and if you believe that you could go through with the process if chosen, join the Be The Match Registry.





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