Information for hematopoietic cell donors

Dear Madam, Dear Sir,

You are a relative of a patient who has been referred for a hematopoietic stem cell transplant (HSCT) as a treatment option for his severe hematopoietic disorder.

Based on the tests performed, your genetic characteristics make you a suitable donor for these hematopoietic cells, which can be obtained from your peripheral blood after stimulation with growth factors (PBSC) or by bone marrow (BM) collection.

For the final selection of a donor, a comprehensive evaluation of your health based on your truthful completion of the attached questionnaire and a medical examination to assess your medical eligibility to donate is required.

Donating hematopoietic cells for your relative is your personal decision and can only be made with your written informed consent! At the time your cells would be donated, the patient will be in the pre-transplantation phase and your refusal to donate at this time, even if it is your right (the donor can refuse to donate hematopoietic cells at any time without giving a reason), could lead to a direct threat to the patient's life!

Please read the following information carefully:

PBSC donation

PBSC donation is preceded by donor preparation at the pre-operative examination level.
Within 30 days prior to the scheduled donation date, the donor will undergo laboratory blood and urine tests, heart and lung x-rays, an EKG, and an examination by an internist to assess their health status.
Blood-forming cells occur naturally mainly in the bone marrow, with only small amounts in the peripheral blood. Therefore, the collection of haematopoietic cells from the peripheral blood is preceded by the administration of the stimulating agent G-CSF (active substance: filgrastim; Neupogen, Zarzio...). The effect of G-CSF is to multiply the haematopoietic cells and wash them into the donor's bloodstream. The donor receives 2 subcutaneous injections of the preparation on four consecutive evenings before the donation. The injections are administered by a healthcare professional or self-administered, if it is not possible to arrange for a healthcare professional to administer the injections, always in the evening (7-8 p.m.). A record is made of each administration of filgrastim.
The actual collection is carried out by a method called separation (apheresis) on a separator apparatus. It is carried out on an outpatient basis, without anaesthesia, in the Apheresis Department of the Institute of Haematology and Blood Transfusion,
U Nemocnice 1, Prague 2.
During the actual collection, the donor lies on a couch and is "connected" to the separator by the elbow veins of both arms. From one vein, the donor's blood is drained into a machine that removes the necessary cells. The other vein is then used to return the cell-free blood to the donor's circulation. This cycle is repeated several times during the donation. In the case where peripheral vein collection is not possible, a central venous catheter (CVC) must be used to 'connect' to the machine.
- These are cases where the donor does not have suitable veins - i.e. veins that are too fragile, thin or deep in the elbow. The femoral or subclavian vein is most commonly used for catheter insertion. The catheter insertion site is disinfected and locally anaesthetised. A punctal needle is inserted into the vein and the catheter is inserted into the central venous system, which is performed while the patient is in the inpatient ward of the IHBT the day before separation. The donor is then connected to the separator using this catheter and the harvest is completely painless.
- The physician will verify whether a CJC is necessary during the outpatient examination and will pass the information on to the Apheresis Department. Further details of this procedure and any risks are given to the donor in preparation for the donation (approximately 14 days before the donation). In this case, the donor must sign a separate informed consent for the insertion of the CJC.
The PBSC collection itself takes approximately 4 hours. Once the collection is complete, the laboratory will determine the number of cells collected and compare the result to the TC requirement (derived from the patient's weight). If there are not enough cells, the donor may be asked for a second additional collection the following day. The donor is then injected with a fifth and final dose of G-CSF the evening before the additional collection.

Possible risks and complications during G-CSF stimulation

During G-CSF stimulation, donors may experience flu-like symptoms (headache, muscle and joint pain, nausea, slightly raised temperature, fatigue, difficulty sleeping). Medications containing paracetamol (Paralen, Paramax) are suitable for controlling 'flu-like' symptoms during stimulation.
Less often, an allergic reaction to a given drug, rash, acceleration of heartbeat and breathing, dizziness may occur.
The risk of serious complications such as severe allergic reaction, heart rhythm disturbances, thrombosis, embolism, bleeding cannot be completely excluded.
During the administration of G-CSF, as a result of stimulation of hematopoiesis, congestion of internal organs, enlargement of the spleen occurs.
A very rare complication of G-CSF administration could be rupture (rupture) of the spleen due to engorgement. Therefore, the donor should avoid increased physical activity to minimize the risk of injury. Engorgement of internal organs disappears within a few days after separation.
Based on follow-up of healthy individuals who have received G-CSF (filgrastim), no long-term risks associated with the use of this agent have been demonstrated to date.
During separation, a certain amount of the donor's blood is always outside the donor's bloodstream (separation kit, separator). This may cause the donor to feel cold, weak, transient lowering of blood pressure, nausea, fatigue. The donor may experience tingling in the tongue area, around the mouth or on the fingertips, which is caused by a transient drop in blood calcium due to the addition of the anti-clotting solution in the device. This discomfort can be corrected by a minor change in the separation conditions. The nurse or doctor performing the separation should therefore be informed in good time of any difficulties.
A haematoma may occur at the site of the needle insertion for connection to the separator.
The risk of infection is minimal due to the use of disposable sets.
After the donation, the donor may experience a slight drop in the platelet count, which will correct itself within a few days.

Bone marrow donation

Bone marrow donation is preceded by preparation of the donor at the pre-operative examination level.
Within 30 days before the scheduled donation date, the donor will undergo laboratory blood and urine tests, X-rays of the heart, lungs and pelvis, an ECG and an examination by an internist to assess his/her health. The preparation also includes the collection of one autotransfusion unit of blood in the blood transfusion department of the donor centre.
The actual collection is carried out in the surgical theatre under general anaesthesia, the procedure takes on average one hour. A puncture needle is used to extract the necessary amount of bone marrow hematopoietic cells from the pelvic bones together with the blood. The volume of graft to be removed is determined by the weight of the patient, but cannot exceed the limit set by the weight of the donor (20 ml/kg; a maximum of 1500 ml is removed). The blood loss is replenished to the donor during/after the procedure with a pre-collected autotransfusion unit. The healthy organism will replenish the removed hematopoietic cells by natural regeneration.
Hospitalization of the donor in the inpatient ward of the donor center lasts a total of 3 days.
Before discharge, arrangements are made for the donor to undergo the necessary checks.

Possible risks and complications of bone marrow donation

The most common problems reported by donors in connection with the procedure are pain in the lumbar region, fatigue, difficulty walking, bleeding (haematoma) at the wound site. The intensity and duration of these problems vary greatly from donor to donor. Most of them report a full return to normal activities within 2-3 weeks.
After bone marrow harvesting, it is sometimes necessary to take pain control medication. Suitable preparations are Ibalgin, Ibuprofen.
After bone marrow removal, the donor may have discomfort due to general anaesthesia, stomach upset to vomiting, sore throat when swallowing, slight confusion.
The risk of serious complications, such as damage to the teeth, infection at the site of harvesting, venous thrombosis, embolism, allergic reactions to the drugs administered, cannot be completely excluded.
General anaesthesia may, in exceptional cases, be associated with serious complications which may result in death (reported incidence of 1 in 7 000 - 200 000 in healthy individuals).

Please note the following warnings:

During G-CSF stimulation, 2 days prior to KD collection and 14 days after PBSC or KD collection, the donor must not take drugs containing acetylsalicylic acid (Acylpyrine, Acylcoffin, Anopyrine, Aspirin, Godasal, Upsarin, etc.). These products reduce blood clotting.
Women during pregnancy cannot undergo stimulation and donate hematopoietic cells. Therefore, it is important to follow the principles of pregnancy prevention during the period of preparation for donation. The pre-sampling examination includes a pregnancy test. Any suspicion of a possible pregnancy should be reported immediately.
The recipient of hematopoietic cells is in the preparation phase about 14 days before the scheduled transplant date. If the transplant does not take place, the patient's life will be in immediate danger. It is therefore important that the donor avoids the risk of injury or infectious disease and protects his/her health.
The donation of hematopoietic cells is a burden on the donor's body. The need for recovery after the donation and possible limitations should be taken into account. Donors can expect to return to work, school and normal activities after PBSC donation within 1-3 days, depending on the physical demands of these activities. Most peripheral blood stem cell donors feel fully recovered within 1-2 weeks after donation, and after bone marrow donation, donors can expect to return to normal activities within 3-7 days, depending on the physical demands of these activities. Most bone marrow donors feel fully recovered within 2-3 weeks after donation.
If the number of hematopoietic cells in the harvested graft is too low compared to the TC requirement, the donor may be asked to repeat the donation - donate KD at the earliest one month after PBSC collection or donate PBSC at the earliest one month after bone marrow collection. In this case, the donor's current status and consent to a second donation will determine the next course of action.

Follow-up after the donor procedure

Donors are followed up for a long time after the hematopoietic cell donation. Regular blood count checks are carried out during the first week after donation, three times during the first year and then once a year for ten years, can be carried out by a general practitioner and the results sent to the IHBT.

Leave of absence with pay

For time off work to undergo a medical examination, a certificate will be issued to the donor. A certificate will be issued in accordance with Section 203(2)(d) and (e) of Act No 262/2006 Coll., the Labour Code, for time off for the actual collection of haematopoietic cells. On the basis of the Registry's confirmation, the donor is entitled to paid leave with full payment of wages for up to 96 hours.

Note: In very rare cases, the patient's condition may deteriorate rapidly immediately before the planned transplantation and the harvested haematopoietic cells cannot be used for transplantation. In this case, the graft may be used for scientific purposes if the donor has given his/her consent. If the donor does not consent or the graft cannot be used for research, it will be disposed of safely in accordance with applicable laws.

Booking potential donor relatives for testing:

Hana Vobrová General Nurse

MON + TUE 6:30-15:00

THU + FRI 6:30-15:00

+420 608 747 624

E-mail: Hana.Vobrova@uhkt.cz

Substitute:

Olga Dostálová, DiS general nurse

MON - FRI 6:30-15:00

Tel: +420 608 747 624

221 977 708

E-mail: Olga.Dostalova@uhkt.cz