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Friday, 13 July 2007

Bone Marrow Part 3: The Donation

(This is the second in a three part series that chronicles the experience of donating bone marrow. Click here for Part 1 and Part 2. Part 4.)

Day 35 - Collection 5:30AM

The day began with a 5:30am wakeup call. Yet it had been hard to get to sleep knowing what was happening today. It didn't really feel like a lot of sleep with the
combination of the bone pain, the unfamiliar bed … we got ready and headed to the hospital.

7:00AM
The day started off rather slowly; we reported to the Apheresis Unit in the Blood Diseases ward. The registered nurse (RN) who would oversee the day's activities, had to verify
that some of my answers to the health questionnaires, from earlier in the procedures, had not changed. After that, a line was inserted into a vein in my left arm. Blood samples were collected and the RN then walked the samples down to the lab in the hospital. (She stated that she gets quicker results if she transports them and waits for the results.) Grant and I were free to await her or to go grab something to eat. Since we had already had breakfast on the way, we set up Battle Star Galactica (BSG) on the DVD player in the room.

9:00AM
After the RN returned, she programmed the centrifuge machine, based upon the results of the samples, to the specific characteristics of my blood that day. Once the
machine was configured and prepared, we began the preparation on me. I was informed that our blood usually has about 3% of stem cells, after taking the injections of granulocyte colony stimulating factor (G-CSF). My blood was running around 20% based on the tested sample. Now a second, much larger needle, was inserted into a second vein in the left arm. This needle, unlike the flexible ones used for IV drips or for the return line, is a steel needle. From this point on I was not allowed to bend my arm until we had finished for the day and all the lines were removed. If I had bent this arm the needle would have sliced through the vein and we would have had to set up on a different vein somewhere else in my body. This line was used to draw the blood out of the body. It was mixed with Anticoagulant Citrate Dextros Solution (ACD) to prevent it from clotting and clogging up the centrifuge machine. Then it was run through the centrifuge. This machine spins the blood and separates it into the different components based on size. Every so often the machine would slip some of the cells it wanted out of the lines and collect it in a separate compartment.

It was now time to sit back and wait. The goal was to let the machine run until 4 pm. Then Grant and I would be free to return to the hotel for the night, and if we did not get a call, we had to be back the next day at 7 am again.


So we watched the mini-series that launched BSG, and the first disk of episodes from season one. It was hard to concentrate and focus on the movies; all I could really think about was the recipient, and wondering how that person was doing, where was he or she, and had the treatments gone well? What was he or she doing this day in preparation of receiving the PBSC's? Grant's role at the hospital was varied; he was part gopher, part emotional support and part assistant. Grant went across the street to Tim Horton's and grabbed my extra large double double, a large iced capp for the RN, and a small coffee for himself. At lunchtime Grant, again in his role as gopher, ended up going to a Williams Coffee Pub and grabbed lunch for him and me.

1:45PM
The ACD actually strips calcium from yo
ur blood to help prevent it from clotting. By early afternoon, I was starting to feel the side effects of this - a little tingling in my lips and fingers and toes. First we tried to treat this with some calcium from TUMS and Usana's Optimizer Active Calcium Chewable. This helped hold it off for a few hours, but finally I asked for the drip. A 3rd needle was now inserted into the back of my right hand to run a Calcium Gluconate drip. We started this around 1:45 pm, and very quickly the tingling in my lips and face subsided.

However, from not moving my left arm most of the day, it was now numb and tingling. My legs were also a little tingly from not being able to get up or stretch out at all. I was, by this time, getting very fidgety and constantly changing my leg positions. Grant again went to get supplies. He grabbed juices for both of us and a stress ball for me to use in my left arm. It really helped me get through to the end of the day.

2:00PM
Grant and I were informed that it had gone very well today. The RN expected us to be done by 4pm and ready to go by 4:30pm. Thus, we were ahead of schedule. We had filtered about 20L of blood; based upon my size, that is my total
blood volume by about three and-a-half times. Out of those 20L only 200ml had been removed as the collected substances. The RN even informed us that she had reduced the rate of extraction for the last hour.

It was very overwhelming to see this bag with such a little volume of material in it and know that that was all that was removed during the day. There was the wonder if it was enough or would we be back tomorrow. Would it help the recipient? These and many other questions ran through my mind again and again.

3:00PM
It was time to start wrapping things up. The RN began taking the lines out. First the draw line was stopped and back-flushed with saline to clean the line and prevent a blood clot from forming. Then it was removed and the RN applied pressure for at least 5 minutes. Then while maintaining pressure on this spot, she prepared and removed the return line. She was holding both tight till she wrapped the whole arm in gauze. Next she removed the IV drip line from the right hand. I was informed it looks like a good volume and that if
we do not hear from the nurse by 9:30pm we are to come back for a second day of extractions.

4:30PM
Grant and I returned to the hotel. I immediately took a nap. We went out for supper to a nice Irish pub.

7:00PM
Grant and I received voice mail from the RN stating that they had actually harvested twice the requested amount of stem cell count. I could go have a drink and celebrate.

I had to stay in town for 24 hours in case there were complications or any reactions, so that if needed I could go back to the hospital and the ward where the bone marrow
- peripheral blood stem cells were extracted.

What Happens After:
I am on hold specifically for this patient for one year from the date of donation. I
cannot donate blood during that time, and my profile in the International Blood Donor Registry is pulled and on hold so that I do not match another person. This is in case the recipient is in need of a top-up of stem cells or bone marrow and I can help by donating again. What happens during and/or after that year?

Well that depends on the recipient and the overseeing body for the recipient. In Canada, that is Canadian Blood Services (CBS) through the Unrelated Bone Marrow Donor Registry (UBMDR), and after 3 months, I can find out how the patient is responding to treatment. At 6 months we can exchange letters with no personal information. At one year, if both recipient and donor want to, the CBS will make arrangements for them to meet.

It amazed me the number of people involved to help make this happen. There are doctors and nurses at both the collection and requesting hospitals, who live and work with this day in and day out. Then there are CBS coordinators at both the National and regional levels, who oversee the procedure for the donors after a match is found. Much care and attention is given to donors by the members of the CBS, to make sure the experience is the best possible for them.

Having gone through all of this, would I do it again? Yes, there is no doubt. To be uncomfortable for about a week for the chance to possibly save someone's life - well, there would be no hesitation on my part. I would also encourage anyone in good health and in the age range, to be a bone marrow donor, to check out the information on www.blood.ca and consider joining the registry. Also tell others about the registry and how easy it could be for you to change someone's life. Even if you find out you cannot be a donor, help to inform others about the registry. The more people we can get on the UBMDR, the more lives we can help to transform.

(Part 1 can be read here. Part 2 can be read here.)
(First Published in Imprint 2007-07-13 as 'Saving a life: making the donation.')

Note: In the United States of America the National Marrow Donor Program can be contacted at 612-627-5802 or on the web at www.NMDP.org for those who have asked for the information.

[Note: The UBMDR has been renamed One Match.]
Part 1 - There's more than blood in you to give
Part 2 - The Callback

Part 3- The Donation

Part 4- The Followup

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