I donated my bone marrow on behalf of my sibling, who is diagnosed with Cutaneous Gamma/Delta T-Cell Lymphoma, a rare strain of cancer that tends to be highly aggressive. The whole donation was made at the Dana Farber Cancer Institute. I was born in Poland, I am ineligible to donate due to MCD or mad cow disease risk. But I was able under advisement from the doctor.
Being a donor for a match is free.
Timeline:
Match Kit: Sent around July 2021
Evaluation Visit: January 31st. About 5.5-hour visit.
Granix daily Injections: February 18th — February 22nd.
Collection Day: February 22nd. From 730AM to 6 PM.
Pre- Donation:
The team at Dana Farber contacted me and gave me an introduction on being a donor [ you may email or text Dana to join]. I gave them my personal information to send me a saliva swab kit to see if I was a match. They give you all instructions inside the package and a return envelope. After sending it back, they gave me a call after a week or so, letting me know I was a match. The next step was a planned visit to the institute to get clearance to donate.
Visit and week after:
I drove up to Dana Farber and met with the donation facility’s coordinator, clinicians, and nurses. They try to get you there early as possible. The duration of the visit lasted about 5.5 hours. During the time, I completed a physical evaluation, blood work [for testing], did a chest x-ray [due to smoking weed], signed release forms/ documents, and a vein assessment.
If I had inadequate access from my veins, they would need to install a central line before the collection; Which I didn’t need.
While chatting with the Clinician, I asked about the Peripheral blood stem cell method vs. the surgical route [bone marrow method]. The Clinician stated multiple factors:
- Due to covid, they’re limiting their surgical rooms for emergencies.
- It’s not an invasive procedure while the surgical route is.
- It all depends on the doctor overseeing the case. The two methods for donating have differential results on the final product or collection.
They gave me instructions for the week prior and post donating. I also received Claritin pills from their pharmacy. I was directed to start taking the prescription three days before the first injection of the Granix [which I will get into later]. Since the Claritin is an antihistamine, it helps with bone ache throughout the time I’m receiving the injections.
The coordinator called me about scheduling, timing, and hotel accommodations a week after the visit.
Dana Farber paid for the room stay.
Side note: If you are struggling financially, Dana can provide you with assistance like free parking at the Dana Farber parking lot and a 250$ gift card for gas or groceries. It depends on your yearly income.
PERSONAL OPINION: Lowball your income to get this incentive. Assume that the financial assistance caps at 30k. It’s an institution with millions of dollars in backing + as I’m writing this [14/3/22], Dana — Farber’s board members haven’t agreed to union nurse contract proposals. It’s been more than a year. Their playing a waiting game to get the lowest number due to the fatigue, the frustration of negotiating at the nurse’s expense, + the billing to cancer patients is outrageous, but that is more of a systemic issue.
Injections
In my medical evaluation visit, the Clinician spoke about daily injections of Granix [tbo-filgrastim] five days leading to the collection day. The dosage of the injections is a combination of 480 mcg/0.8 ml and 300 mcg/0.8 ml.
The Granix increases blood cell count. The abundant amount of blood cells gets stored in the pancreas. Your pancreas can expand during the daily injections—one of the reasons why they say no excessive exercise or heavy lifting.
I had the option to either do self-injections at home or take them to their clinic. I decided to get the daily injections at their institute. I figured it would be much easier to stay in Boston and not drive back and forth. They are side effects from these injections. Tiredness, nausea, bone pain [especually lower back], flu-like symptoms, fever, muscle aches, irritation where the injection was. There are probably more, but these are the most common. Just a reminder that each person experiences the side effects differently. My experience may be different than yours. For me, the first three injections felt fine. I didn’t notice anything up until the night of. I started to feel minor bone pain around my lower back; my temperature went up, even though it didn’t. Morning of the 4th injection day, as I was driving up to the institute, I felt sensations from the bumps on the road and was feeling a bit tired. The night of it was uncomfortable sleeping due to lower back pain, so I took every single hotel pillow in the room to support my back. I did fall asleep. I also did some light stretching and soaked in the bath for 20 minutes to relax my muscles. I feel like it helped. The last injection was on the collection day.
Apheresis Machine:
This is the machine that will process the donation. The nurse mentioned it’s about 40% accurate collecting the product[thats what nurses call it, but it means a collection of the specific blood cells]. It will beep a lot in the beginning. But once the nurse adjusts the flow from the lines, the beeping goes down. For example, when I stood up and had my right arm down, the machine triggered a blood flow warning. The nurse periodically checks the collection or product bag to see if there are clumps in the product bag. The noise from the machine creates two sounds that are layered. The background noise sounds like an old film strip, while on top layer sounds like a car signal or a metronome. The coil you see on the image heats up the return line.
A pdf from W.H.O about the machine for more information. https://www.who.int/medical_devices/innovation/hospt_equip_3.pdf
Collection day:
I got to Dana’s donor clinic around 730AM. Meet my nurse for the day, Great fellow: history/ architecture buff, insightful talks on the pandemic, nursing shortages, unionization. He guided me throughout the whole time I was there. I sat on a recliner during the duration. My right arm was the access arm [donor’s blood flowing into apheresis machine]. This arm needed to have minimal motion… pretty much no bending of the arm. This arm was covered with a heating pad most of the time.
Side note: the nurse did have to change the access from the first insert due to the blood flowing poorly. On the apheresis machine screen, there is an indication of how fast or slow the blood flows through the line. Another sign that I should have spoken up and didn’t was that the access needle felt uncomfortable. Once he found another vein to use, it felt much more comfortable.
My left arm was the return arm [rest of donors blood entering back into donors body]. I was able to move it but still had limits. The return needle was on my wrist above my thumb. Sadly, since the start of the collection, you cannot use the restroom. The nurse gave me a pee-type bottle or could bring a bedside commode [portable seating toilet pan]. I’m pee shy, so I just held it throughout the eight hours. The last four minutes felt like my kidney was going to explode. I counted down the seconds to the end so I could use a restroom. You get a lot of fluid from a drip bag. It’s an anticoagulant citrate dextrose solution USP [acd] solution A. I used about 1.5 of 750ml bags and four 250ml bags combined. The packs help the blood not get coagulated[ blood changing from liquid to jelly] when flowing in the line back to your body. I was able to stand up from the chair and stretch my legs within proximity of a 1-meter boundary due to the cables running to the apheresis machine. One condition is maintaining a straight access arm. No bending at all. Breakfast and lunch were provided. Hospital food from the cafeteria, whatever they had. Which was nice.
After inserting the access and return needle, they check your vitals and draw blood to get results. While waiting on lab results, the nurse preps everything. The nurse places the peripheral intravenous line on both arms. I also got another injection of granix. At the initial checkup [January 31st], my WBC was 4.50 K/uL; the typical range is 4.00 to 10.00 k/ul. On the collection day the number 27.69 K/uL [feb 22]. The PA came, and we talked about how they were worried that I might not hit the minimum count after 6 hours and mentioned I might have to come back the next day.
The count is calculated.
The outcome from the formula is placed into the machine.
Here are two links about the formula: https://www.sciencedirect.com/science/article/pii/S2531137919300999
https://pubmed.ncbi.nlm.nih.gov/9337061/
The max time that a donor can be on the machine is eight hours. They gave me a choice to stay eight hours or stop after six. I decided to stick around the entire eight hours.
The nurse mentioned that the target count has a 15% buffer included in the formula. There was a potential that the Granix injection I got in the morning produced more cells during the collection than the number that came from the results mentioned. The doctors want that target count; it’s not the needed target count. TDLR: there are a lot of factors at play.
That said, the PA said the Clinician would call me at night after their lab counts the product. I was placed on standby.
It was a bit frustrating to hear that.
Throughout the eight hours, I watched Netflix, kept dozing off, chatted with the nurses. I was watching the time pass by slowly.
After eight hours, the machine stopped, and the nurse began the post-procedure. He took my vitals and blood to get it tested before getting released.
The nurse removed PIV on each arm and placed a pressure dressing.
My post-collection WBC count was 26.24 K/uL.
I got back to the hotel room and ate; I had a massive headache. The Clinician called around 8 PM to let me know I surpassed the minimum target and didn’t need to come in for around. I took Tylenol and passed out. Throughout the night, I keep waking up like pee breaks. The nurse mentioned that might happen.
Post:
The Clinician calls for checkups: 24 hours post-donation, a week, and a month.
Thanks for reading.
Hopefully, this gave you some insight into becoming a donor.
It’s time-consuming, but I believe it’s worth it to save a life potentially.
If there was a medical mistake that I got wrong, my apologies; let me know.
I will correct it.