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Steps: Procuring Unrelated Hematopoietic Cells

Procurement varies according to whether the best choice of cells is from a donor or a cord blood unit.

When a donor is selected by the physician, the donor is prepared, the procedure is scheduled and the cells are collected from the donor and delivered to the patient’s transplant center.
When a cord blood unit is selected by the physician, the cord blood unit is already collected and stored frozen. The cord blood unit is requested, confirmatory typed and delivered to the patient’s transplant center.

1. Collect the unrelated hematopoietic cells

The collection process varies according to the cell source chosen by the physician: bone marrow, peripheral blood stem cells (PBSC) or cord blood.

Bone marrow

Bone marrow is the soft, blood-forming cells inside of bones. Marrow is collected in a surgical procedure at a hospital, which may be called a collection center. (A collection center has the facilities to collect bone marrow and the experience to care for donors before and after the collection procedure.)

Before donating marrow, the donor is often required to donate one or more units of his or her blood that will be given back after the marrow donation. On the day of marrow donation, the donor enters the hospital, receives a general or regional anesthetic and marrow is aspirated (removed using a hollow needle) in several places from the iliac crest (back hip bones). The donor usually returns home the same day but sometimes hospitalization is needed for up to 36 hours.

PBSC

PBSC are blood-forming cells collected from the bloodstream. PBSC collection is a laboratory procedure performed at an apheresis center. (An apheresis center is a hospital or blood center.)

Donating PBSC is a two-step process: preparing the donor with injections of filgrastim (G-CSF or granulocyte-colony stimulating factor) and then collecting the PBSC.

Preparing the donor with filgrastim injections - For five days, the donor receives injections of a synthetic growth factor called filgrastim. Filgrastim increases the number of hematopoietic cells and moves these cells out of the marrow and into the bloodstream. The injections may be given by a home health nurse, a nurse or physician at a local clinic, or medical staff at a donor center.
Collecting PBSC - After the fifth injection, PBSC is collected through an apheresis process, similar to a plasma or platelet collection procedure. The donated cells are checked to make sure enough hematopoietic cells are collected. If more cells are needed, a second collection is performed the next day.

Cord blood

Cord blood is collected from the umbilical cord and placenta immediately after a baby’s birth and is then stored frozen at a cord blood bank.

Before the baby’s birth, the mother signs an informed consent document allowing for blood to be collected from the placenta and umbilical cord blood after her baby is born. The mother is tested for diseases that could be transmitted through blood. The medical history of the baby’s family is taken and assessed.

The cord blood is:

Checked for an appropriate volume of hematopoietic cells
Stored frozen at a cord blood bank
HLA tested for A, B, C and DRB1 by a laboratory working with the NMDP

Before an NMDP cord blood unit can be used for transplant, a second NMDP-affiliated laboratory performs confirmatory testing at high resolution.

2. Deliver the donated hematopoietic cells to the transplant center

Travel arrangements for the hematopoietic cells are based on the timing of the patient’s transplant and vary by the cell source.

Bone marrow and PBSC are hand-carried by trained couriers to the patient's transplant center immediately after the marrow or PBSC is collected (usually with 12 hours). The cells are usually transplanted within 12 hours after delivery.
Frozen cord blood units are delivered by commercial aircraft to the patient’s transplant center several days before the transplant. Temperature sensors in the packaging ensure the cord blood unit remained frozen and stable throughout the transport.