Preparing for Apheresis Procedure: Peripheral Blood Stem Cell Collection

Your child will have blood stem cell collection through a process called apheresis. Stem cells are cells that are used to make new bone marrow. Once placed inside your child’s body, these cells will begin making new red blood cells, white blood cells and platelets. Your child may have been given a medicine to make more of these cells prior to this procedure.

During an apheresis procedure, some of your child’s blood is removed from the body through tubes and processed by an apheresis machine. This machine separates the different parts of your blood to collect the stem cells and return the rest of your blood cells back to your child. Blood is taken out and returned to your child either by needles placed in the veins in both arms or through a central venous catheter placed near the heart, whichever is most appropriate for your child. An anticoagulant, or blood thinner, is added to keep the blood from clotting in the machine. The amount of blood that flows outside of your child’s body through the machine and tubing at any time during the procedure is about 1 cup.

Your child may need more than one day of collection to gather enough cells.

If your child is taking any medicines, these may need to be stopped for the procedure. Talk with your doctor.

• Have your child eat calcium-rich foods (like milk, yogurt, and cheese). We may also recommend you give calcium supplements. This will help lessen the side effects from the anticoagulant medicine (citrate) used during the procedure.
• Have your child drink plenty of liquids – at least 6 to 8 glasses a day. It makes it easier to find a vein when it’s puffy and well-hydrated if an IV is placed.
• Have your child eat a good meal before the procedure. The procedure is best tolerated with food in your stomach.
• Have your child dress in loose clothing and short sleeves that allows access to the catheter or their arms (if IV is needed).
• Your child may need more than one day of collection to acquire enough stem cells.

It varies. The flow time can range from 2 to 8 hours.

• If your child is small and does not weigh very much, they may require a blood prime. This is a blood transfusion into the machine to decrease unwanted side effects such as low blood pressure. A premedication may be necessary prior to getting the transfusion if there is history of previous reactions to blood products.
• Your child will have a heart monitor placed with stickers on their chest and have their vitals checked every half hour
• Your child will be asked to use the restroom right before the procedure. If they need to go pee during apheresis, a urinal or portable potty chair (commode) is provided at bedside.
• Blood will be drawn out of the central line tubing for labs before, during and after the procedure.
• Your child can sleep, listen to music, watch TV, or play on an iPad during the procedure.
• If an IV is necessary, arm movements will be limited to prevent the IV from coming out.
• We cannot disconnect your child from the machine until the end of the procedure. Your child will not be able to get up and walk around during the collection.
• It’s fine for your child to eat and drink during the procedure. Ask your nurse about the hospital room service menu and how to order.
• Some patients may have side effects such as numbness or tingling around the mouth, nausea, or vomiting from the side effects of the anticoagulant being used. Alert the nurse if you notice any changes in your child’s well-being or 
• In the unlikely event of the apheresis machine malfunction due to clotting the procedure might be stopped. This could result in blood loss. The amount of blood that flows outside of your child’s body at one time (through the machine and tubing) is about 1 cup.

• Your child can start their regular (light) activity and foods right away.
• If another day of collection is needed, your child will need to take more
  calcium and drink more water.
• The anticoagulant used during the procedure may put your child at risk for bleeding for up to 4 hours after apheresis. Have your child avoid rough play for this time period.
• Your child’s platelet count may fall after the procedure and may increase their chance of bleeding. A complete blood count will be obtained after procedure to see if transfusions are necessary.
• If your child had GCSF injections, any related symptoms or discomfort will get better over the next two weeks.
• If an IV was used, leave the bandage on for at least 4 hours. If you see bleeding at the site soaking through the bandage, apply fingertip pressure for 5 minutes and keep the bandage on for an additional 4 hours.

We will notify you by phone about 3 to 4 hours after the procedure with information on whether or not a second collection day is needed and if the medication you have been given to increase your stem cells should be discontinued.

If a temporary central catheter was used, it will be removed after the procedure.

• Keep the dressing on for 48 hours (2 days). Replace the dressing if it becomes wet or dirty.
• After 48 hours, you may remove the dressing and shower as usual. No baths or going under water for at least 7 days.
• If there is any bleeding, apply pressure for 5 minutes. If it continues, call your child’s doctor.

Call if your primary care team if your child has any of the following warning signs:

• Fever or chills
• Redness or swelling at line exit site
• Any drainage at line exit site
• Pain
• Bleeding that does not stop after 2 minutes of holding pressure.
• Shortness of breath or difficulty breathing — CALL 911

Call your primary care doctor for the following signs

• Back pain below the ribs
• Dark or reddish urine
• Yellowing of the skin or eyes (this may be sign of delayed reaction if it happens days or weeks after the transfusion)
• A change in your child’s health that concerns you