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Increasing numbers of donors now have their stem cells collected from the circulating bloodstream in a process called peripheral blood stem cell (PBSC) collection, or "apheresis."
Growth Factors 
For several days prior to apheresis, you will be injected with growth factors--medication that increases the number of stem cells circulating in the bloodstream. This growth factor, usually G-CSF (Neupogen) or GM-CSF (Leukine), is given by subcutaneous (under the skin) injection. These injections can be given by a nurse from a home care company or by a member of your family.
The growth factor is given daily, and you will receive between five and seven doses before your first apheresis begins. While you are receiving growth factors, your blood counts will be checked daily, by a nurse from a home care company or at your local hospital or clinic. Rarely, persons receiving growth factors will experience side effects. The most common side effect is bone pain. In most cases it can be relieved by taking Tylenol.If you have pain or if your pain is not relieved by Tylenol, please tell your nurse or physician.
How The Procedure Works
Apheresis is done by inserting a needle into one arm and connecting tubing to the apheresis machine, which separates the stem cells and collects them. The remaining blood components (white cells, red cells and platelets) are returned to you through a second needle in your other arm.
Sometimes, rather than having needles placed in the arms, donors may prefer to have a central venous catheter placed in the vein beneath their collarbone. This minor surgical procedure is routinely done in Morgantown and may be done in the hospital's Ruby Day Surgery Center. Local anesthesia is usually used when the catheter is inserted. The procedure takes about an hour.
Preparations for Apheresis
 You will need to report to the Blood and Marrow Transplantation Unit early in the morning for your apheresis procedure. If you live outside the Morgantown area, arrangements for lodging can be made by calling the transplant nurse coordinator or social worker. Someone should accompany you to this appointment in case you need to be driven home.
Before your apheresis procedure, you should:
- Eat a normal breakfast.
- Drink a full eight-ounce glass of milk (You need the calcium for the procedure.)
- Take any prescription medicine you usually take. (Please notify the apheresis nurse of any medication taken.)
- Do not take aspirin, Ibuprofen or other over-the-counter medications unless approved by a transplant physician. (You may take Tylenol® or Extra-Strength Tylenol®.)
- Empty your bladder.
Generally, at least three collections are necessary on three different days -- each takes three to four hours. You may want to bring a book or magazine with you to help you pass the time.
Side Effects
Generally, apheresis is well tolerated. However, the following side effects may occur:
- Lightheadedness: Eating breakfast helps. You may want to bring a snack with you and something to drink in case you need to eat or drink during the process.
- Coldness: Bring a sweater or jacket with you.
- Numbness around the lips: This is caused by changes in the amount of calcium in your bloodstream. Bring some TUMS® with you to replace the calcium. You may also want to eat foods high in calcium the evening and morning before your procedure.
After apheresis you should not lift anything heavy for several hours to allow the needle sites to heal.
Once a donor's stem cells have been collected, they are frozen and stored until the patient is ready to receive them. In some cases, we are not able to collect enough stem cells through apheresis. If that happens, you will then need to have a bone marrow harvest.
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This is a publication of the Blood and Marrow Transplatation Program of the Mary Babb Randolph Cancer Center and Ruby Memorial Hospital at West Virginia University’s Robert C. Byrd Health Sciences Center.
Acknowledgment: Funding for this handbook was provided by Annette, Marc and Darren Tanner in memory of Douglas H. Tanner.
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