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The procedure for removing bone marrow for transplantation is called the bone marrow harvest. It is done under anesthesia in the sterile conditions of an operating room. Just as the body replaces blood donated for transfusions, in a matter of days it will replace the bone marrow that was removed. Bone marrow is usually harvested on the day the patient is ready to receive it, although it can also be harvested beforehand and stored (frozen) until the day of transplant.
Pre-Admission Process
The day before the bone marrow harvest you will come in for pre-admission testing at the Pre-admission Unit on the fourth floor of the Physician Office Center. A nurse will check your vital signs (pulse, respiration, temperature and blood pressure) and ask questions about your general health. You will then speak with a member of the anesthesia team. You will also meet with a nurse coordinator in the Mary Babb Randolph Cancer Center to sign consent forms during this visit.
The pre-admission unit nurse will check the operating room schedule but may not be able to confirm immediately what time you should report to the hospital the following morning. That evening you will be called between 4 and 8 p.m. to let you know when you should report to surgery. It is important that the nurses know where they can reach you with this information. If you are not going to be at home or if the nurses will be unable to reach you, you must call them at (304) 598-6200 before 6:30 p.m. Do not eat or drink anything after midnight. This is a requirement from the anesthesiologist; it prevents vomiting during the harvest procedure.
Arriving at the Hospital
On the morning of the harvest, you will wait on 2 West, in Ruby Memorial Hospital's Day Surgery Center, before you go to the operating room. Avoid bringing valuables to the hospital with you. Before going to the operating room, on the morning of the harvest, you must remove your clothes and wear only a hospital gown. You will be asked to go to the bathroom and empty your bladder. All jewelry must be removed and either locked in the hospital safe or given to a member of your family. All hairpins, partial plates, dentures, contact lenses, nail polish and makeup must be removed. You must have someone with you who can drive you home after the procedure.
You will need an IV line in your hand or arm to give you fluids during and after the harvest. The IV will be started in your room by a nurse or in the holding area before you go to the operating room. It will be taken out later that day when you are drinking fluids well.
The Surgical Procedure
Bone marrow is harvested in the operating room under sterile conditions. You will be given either general anesthesia to put you to sleep or a spinal block to numb any feeling below the waist. You will be placed on your stomach so that your rear hipbones are exposed. Members of the bone marrow transplant team collect the marrow by placing a needle through the skin and into the inner cavity of the hipbone. The special stem cells and some blood are withdrawn through the needle with a syringe.
For the adult donor, the needle is placed through the skin three or four times on each side of the rear hipbones. Several collections of bone marrow will be obtained through each of these holes in the skin. For child donors, more punctures may be necessary, since a smaller amount of marrow can be collected from each site. Once the procedure is finished, a pressure dressing is placed over the harvest sites to prevent bleeding.
Usually enough marrow can be collected from the rear hipbones for the transplant. Occasionally the donor needs to be turned over so that the front sides can be used. About 500 to 1,000 cc (one to two quarts) of marrow are collected for an adult patient. This may sound like a large amount, but it is the number of marrow cells, not the amount of fluid, that is important in blood formation. Only about five percent of your marrow cells are collected, along with some blood. This affects only your red blood cell count. Your red blood cells will be returned to you a few hours later, after they are separated from the bone marrow. This will keep you from feeling tired or "washed out" after the harvest.
After harvest, your marrow will be processed and taken immediately to the Blood and Marrow Transplant Unit. It will be then given to the patient through his or her IV line that same day, like a blood transfusion, or frozen for future transplantation.
The harvest process lasts about one hour. Afterward, you will be taken to the recovery room.
Recovery Room
If you have received general anesthesia, you will wake up with an oxygen mask over the lower half of your face. Oxygen is given to help you breathe. The mask will stay on until you are fully awake.
As you wake up, you may feel sleepy and tired. Your throat may feel dry and sore from the breathing tube placed there during the harvest. It is important not to eat or drink anything until the doctors or nurses say that it is all right to do so. You will be encouraged to drink clear liquids at first and then permitted to advance to more solid foods. If you feel nauseated, your nurse can give you medications to make you feel more comfortable.
Before attempting to get out of bed for the first time, call the nurse to help you. The nurse will be in and out of your room frequently, checking both your vital signs and pressure dressing.
You may experience some pain at the bone marrow harvest sites. If you do, please let your nurse know, and he or she will give you pain medication.
There are several things you should do after having general anesthesia: change your position in bed, breathe deeply and cough every two hours. By doing this, you are expanding your lungs and helping to prevent infection.
If you had a catheter to empty urine from your bladder, it will be removed. Please tell the nurse when you urinate for the first time after the catheter has been removed.
In the late afternoon or early evening, you will be encouraged to get out of bed and walk, if you have not already done so.
Discharge from the Hospital
Following the harvest, you will be allowed to go home either the same day or the following morning. In order to be discharged, you must be able to:
- Urinate on your own (without the use of a catheter).
- Drink fluids without vomiting.
- Walk.
In addition you must have:
- Normal vital signs
- No excessive bleeding from the harvest sites
- Someone to drive you home.
Whether you are discharged the day of the harvest or the following morning, we suggest that you bring loose-fitting clothing (for example, sweatpants) to wear home from the hospital.
The needle puncture sites may be sore for up to a week. There may be some temporary stiffness, and there may be considerable bruising over the hips. Many donors have compared the discomfort and stiffness that they felt after the harvest to "slipping on ice and landing on their bottom." The doctor will prescribe pain medication for you. Please do not operate vehicles or other machinery while on narcotics. After the first few days, when the initial pain or soreness lessens, you may take Tylenol® or Extra-Strength Tylenol®. Do not take aspirin or Ibuprofen.
Special Instructions for Discharge
The morning after harvest you can remove the pressure dressing. Although showers are acceptable, do not take a tub bath or expose the site to standing water for five days after the harvest. Report the following to the doctor immediately:
- A temperature of 101.5 degrees F or higher
- Drainage or discharge from the puncture sites
- Severe or prolonged pain at the puncture sites
- Lightheadedness or fainting
The transplant unit's telephone number is (304) 598-4127. There is always someone there who can help you or contact the physician for you.
Expected Follow Up
You should schedule an appointment with your family doctor one week after the harvest so the doctor can check your blood count and examine the puncture sites. If you do not have a family doctor, please let someone from the transplant team know so that appropriate arrangements can be made.
Returning to Work or School
The transplant doctor will let you know when you can safely return to work or school. His or her decision will depend on the type of work you do, with those who have a desk job usually able to return to work earlier than those who do heavy lifting. Please let the doctor know if your employer or school requires a written excuse, if you need to be excused from specific duties or activities or if you need a statement that you can safely return to work or school.
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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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