Fears and doubts still remain behind this gesture of generosity. Let’s try to clarify the subject once and for all …
It is important that there are more and more bone marrow donors because for the transplant it is essential that there is tissue compatibility between the donor and the recipient, i.e. a genetic similarity necessary for the success of the operation. However, compatibility is very rare: it occurs in 25% of cases between brothers and sisters (but never between parents and children) and in 0.001% among people who do not have blood relations. The bone marrow, not to be confused with the spinal cord, looks like blood at the sight but contains hematopoietic stem cells from which the white blood cells, red blood cells and platelets originate: donating it can cure some blood or cancer diseases, such as severe forms of leukemia, aplastic anemia, and some genetic diseases.
To be able to donate the bone marrow must be aged between 18 and 35 years and a body weight of at least 50 kg. Furthermore, one must enjoy good health: that is, there are some exclusion pathologies that are not compatible with the donation. Which? Malignant arrhythmias and severe hypertension, asthma and COPD, epilepsy, tumors, deficiency of coagulation factors (hemophilia, afibrinogenemia), rectocolitis hemorrhagic ulcer, Chron’s disease, autoimmune diseases, thalassemia major, drepanocytosis, diabetes, positivity for HCV, HBV, HIV, syphilis, depressive disorders. Even pregnant women, those who take drugs, those who conduct sexual behavior at risk and those who abuse alcohol cannot donate bone marrow.
How to become a donor
It is sufficient to undergo a blood sample necessary to perform the HLA typing (Human Leucocyte Antigens), that is the extraction of genetic data, essential to verify the compatibility between a donor and a patient who needs a bone marrow transplant. In addition to the withdrawal, the donor must sign the Ibdmr membership. From this moment on, you become a potential bone marrow donor. Then if there is a finding of first compatibility between a donor and a patient, the donor is called for other blood samples aimed at further investigations on the level of compatibility. The process ends with a medical examination of the donor to ascertain clinical suitability; once the transplant center of the patient considers the donor compatible, the date of the intervention is decided.
The hematopoietic stem cells can be donated either with removal from bone marrow or with removal from peripheral blood. Although at the time of registration in the Registry the donor can indicate a hypothesis of choice between one of the two modalities, the final decision is up to the transplantologist based on the needs of the patient and the suitability of the donor, evaluated by the doctor of the Donor Center.
Bone marrow sampling
The most traditional donation is that of the bone marrow coming from the iliac crests, which constitute the skeleton of the pelvis. The donor is subjected to a general anesthetic, so that he does not feel any pain, and the intervention can last from 45 to 60 minutes. After the procedure, the donor remains under observation for about 24 hours then he can go home observing 5 days of rest. For a year, we remain suspended from blood donations: after an average of 12 months from the operation, it is possible to donate the bone marrow again.
Is bone marrow sampling painful or dangerous?
No pain is felt during collection. After the operation it is possible, on the other hand, to feel a slight dull ache in the pelvic area, which with the passing of the hours becomes soreness, until it disappears completely also thanks to the assumption of a normal painkiller. The procedure foresees minimal risks linked to anesthesia, so that people with a real anesthetic risk are not even nominated for donation, for their own protection.
Withdrawal from peripheral blood
Peripheral blood sampling is, according to data from the Bone Marrow Donors Association, used in 8 donations out of 10. In this case, the donor is given a mobilizing agent, which promotes the growth of stem cells in the bone marrow and their passage to peripheral blood, in the 3-4 days prior to collection. It then proceeds with the actual extraction, which takes place through the apheresis procedure: the blood, taken from a vein of the donor’s arm, enters a centrifuge where the hematopoietic stem cells are isolated and collected, while the rest of the blood is reinfused in the opposite arm.
Is peripheral blood sampling painful or dangerous?
Fever, headache, bone pain, fatigue, fatigue and general malaise may occur during administration of the mobilizing agent, which occurs in the days prior to collection. Symptoms may persist until drug withdrawal. On the other hand, during the apheresis extraction, a decrease in mineral salts can take place, which can be trivially treated with direct integration. There are no risks related to this type of withdrawal.
