Blood & Bone Marrow Stem Cell Collection

1. Treatment Overview

The Smart T Web Hospital, Gujarat's premier healthcare institution since 2012, operates the region's most advanced Blood & Bone Marrow Stem Cell Collection Program. Our state-of-the-art facility provides comprehensive hematopoietic stem cell harvesting services, supporting both autologous and allogeneic transplantation procedures.

Our program collects hematopoietic stem cells from either peripheral blood via advanced apheresis technology or directly from bone marrow under sterile conditions. All collected cells undergo rigorous processing and quality control measures to ensure maximum viability and clinical efficacy. These cells form the foundation for stem cell transplantation, helping rebuild healthy blood and immune systems.

2. What are Hematopoietic Stem Cells

2.1 Definition and Characteristics

Hematopoietic stem cells (HSCs) are multipotent stem cells that give rise to all blood cell types:

• Self-renewal: Ability to create identical copies of themselves
• Multipotency: Can differentiate into all blood cell lineages
• Location: Primarily found in bone marrow and peripheral blood
• Mobility: Can circulate between bone marrow and bloodstream
• Regeneration: Capable of rebuilding entire blood system

2.2 Cell Types Generated

Hematopoietic stem cells differentiate into:

• Red blood cells (erythrocytes)
• White blood cells (lymphocytes, neutrophils, monocytes)
• Platelets (thrombocytes)
• Immune system cells (B-cells, T-cells, NK cells)
• Dendritic cells and macrophages

2.3 Clinical Importance

HSCs are crucial for:

• Treating blood cancers and disorders
• Restoring immune function after chemotherapy
• Correcting genetic blood disorders
• Supporting cancer treatment protocols
• Regenerative medicine applications

3. Types of Stem Cell Collection

3.1 Peripheral Blood Stem Cell Collection (PBSC)

• Method: Apheresis procedure through IV access
• Duration: 4-6 hours per session
• Sessions: 1-3 collections typically required
• Advantages: Less invasive, outpatient procedure
• Preparation: Growth factor mobilization required

3.2 Bone Marrow Collection

• Method: Surgical aspiration under anesthesia
• Duration: 1-2 hours procedure
• Location: Operating room environment
• Recovery: Same-day or overnight observation
• Advantages: High stem cell concentration

3.3 Cord Blood Collection

• Source: Umbilical cord blood after birth
• Timing: Immediate post-delivery collection
• Advantages: High potency, lower matching requirements
• Storage: Long-term cryopreservation
• Applications: Pediatric and adult transplants

4. Medical Indications

4.1 Blood Cancers

• Leukemias:
  • Acute lymphoblastic leukemia (ALL)
  • Acute myeloid leukemia (AML)
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myeloid leukemia (CML)
• Lymphomas:
  • Hodgkin's lymphoma
  • Non-Hodgkin's lymphoma
  • Mantle cell lymphoma
  • Burkitt lymphoma
• Other Blood Cancers:
  • Multiple myeloma
  • Myelodysplastic syndrome
  • Primary myelofibrosis

4.2 Non-Malignant Conditions

• Severe aplastic anemia
• Sickle cell disease
• Thalassemia major
• Severe combined immunodeficiency
• Primary immunodeficiency disorders

4.3 Solid Tumors (Selected Cases)

• High-risk neuroblastoma
• Germ cell tumors
• Selected sarcomas
• High-risk breast cancer

5. Peripheral Blood Collection (Apheresis)

5.1 Mobilization Process

Stem cells are mobilized from bone marrow to peripheral blood using:

• G-CSF (Granulocyte Colony-Stimulating Factor):
  • Daily injections for 4-5 days
  • Increases stem cell production and circulation
  • Filgrastim or lenograstim commonly used
• Plerixafor (AMD3100):
  • CXCR4 antagonist for poor mobilizers
  • Given 11 hours before collection
  • Enhances stem cell release
• Chemotherapy + G-CSF:
  • Cyclophosphamide commonly used
  • Disease treatment + mobilization
  • Higher stem cell yields possible

5.2 Apheresis Procedure

The collection process involves:

• Vascular Access:
  • Peripheral IV or central venous catheter
  • Adequate blood flow rates required
  • Sterile technique maintained
• Machine Operation:
  • Blood continuously processed
  • Stem cells separated by centrifugation
  • Other blood components returned
• Monitoring:
  • Vital signs tracked continuously
  • Cell count monitoring
  • Calcium supplementation as needed

5.3 Collection Targets

• CD34+ cells: >2 × 10⁶/kg for autologous
• CD34+ cells: >4 × 10⁶/kg for allogeneic
• Total nucleated cells: >2 × 10⁸/kg
• Viability: >85% post-thaw

6. Bone Marrow Collection

6.1 Procedure Overview

Bone marrow collection involves:

• Anesthesia: General or spinal anesthesia
• Position: Prone or lateral decubitus
• Site: Posterior iliac crests primarily
• Volume: 10-20 ml/kg donor weight
• Duration: 60-120 minutes

6.2 Aspiration Technique

• Multiple Punctures:
  • 100-200 aspirations typically
  • Small volumes per aspiration (2-5ml)
  • Bilateral iliac crest harvest
• Sterile Technique:
  • Operating room environment
  • Surgical asepsis maintained
  • Quality control throughout

6.3 Post-Collection Care

• Recovery room monitoring
• Pain management protocols
• Ambulation within 4-6 hours
• Discharge same day or next morning
• Follow-up within 24-48 hours

7. Pre-Collection Preparation

7.1 Donor Evaluation

• Medical History:
  • Comprehensive health assessment
  • Previous medical conditions
  • Current medications
  • Allergies and reactions
• Physical Examination:
  • Complete physical exam
  • Vital signs assessment
  • Cardiovascular evaluation
  • Vascular access assessment

7.2 Laboratory Tests

• Blood Tests:
  • Complete blood count
  • Comprehensive metabolic panel
  • Liver function tests
  • Coagulation studies
• Infectious Disease Screening:
  • HIV 1/2, HTLV I/II
  • Hepatitis B and C
  • CMV, EBV testing
  • Syphilis screening
• HLA Typing:
  • High-resolution typing
  • Compatibility assessment
  • Cross-matching when indicated

7.3 Informed Consent

• Detailed procedure explanation
• Risk and benefit discussion
• Alternative options reviewed
• Questions addressed
• Written consent obtained

8. Collection Procedures

8.1 Day of Collection

Collection day protocols include:

• Pre-procedure Checks:
  • Identity verification
  • Vital signs assessment
  • Laboratory results review
  • Equipment functionality check
• Patient Preparation:
  • Comfortable positioning
  • IV access establishment
  • Baseline measurements
  • Anxiety management

8.2 Monitoring During Collection

• Continuous vital sign monitoring
• Blood pressure every 15 minutes
• Calcium levels monitoring
• Volume status assessment
• Comfort and anxiety levels

8.3 Collection Quality Control

• Real-time Monitoring:
  • CD34+ cell count tracking
  • Collection efficiency assessment
  • Product volume monitoring
  • Contamination prevention
• End-point Criteria:
  • Target cell dose achieved
  • Maximum collection time reached
  • Donor tolerance factors
  • Product quality parameters

9. Cell Processing & Quality Control

9.1 Initial Processing

• Volume Reduction:
  • Red blood cell depletion
  • Plasma reduction techniques
  • Concentration optimization
  • Final volume adjustment
• Cell Washing:
  • DMSO incompatibility removal
  • Debris elimination
  • pH optimization
  • Osmolarity adjustment

9.2 Quality Control Testing

• Cell Count Analysis:
  • Total nucleated cell count
  • CD34+ stem cell enumeration
  • Viability assessment
  • Differential cell count
• Functional Testing:
  • Colony-forming unit assays
  • Proliferation capacity
  • Differentiation potential
  • Metabolic activity
• Safety Testing:
  • Sterility cultures
  • Endotoxin testing
  • Mycoplasma screening
  • Virus testing protocols

9.3 Product Release Criteria

• Minimum CD34+ cell dose met
• Viability >70% (fresh) or >50% (frozen)
• Sterility testing negative
• Endotoxin levels <5 EU/kg
• Documentation complete

10. Storage & Preservation

10.1 Fresh Storage

• Temperature: 2-8°C refrigeration
• Duration: Up to 72 hours maximum
• Containers: Blood collection bags
• Monitoring: Continuous temperature logging
• Transport: Validated cold chain

10.2 Cryopreservation

• Cryoprotectant:
  • DMSO (10% final concentration)
  • Controlled addition protocol
  • Temperature equilibration
  • Osmotic protection
• Freezing Protocol:
  • Controlled-rate freezing
  • -1°C per minute cooling
  • Liquid nitrogen vapor phase
  • Final temperature -196°C

10.3 Long-term Storage

• Storage Systems:
  • Liquid nitrogen dewars
  • Automated storage systems
  • Backup power supplies
  • Alarm monitoring systems
• Documentation:
  • Storage location tracking
  • Temperature monitoring logs
  • Inventory management
  • Chain of custody records

11. Therapeutic Applications

11.1 Autologous Transplantation

• Multiple Myeloma:
  • High-dose chemotherapy support
  • Improved progression-free survival
  • Standard of care for eligible patients
• Lymphomas:
  • Relapsed/refractory disease
  • Consolidation therapy
  • Salvage treatment option
• Solid Tumors:
  • High-risk neuroblastoma
  • Germ cell tumors
  • Selected high-risk cases

11.2 Allogeneic Transplantation

• Acute Leukemias:
  • High-risk or relapsed disease
  • Curative treatment option
  • Graft-versus-leukemia effect
• Bone Marrow Failure:
  • Severe aplastic anemia
  • Myelodysplastic syndromes
  • Primary myelofibrosis
• Immunodeficiencies:
  • Primary immunodeficiency disorders
  • Severe combined immunodeficiency
  • Hemoglobinopathies

11.3 Gene Therapy Applications

• Ex-vivo genetic modification
• CAR-T cell manufacturing
• Gene editing protocols
• Regenerative medicine research

12. Donor & Patient Eligibility

12.1 Autologous Donor Criteria

• Medical Criteria:
  • Adequate performance status
  • Organ function within limits
  • Disease status appropriate
  • No active infections
• Age Considerations:
  • Upper age limit typically 70-75 years
  • Physiological age more important
  • Comorbidity assessment crucial

12.2 Allogeneic Donor Criteria

• HLA Compatibility:
  • 10/10 match preferred
  • 9/10 match acceptable
  • Related vs unrelated donors
  • Haploidentical options
• Donor Health:
  • Age 18-55 years typically
  • Excellent general health
  • No malignancy history
  • Negative infectious disease screening

12.3 Exclusion Criteria

• Active uncontrolled infection
• Severe cardiac dysfunction
• Significant pulmonary disease
• Liver or kidney failure
• Pregnancy

13. Side Effects & Risks

13.1 Peripheral Blood Collection Risks

• G-CSF Related:
  • Bone pain (most common)
  • Headache and fatigue
  • Flu-like symptoms
  • Rare: splenic enlargement
• Apheresis Related:
  • Citrate toxicity (tingling, numbness)
  • Hypocalcemia symptoms
  • Hypotension
  • Catheter-related complications

13.2 Bone Marrow Collection Risks

• Procedure Related:
  • Pain at aspiration sites
  • Bruising and swelling
  • Temporary stiffness
  • Fatigue for 1-2 weeks
• Anesthesia Risks:
  • General anesthesia complications
  • Respiratory depression
  • Cardiovascular effects
  • Allergic reactions
• Rare Complications:
  • Infection at puncture sites
  • Nerve injury
  • Bleeding complications
  • Pelvic fracture (extremely rare)

13.3 Risk Mitigation

• Comprehensive pre-collection assessment
• Experienced medical team
• Continuous monitoring protocols
• Emergency response capabilities
• Post-procedure follow-up

14. Success Rates & Outcomes

14.1 Collection Success Rates

• Peripheral Blood:
  • Success rate: >95% for adequate collection
  • Single session success: 60-70%
  • Multiple session success: >90%
  • Poor mobilizer rate: 5-15%
• Bone Marrow:
  • Success rate: >98% for adequate collection
  • Target cell dose achieved: >95%
  • Complications rate: <2%
  • Donor satisfaction: >95%

14.2 Cell Quality Outcomes

• Fresh Products:
  • Viability: >95%
  • CD34+ recovery: >85%
  • Sterility: 100%
  • Endotoxin compliance: 100%
• Cryopreserved Products:
  • Post-thaw viability: >80%
  • CD34+ recovery: >70%
  • Functionality maintained: >85%
  • Storage stability: Excellent

14.3 Transplant Outcomes

• Engraftment rates: >95%
• Time to neutrophil engraftment: 10-14 days
• Time to platelet engraftment: 14-21 days
• Graft failure rate: <5%

15. Treatment Cost

15.1 Cost Components

• Collection Procedure:
  • Peripheral blood collection: ₹1,50,000 - ₹2,50,000
  • Bone marrow collection: ₹2,00,000 - ₹3,00,000
  • Mobilization medications: ₹50,000 - ₹1,00,000
• Processing & Testing:
  • Cell processing: ₹75,000 - ₹1,25,000
  • Quality control testing: ₹25,000 - ₹50,000
  • Cryopreservation: ₹50,000 - ₹75,000
• Storage & Transport:
  • Storage fees: ₹10,000 - ₹25,000 per year
  • Transport costs: Variable

15.2 Insurance Coverage

• Government schemes: CGHS, ECHS coverage
• Insurance companies: Most major insurers
• ESI and other schemes accepted
• Payment plans available

15.3 Financial Assistance

• Hospital financial aid program
• Government assistance schemes
• NGO partnerships
• Charitable trust support

16. Our Expert Team

16.1 Medical Directors

• Dr. Rajesh Patel - Medical Director
  • MBBS, MD (Medicine), DM (Hematology)
  • 25+ years hematology experience
  • Stem cell transplant specialist
  • International training in apheresis
• Dr. Priya Sharma - Collection Director
  • MBBS, MD (Transfusion Medicine)
  • 15+ years apheresis experience
  • Certified apheresis specialist
  • Quality assurance expert

16.2 Nursing Team

• Specialized apheresis nurses
• Critical care certified
• Continuous education programs
• Patient care specialists

16.3 Laboratory Team

• Cell processing specialists
• Quality control analysts
• Cryopreservation experts
• Documentation specialists

17. Advanced Technology

17.1 Apheresis Equipment

• Latest Generation Machines:
  • Spectra Optia apheresis system
  • CMNC collection protocols
  • Real-time monitoring
  • Automated quality control
• Backup Systems:
  • Multiple machine availability
  • Emergency protocols
  • Power backup systems

17.2 Processing Technology

• Cell Processing:
  • Closed system processing
  • Automated cell washing
  • Volume reduction systems
  • Sterile connection devices
• Quality Control:
  • Flow cytometry analysis
  • Automated cell counters
  • Viability analyzers
  • Colony assay systems

17.3 Storage Systems

• Controlled-rate freezers
• Liquid nitrogen storage
• Automated inventory systems
• Temperature monitoring

18. Research & Clinical Trials

18.1 Ongoing Research

• Collection Optimization:
  • Novel mobilization strategies
  • Poor mobilizer solutions
  • Collection efficiency studies
  • Donor safety improvements
• Cell Processing:
  • Cryopreservation protocols
  • Cell expansion techniques
  • Quality enhancement methods
  • Contamination prevention

18.2 Clinical Trials

• Novel mobilization agents
• Gene therapy protocols
• Regenerative medicine studies
• International collaboration

18.3 Academic Partnerships

• Leading medical colleges
• Research institutions
• International collaborations
• Publications and presentations

19. Patient Support Services

19.1 Pre-Collection Support

• Education and Counseling:
  • Detailed procedure explanation
  • Expectation setting
  • Risk and benefit discussion
  • Emotional support
• Logistics Support:
  • Scheduling coordination
  • Travel arrangements
  • Accommodation assistance
  • Insurance authorization

19.2 During Collection

• Dedicated nursing care
• Comfort measures
• Family communication
• Real-time updates

19.3 Post-Collection Care

• Recovery monitoring
• Pain management
• Follow-up appointments
• Long-term wellness programs

20. Frequently Asked Questions

20.1 General Questions

20.2 Safety and Risks

20.3 Process and Preparation