Donating lymphocytes to your family member

Lymphocytes are a type of white blood cell. White blood cells are an important part of your immune system. They are responsible for fighting infections and other cells that appear abnormal to them.

After you donate your stem cells and your family member has their transplant, they may also need your lymphocytes. Your lymphocytes could help to: 

• fight a specific infection they have 
• strengthen their immune system.  

Their immune system may need a boost if: 

1. some of their original stem cells are still in their body after the transplant (called ‘mixed chimerism’ ), or 
2. their disease has come back. 

In both situations, your lymphocytes can help to make your family member’s new immune system stronger. This would allow it to destroy any remaining original stem cells, both healthy and diseased.

The lymphocytes are collected by a process called leukapheresis. It is similar to apheresis, the procedure you had to collect your stem cells. The main difference is that you will not need any G-CSF injections when donating lymphocytes. 

Just as before your stem cell collection, you will have a detailed medical check before the lymphocyte donation. This is to make sure that you are healthy enough for the procedure. 

• We will examine you and review your health history. This may include any operations you have had, adverse reactions to medicines, and your travel and sexual health history. 
• We will ask if you smoke or drink. 
• If it’s been over a year since your stem cell donation, you will have a chest X-ray to check your lungs and an electrocardiogram (ECG) to check your heart’s rhythm. We will also check your blood pressure, weight and height. 
• We will take your urine sample to check for infections.  
• You will have several blood tests. These include tests for:  
  • full blood count  
  • blood type  
  • liver and kidney function  
  • viruses, including HIV, Hepatitis B, Hepatitis C and syphilis.  

These tests help us find any underlying conditions or infections that could affect you or your family member who will receive your lymphocytes. Please drink plenty of water before your blood tests. This helps to make your veins easier to find.

In the UK, the law requires us to check for viral infections before collecting and storing stem cells. The results of the viral blood test are valid for 30 days. If your stem cell donation is delayed, we may need to repeat this test. 

• We will review your family health history.  
• We will ask you some questions about your personal life. For example, what your marital status and occupation is. 
• We will review any medicines you may be taking and advise if any of them need to be stopped for the donation. 
• We will check the veins in your arms to make sure they are suitable for the collection of lymphocytes. If your veins aren’t suitable, you may need to have a catheter inserted into one of the larger veins at the top of your leg instead. This happens in five out of 100 people.
• If you are a female of child-bearing age, you will need to take a pregnancy test before the collection. We will let you know when you need to take the test and we can also give you a pregnancy test kit. 
• We will ask you to avoid raw or undercooked meat (especially pork) and shellfish until after your donation. This will lower your risk of getting Hepatitis E. In recent years, more people in the UK have been getting Hepatitis E. Most people don’t have any symptoms, and the infection usually goes away on its own. But it can be harmful if passed to someone with a weak immune system.   

It’s very important that you inform us if you feel unwell or develop flu-like symptoms between your assessment and donation. Having an infection can affect the quality of your lymphocytes. It can also contaminate the lymphocytes, passing the infection on to your family member.  

If we have any concerns, even small ones, about your health and ability to donate, you will need extra tests to make sure you can be a donor. If these tests show that you cannot donate, this is to protect your health and safety. 

If you need more tests to check your health, we will talk to you about it and make the arrangements. Some or all of these tests may be done through your own GP. 

We will ask you not to travel abroad from the time of your medical check until two days after donating your lymphocytes. This is because you may need extra travel-related blood tests which can interfere with your donation schedule. If you have already made plans, please talk to your clinical nurse specialist (CNS).

The doctor or clinical nurse specialist (CNS) will ask you to sign a consent form to donate your lymphocytes. This will confirm that you agree to have the procedure and understand what it involves. 

They will review the donation process and go over the consent form with you before you sign it. They will also answer any questions you may have so please ask if anything is unclear.

• Your lymphocyte collection will take place in the Apheresis Unit, 4th Floor University College Hospital Macmillan Cancer Centre. You will need to arrive to the Apheresis Unit at 8.30am. 
• First, you will have a blood test to check your blood counts. 
• We will collect your lymphocytes using a procedure called leukapheresis. During leukapheresis, a constant flow of blood is taken from the bloodstream, passed through a machine called a ‘cell separator’, and then put back into your bloodstream. 
• An apheresis nurse (a nurse who will carry out the collection) will assess the veins in your arms. This is to make sure that they are suitable for the collection. 
• If your veins are suitable, you will have two needles. We will insert a larger needle in your non-dominant arm (the arm that you don’t write with), if possible, and a smaller needle in the other arm. During the collection, blood will be taken from the larger needle into the cell separator. The cell separator will separate the blood into the different types of blood cells and collect the lymphocytes into a collection bag. Some of your plasma will also be collected. Plasma is the fluid in the blood in which all the blood cells are suspended. The rest of your blood, together with the remaining plasma, will then be returned to you via the smaller needle in the other arm. 
• If your veins are not suitable, we will insert a special catheter (thin, semi-rigid tube called a vascath) into the large vein at the top of your leg. This will allow a constant flow of blood to be taken from and returned to your bloodstream. We will apply local anaesthetic (pain relief) on to your skin before inserting the vascath. The vascath will remain in place as long as the lymphocytes are being collected and will be removed once the collection is finished. 

Preparing the cell separator

An apheresis nurse will prepare the cell separator for the collection and stay with you throughout the procedure. The collection will last about three to four hours. You will need to stay fairly still on a reclining bed during this time. 

The nurse will fit a sterile kit into the cell separator so that your blood is not exposed to outside infections during the harvest. 

Once the two lines from the kit are attached to you, the nurse will enter your height, weight and your morning blood test results into the cell separator control panel. Then the lymphocyte harvest can begin. 

How much blood will there be in the cell separator?

The amount of blood in the cell separator at any time is 160ml (about half a glass of water). The amount of blood cells taken from you by the end of the procedure will be about 100-200ml. 

Beginning the lymphocyte harvest

As the blood enters the cell separator, a drug called ACD-A is added to it. ACD-A stops the blood from clotting while it is going through the cell separator. 

Are there any side effects that can occur during the collection?

Yes, the most common side effects are caused by ACD-A. 

What side effects does ACD-A cause?

You may feel sick or you may have some tingling in your lips and nose or fingertips. These side effects are short-lasting and should stop once you have received calcium supplements. These will be chewable calcium tablets or a calcium infusion. 

If you experience any of these side effects, tell your nurse straight away. They will help to relieve these symptoms very quickly. It may also be a good idea to have a milky breakfast before the lymphocyte collection. 

Why does ACD-A cause side effects?

The blood would naturally clot within the cell separator. As calcium helps the blood to form clots, ACD-A is used to absorb the calcium from the bloodstream and prevent the blood from clotting. This lowers the calcium levels in the blood and may cause side effects. 

What other side effects or problems can occur?

As your blood pressure drops during the collection, you may feel light-headed, especially at the beginning. Please tell your nurse if you experience this. 

It is also sometimes difficult to get enough blood to flow from the veins in your arm. Your apheresis nurse may need to adjust the position of the needle to allow a better flow. This should not be painful but please tell the nurse if you feel any discomfort. 

A small number of platelets may remain in the cell separator during the collection. This may cause your platelet levels to drop a little and lead to an increased chance of bruising or bleeding. For this reason, you should avoid taking aspirin on the day of the collection and for a week after. This also includes medicines that contain or are similar to aspirin. We will take a small blood sample at the beginning and end of the collection to monitor your blood cell counts, including platelets. Your blood counts will go back to normal within a few days of the collection. 

What can I do during the harvest?

• You will need to remain in bed or seated for the entire time the harvest takes (three to four hours).  
• Wear loose-fitting clothes so you are comfortable during that time.  
• Bring something that can help you pass the time, for example a book or a tablet.  
• You will be able to eat and drink so feel free to bring some snacks. 
• One visitor will be able to stay with you during the harvest.  
• If you wish to use the toilet, a nurse can help you to use a commode or urine bottle by the bedside.  

What happens when the harvest has finished?

Your apheresis nurse will disconnect you from the cell separator and take the lymphocytes to the laboratory. You will have a blood test to check your full blood count. After that you will be free to get up and move around. 

You will need to wait for the results of your blood test before you can go home. This is to make sure that your platelet count is stable. The results should be available within an hour and you will be well enough to travel home by yourself after that.   

The nurses will talk to you about your blood test result and advise you of anything to look out for. Please contact us if you notice any signs of infection, such as raised temperature, body aches and feeling shivery or generally unwell.

• Bone marrow transplant team (Monday to Friday, 9am to 5pm) 

Tel: 020 3447 9712 or 020 3447 7375     

Email: uclh.bmtdonor@nhs.net and uclh.bmt@nhs.net 

• Out of hours for urgent medical advice (including weekends and bank holidays) 

Tel: 07852 220900