Donation, collection and transplantation of hematopoietic cells

Collection of hematopoietic cells
náhled | 100px | Jehla používaná při odběru kostní dřeně z pánevních kostí náhled | Odběr kostní dřeně z pánevní kosti (prováděný v anestézii) náhled | Odběr "nastimulovaných" kmenových buněk ze žíly pomocí separátoru V současnosti se krvetvorné buňky získávají dvěma způsoby:

Bone marrow collection

 * From the pelvic bones (puncture into the pelvic bones and suction of the bone marrow - maximum 1500 mL, according to the weight of the donor), under anesthesia,2–3 days in the inpatient department of a specialized collection center; convalescence,
 * after collection, punctures in the pelvic bones hurt, and the donor's condition returns to normal within 7–14 days.

Collection of stimulated stem cells from peripheral blood

 * Outpatient without anesthesia,
 * collection is preceded by stimulation of hematopoietic cell production (four evenings before the collection, the donor receives 1-2 injections of a stimulant, resulting in hematopoietic stem cells being flushed into the bloodstream),
 * then, the hemopoietic stemm cells are removed from the vein using a device called separator (this procedure takes several hours),
 * in case of there being an insufiicient number of collected cells, it is necessary to perform a shorter additional collection the following day,
 * the donor may have different reactions to the stimulant, usually bruising in the bones and lower back, headaches, tiredness (symptoms are similar to those of a flu),
 * the problems caused by the stimulation disappear shortly after collection..

Transplantation procedure
Hematopoietic stem cells are given through a vein (similar to a transfusion) and end up in the bone marrow, where they settle. Before the transplant, the patient must be prepared by chemotherapy or whole-body irradiation to destroy their bone marrow. After the allogenic transplant, the patient must receive immunosupressants.

Czech Registry of Hematopoietic Cell Donors
Formerly called the Czech Register of Bone Marrow Donors, * it was established in 1991 at the Institute of Clinical and Experimental Medicine (IKEM) in Prague. Registry records and searches for potential donors for Czech and foreign patients on the basis of tests known as "typing HLA" (Human Leukocyte Antigen - a system of hereditary character on white blood cells, which very diverse and significantly affects the mutual compatability of the transplanted cells and the body of the patient; it is therefore necessary to have a wide range of possible combinations of HLA traits available to find the same donor, which in practice means having a sufficient number of donors). There are more than 60 registries in the world, in which almost 19 million people are already registered.

Conditions for entering the register

 * Age 18–35 years (records in the register up to 60 years of age, unless a person requests exclusion or there are circumstances preventing the possible donation of hematopoietic stem cells),
 * good health and no serious diseases (infectious jaundice, tuberculosis, severe asthma, AIDS, serious diseases of the blood, blood vessels, heart, chronic diseases of the internal organs, diabetes),
 * if a person does not take certain drugs for a long time,
 * weight of at least 50 kg,
 * inital blood collecion and provision of contact details to the registry database..

How to find a donor for a patient

 * Genetic markers on white blood cells (HLA) are determined from a blood sample taken at entry into the registry,
 * in case of agreement in the basic genetic traits with the patient, further blood collection follows – more dtailed blood tests that specify the degree of agreement with the patient,
 * if the necessary degree of agreement between the donor and the patient is confirmed on the basis of blood tests, preparations for hematopoietic stemm cell collection will begin (detailed medical examination: blood collection for laboratory tests, heart and lung X-ray - in case of a bone marrow collection, also a pelvic X-ray, ECG, internal examination, possibly additional examination).

Related articles

 * The main histocompatability complex
 * Genetics of transplants, transplant laws