Sergey, 36, a Russian-born mechanical engineer from New York, reclines in bed in the Apheresis Unit at Rambam. He is hooked up to an imposing machine with dials, sensors, and tubes that feed their viscous red, pinkish and yellowish contents into suspended, plastic blood bags.
Sergey received word a week ago that his elder brother, who lives in Israel, had been diagnosed with leukemia and would receive chemotherapy followed by bone marrow transplantation (BMT), an aggressive strategy intended to replace a person's failed immune system. Sergey booked an urgent flight and came to Rambam to donate stem cells.
If you're thinking Bloodmobile with the juice and the cookies, think again.
First, a sample of Sergey's blood was type-tested for compatibility with his brother's blood. Luckily, the two men fell into the 25% category of siblings that match, although Sergey's brother will nevertheless receive high-dose immunosuppressant medication against graft-versus-host disease (GVHD).
Sergey spent the next five days injecting himself twice daily with Neupogen, a drug that increases the body's production of young stem cells in order to create a surplus for harvest.
"Do you remember the last time you had a serious flu?" Sergey asks rhetorically. "That's what [an excess of white-cell production in the bone marrow] feels like without the fever: aching bones and joints."
The machine to which Sergey is connected is an apheresis device. A large steel suction needle taped to his right arm draws out his blood, which passes through a centrifuge that separates blood into its component parts according to relative densities: yellowish plasma with suspended platelets (coagulants), young white cells (stem cells), mature white cells (immune system infection-fighters) and red cells (oxygenators). A pump feeds anticoagulants into the centrifuge to keep the blood from clotting during collection.
"We are harvesting Sergey's young stem cells, the factory for all the blood cells," explains biochemist Dr. Lilach Bonstein, Deputy Director of the Blood Bank and Apheresis Unit at Rambam.
His brother won't require Sergey's red blood cells but, of course, Sergey does, so they're flowing from the centrifuge back into his body via a catheter taped to his left arm. On this warm day, Sergey has pulled a blanket up to his chest. A film of cold sweat glistens on his forehead. He's cold because his blood isn't being returned to him at body temperature.
Stem cell collection by apheresis takes six hours, and as it progresses, Sergey reports feeling better and better: "Imagine you've been taking medicine to increase your white cell counts and all of a sudden, they collect the surplus; it's like flying! But no matter how you feel physically during this procedure, it's irrelevant," he adds. "People do it for their family."
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LIQUID GOLD
What if a BMT patient lacks a nearby or sufficiently large family, or no match among family members is found?
Dr. Bonstein explains that although red-cell and platelet units are available for purchase from Magen David Adom (MDA), BMT patients consume blood products, especially platelets, in huge quantities throughout their 1-2 month recuperation. Hospitals prefer apheresis single-donor platelet units whenever possible because one such unit equals 6-12 portions from MDA and goes easier on patients' compromised immune systems. "For us," she says, "single-donor units are like gold."
Whenever Dr. Bonstein needs platelets or other blood products on behalf of a patient with a small or far-away family or no family at all, she conveys the patient's blood type to the Seret Vizhnitz Hasidic Community (est. 1951), the largest Hasidic population in the North, which immediately sends over yeshiva students.
"They are willing to come whenever we need them," Dr. Bonstein says gratefully. "We use 1,000 units of single-donor platelets per year, and almost 10% comes from them." |