Questions

1 What are the adverse effects associated with haematopoietic stem cell donations?

2 Which method of haematopoietic stem cell donation (i.e. bone marrow harvest versus peripheral stem cell collection) is more tolerable and safer for the healthy donors?

Relevance to nursing care

Nurses play a significant role in preparing healthy donors in pre- and post-haematopoietic stem cell donation procedures. Therefore, it is vital for the nurses to educate and pre-empt the donor for the potential adverse effects and provide assurance in relation to their experience.

Study characteristics

Six trials with 807 donors were included in the review.1 All trials were part of larger randomised controlled trials of bone marrow and peripheral blood stem cell allogenic transplants. No significant differences were noted in the age or gender of donors, with all donors being related to the recipient. The methodological quality of the studies was poor because of attrition bias and failure of long-term follow up. Adequate allocation concealment was evident in one trial. Blinding of the assessor of outcomes and the donors was not possible in this setting. Meta-analysis was also not possible because of different tools used to measure each outcome, the different time points of outcome assessment and the presentation of data in some of the included trials. The major review findings were presented in narrative form as follows:

* More bone marrow donors experienced pain at the donation site in comparison with peripheral blood donors (five trials).

* Both groups experienced pain in subsequent donations, with bone marrow donors experiencing more back pain and peripheral blood donors experiencing more skeletal pain (six trials).

* Bone marrow donors were more likely to develop haemorrhage, anaemia and hypotension in comparison with peripheral blood donors (six trials).

* Bone marrow donors experienced more days of restricted activity and more discomfort in comparison with peripheral blood donors (five trials).

* Both groups demonstrated increased fatigue and reduced energy and anxiety following the procedures (three trials).

* Four trials measured incidence of life-threatening adverse events related to donation and none of them reported any events.

Implications for nursing care

In either method, the haematopoietic stem cell donors experienced pain and mood disturbance. Therefore, adequate pain control and psychological support are important elements in providing care for the donors undergoing haematopoietic stem cell collection.

Implications for research

Future research should focus on conducting further primary trials that use standardised instruments to measure outcomes and have a long-term follow up on adverse events related to haematopoietic stem cell collection.

National University Cancer Institute, Singapore A member of the Cochrane Nursing Care Network (CNCN)

Reference