Post-donation guidelines

Private GP Appointments

If a donor is unable to access their GP, or their GP is unable to provide a timely appointment, DFU can arrange referral to a private GP practice close to the donor’s home and cover the costs. This does not need to be raised as a SAR to track the cost if it is just a one-off appointment. If a series of appointments is required, for example a course of physio sessions, it should be raised as a SAR.

Emotional and Physical Recovery

The Young Donor Project found a possible link between emotional and physical recovery post-donation. Donors who experience emotional distress post-donation may find it reflected in a slower physical recovery, and vice versa. If a donor is experiencing extreme distress or low mood during any conversation with Anthony Nolan then this will be discussed with the medical officer immediately. If the donor is at risk of immediate harm the Anthony Nolan Safeguarding procedure will be followed.

When speaking to donors for the day 2/3 follow up call, it is standard procedure to ask the donor about their emotional wellbeing. It may be appropriate at this point to bring this possible link between emotional and physical recovery to their attention, to encourage them to be aware of their recovery in a holistic sense and encourage them to reach out for support if needed.

If the donor notes feeling worse than usual emotionally, or notes any distress whether directly related to the donation process or in their own life, it may be appropriate to discuss the following with them:

What are the things causing stress/distress now?

Has the donation process itself impacted their emotional wellbeing, or brought up/amplified difficult emotions?

What support do they have? (e.g. is there anyone in their family or friends, social/religious/work group that they feel comfortable talking to, or any activity that they find relaxing/a good distraction)

If they don’t have any support in place; what kinds of things do they think may be helpful for them? (e.g. do they find talking helpful, or prefer to find other activities to distract them etc.)

If a donor feels worse emotionally after the donation, DFU will offer a second follow-up phone call a week after donation to check in on their wellbeing. If in this call a donor is still experiencing low mood or distress, then it should be discussed with the DFU Manager and the Medical team. It may be appropriate to offer the option of counselling sessions with Anthony Nolan’s counsellor, or the Medical team may advise the donor to see their GP for further support. This will be decided on a case-by-case basis. DFU does not provide counselling or psychological support for the donor themselves but, following the training and guidance from regular clinical supervision sessions, offers a safe and non-judgmental space for the donor to talk through how they are feeling. Through these discussions DFU will gather the relevant information from the donor to share with the Medical Team and DFU Manager to determine next steps.

Abdominal Swelling and Pain or Discomfort (PBSC)

Anthony Nolan Recovery Data

No Anthony Nolan recovery data for infection at donation site is currently available. This section will be updated as and when this data is available.

Symptom Overview and Initial Conversation with Donor

The main concerns with pain and discomfort on the upper left side of the abdomen that develops during GCSF injections, or shortly after the donation (within 14 days), are issues relating to the spleen.

Many donors who receive GCSF will develop a slight enlargement of the spleen that settles after donation5. However, in some rare cases there may be more serious complications.

If the donor is experiencing moderate to severe pain on the upper left side of the abdomen, and/or if they feel very unwell, weak, or faint; inform the Medical Team immediately and advise the donor to seek immediate medical attention.

If the swelling or discomfort is mild and/or not left sided, please ask:

When did it start?

How would they rate the pain/discomfort?

Have they taken any painkillers? If yes, what painkillers did they take, and did it help?

Where is the pain located? (e.g. all over the stomach/abdomen, or more in one area?)

Have they recently had any injuries to their stomach or abdomen through impact/a fall, or have they recently done more strenuous exercise than usual?

Any nausea, or feeling unusually full/bloated after eating small amounts?

Any visible swelling across the stomach/abdomen?

Any bruising, redness, or a rash?

Management of Symptoms

In most cases, enlarged spleen will return to normal within about 14 to 21 days. Flag the issue to the Medical Team in all cases, but if it is only mild swelling or discomfort of the upper abdomen, advise the donor that this should reduce over time. Advise them to avoid any situations where there is risk of impact to the area until it resolves (e.g. contact sports).

If the swelling continues for over 21 days, speak with Medical Team again, and if appropriate, they may refer the donor to their GP or to the Collection Centre for scans.

DFU to follow up with the donor until the swelling and pain or discomfort resolves.

Back Pain (BM only)

Anthony Nolan Recovery Data

January 2020-2022: At day 2/3, 56% of donors note pain at donation site, 27% note stiffness, and 9% note muscular pain.

At day 7, 39% note pain at donation site, 37% note stiffness, and 24% note muscular pain.

At day 30 4% note pain at donation site, 4% note stiffness, and 5% note muscular pain6.

Symptom Overview and Initial Conversation with Donor

Pain and discomfort around the donation site, along with stiffness and back ache, is very common for at least the first week post-bone marrow donation and may continue up to a month.

As advised in the Post-Donation Thank You Leaflet (DOC 1429), remind donors to avoid strenuous activities for 7-14 days, and encourage them to make a gradual return to their usual level of activity as they feel able to.

The donor may try the following to help alleviate the pain:

Short walks may help with stiffness of the muscles and reduce pain

Painkillers as needed. Donors may receive painkillers from the Collection Centre, but if not, they can take paracetamol or co-codamol (not to be used at the same time as both contain paracetamol), or they can use ibuprofen from 72 hours post-donation provided there are no complications such as bleeding from the donation site or extensive bruising, and the collection centre has not advised against using it (aim to use no longer than 14 days, and avoid this if they have any stomach ulcers or indigestion issues).

If there is any mild swelling across the lower back, applying a cold compress or ice pack for 10 minutes at a time may help.

Management of Symptoms

If the back pain, stiffness, or discomfort is continuing at 4 weeks post-donation, or if the pain is severe, contact the Medical Team with a summary of the donor’s current symptoms.

Ask the donor:

Any change, improvement, or worsening, of the back pain in the 4 weeks since donation?

Location of the pain

Is the pain constant, only after exercise, only at night etc.?

Do they take any painkillers currently? If yes, what do they take and how often?

Does light exercise or stretching help at all (if they have tried that)?

How severe is the pain?

Send the responses to the Medical Team to discuss further. If required, and if agreed by the Medical Team and DFU manager, the donor may be referred for physiotherapy for 4-8 sessions to support their recovery. DFU will send the referral letter to a local physio once permission has been received from the donor to share their details.

In cases of severe pain, the Medical Team may refer the donor to the specialist, Professor Hart at Joint Recon (https://www.jointrecon.com). DFU will send the referral letter by encrypted email to his secretary, Elizabeth Hart ahartmedsec@ccf.org , requesting a review and MRI if needed.

In both referral cases, a SAR will be raised by DFU. The donor is seen as a private patient and the SAR will be used to track their recovery and incurred costs. DFU will follow up with the donor until they are fully recovered.