tests of your liver and kidneys to determine that these organs 
are functioning well. You (your child) will have approximately 
100/ml of blood or 1/2 cup removed for chromosome studies, 
determination of colony- forming cells, and DNA and RNA analysis. 
You will sign a separate consent form for the bone marrow 
aspiration and biopsy, which will be done with a local anesthetic 
on the 2West Hematology ward. Bone marrow aspiration and biopsy 
have minimal risks, but do include local pain, bleeding, and 
infection at the puncture site. 
COLLECTION OF PERIPHERAL BLOOD STEM CELLS 
G-CSF Administration : To increase the number of immature CD34 
cells in the blood, the drug G-CSF will be given to you (your 
child) either as an outpatient in the clinic or as an inpatient 
at the Clinical Center. This drug stimulates the bone marrow to 
release CD34 cells into the blood, where they can be more easily 
collected. Daily under- the- skin injections of G-CSF will be 
given for 1 week. G-CSF may cause fever, flu- like symptoms, 
muscle aches, bone pain, rash, redness at the injection site, a 
decrease in the platelet count, and temporary worsening of skin 
conditions such as psoriasis and eczema. You (your child) will 
be treated for any of these symptoms if they occur. They 
disappear after discontinuation of the drug. 
Central Line Placement : On the 4th or 5th day after starting G- 
CSF, you (your child) will have a special intravenous line called 
a "central line" inserted into a large vein in your groin, neck, 
or chest. This will be done using local anesthesia by a line 
insertion specialist. You will sign a separate consent for this 
procedure. This line is needed for the collection of CD34 cells 
from your blood. If your platelet count is very low, we may give 
you (your child) a platelet transfusion before inserting this 
line. You (your child) may have mild pain and bruising at the 
insertion site. Rarely, infections or more serious bleeding 
develop at the insertion site, which can be treated by removal of 
the line, antibiotics, or pressure to the site. It will be 
removed on day 7, after completion of CD34 cell collection. 
Apheresis : On days 5, 6, and 7 after beginning G-CSF, you (your 
child) will undergo a procedure called apheresis to collect the 
CD34 cells in your blood. Your circulation will be connected to 
an apheresis machine through one opening in your central line, 
and blood will slowly flow through the machine for 1-3 hours. 
The machine separates out and saves a fraction of your blood 
containing CD34 cells, while continuously returning red blood 
cells, platelets, and plasma to you (your child) through the 
second opening in your central line. After the apheresis ends, 
the central line will be removed. Apheresis has very few side 
effects, but some patients experience light-headedness, nausea, 
or tingling in the fingers and toes. These symptoms can be 
corrected by slowing down the flow through the machine. The G- 
CSF will be discontinued on day 7. Repeated apheresis can make 
patients anemic; there is a very small possibility that you (your 
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Recombinant DNA Research, Volume 19 
