During the procedure, blood is prevented from clotting in the extracorporeal circuit by a citrate‐based anticoagulant. This functions by binding the calcium in the blood and removing it from the clotting cascade. Donors may experience symptoms of hypocalcaemia, such as muscular irritability, tetany, numbness and ‘pins and needles’ in extremities, light‐headedness, nausea and vomiting (Freshwater and Maslin‐Prothero [42]). This side‐effect is known as citrate toxicity and is controlled by giving the donor calcium supplements or reducing the dose of citrate administered by decreasing the blood flow rate (Stroncek et al. [107]).

Different procedures may produce varying haemodynamic effects. Fluid overload may be a problem for patients with cardiac or renal impairment, whereas hypovolaemia may be of concern in the paediatric setting (Crookston and Novak [26]). Blood pressure in particular should be monitored, as hypotension may occur.

With red cell and plasma exchanges, patients may experience transfusion reactions, for example fever, chills and allergic reactions (see Chapter c12: Respiratory care, CPR and blood transfusion).

There is a potential for cellular loss, particularly platelets, as large volumes of donor or patient blood circulate through the apheresis machine and blood cells are intentionally or incidentally removed. Studies show that individual apheresis procedures produce only modest decreases in circulating blood cell counts, which are not associated with immediate toxicity (Crookston and Novak [26]). Patients with underlying instabilities or those undergoing repeated procedures may need to be supported by blood component transfusion. These are monitored closely by the apheresis nurse who is providing one‐to‐one care with the patient. Repeated monitoring of blood counts throughout the procedure is necessary.

Any adverse reaction must be dealt with promptly and must be documented. The patient/donor must have recovered as fully as possible before being allowed to leave the facility (Howell et al. [52]).

Patients and donors should be encouraged to rest and take refreshment before leaving the cell separator facility. A full blood count should be taken at the end of the procedure and advice given depending on the result. For instance, there is a potential for platelet loss during stem cell collections by means of apheresis and patients and donors should be advised to moderate alcohol consumption and avoid strenuous exercise and activities that may put them at risk of bleeding or bruising. The platelet count usually recovers within a few days (Crookston and Novak [26]).

Apheresis should be strictly regulated within a quality management system with clear standard operating procedures and documentation. Archived documentation should be maintained according to governmental, regulatory or institutional policy, whichever is longer (FACT‐JACIE [40]). Due to the strict regulatory nature of apheresis, a record‐keeping system must be in place to ensure the authenticity, integrity and confidentiality of all documents (MHRA [76]). All nursing records must be clearly maintained to ensure accurate data (NMC [86]).

If the donor or patient is likely to feel fatigued, it is sensible that someone accompanies them home. Advice needs to be customized to the particular procedure undertaken.