Processing cord blood from premature infants into autologous red-blood-cell products for transfusion.

BACKGROUND AND OBJECTIVES: The use of umbilical cord blood (UCB) for transfusion purposes has gained interest the past years. UCB transfusion could serve premature infants, who often need transfusions early in life. MATERIAL AND METHODS: We investigated the suitability of different storage media. UCB was collected after 25 0/7--35 6/7 gestational weeks and centrifuged to concentrate red cells subsequently stored in saline-adenine-glucose-mannitol (SAGM), or in additive solution-3 (AS-3), or stored as whole blood in citrate-phosphate-dextrose-adenine-1. Quality parameters were measured at 7 day intervals during 35 days and compared to the standard RBC product. RESULTS: White-blood-cell- and platelet counts were higher in the UCB products. In the fractionated units, haemolysis remained below 1·0% in 64% after 14 days, and in 30% after 21 days. Storage in SAGM or AS-3 showed similar quality. Whole blood UCB showed better pH and haemolysis rates after 21 days. CONCLUSION: UCB can be processed into autologous products for premature infants. Shelf-life is limited to 14-21 days and compares unfavourably to stored whole blood. Considering the early transfusion needs in these infants, a short shelf-life would not be a practical objection.

A comparative cohort study on transfusion practice and outcome in two Dutch tertiary neonatal centres.

The objective of this study was to investigate how a red blood cell transfusion volume of 15 or 20 mL kg(-1) body weight affects the total number of administered transfusions and neonatal complications in premature infants born before 32 gestational weeks. In this observational study, we analysed clinical data from two cohorts of 218 and 241 premature infants admitted to two neonatal centres which used the same transfusion guideline and product, but different transfusion volumes. Outcome parameters were the number of administered transfusions and the composite outcome of bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular haemorrhage and mortality. The proportion of transfused infants was significantly lower (59 vs. 77%) in the centre using a lower transfusion volume of 15 mL kg(-1). In infants born between a gestational age of 24 0/7 weeks and 27 6/7 weeks. a similar proportion received transfusions in both centres, with an equal number of transfusions per infant. In infants born between a gestational age of 28 0/7 weeks and 31 6/7 weeks, the proportion of transfused infants (49 vs. 74%) was significantly higher in the centre using a larger transfusion volume. In these infants, transfusion with 20 mL kg(-1) resulted, however, in a mean reduction of one transfusion episode per infant. The higher proportion of transfused infants was associated with a higher pre-transfusion haematocrit in less ill infants, suggesting the use of different triggers based on clinical grounds. Composite clinical complications were similar in both cohorts. Clinical neonatal outcome was similar disregard of a higher proportion of transfused patients and a higher total amount of RBC transfused in one of the centres. A larger transfusion volume of 20 mL kg(-1) prolonged the interval until next transfusion and can reduce donor exposure in infants born between a gestational age of 28 0/7 weeks and 31 6/7 weeks.

The use of cord blood for transfusion purposes: current status.

Although the use of umbilical cord blood (UCB) for transfusion purposes has been proposed decades ago, the employ is still limited. In this article we review studies evaluating UCB collection efficiency and sterility, examine processing and storage of UCB-derived red blood cells (RBC) and discuss clinical studies in which UCB was used for transfusion purposes. Efforts to provide preterm newborns with autologous RBC derived from UCB have not been very successful. UCB collected after full-term deliveries can however easily be processed into RBC products and could be used autologous in case surgery of the neonate is indicated early after birth, or for allogeneic small volume paediatric transfusions. To harvest enough UCB volume, immediate clamping of the umbilical cord is commonly used as standard practice. Although delayed cord clamping has shown to improve the iron status in full-term infants; for small-for-gestational-age infants this has not been demonstrated. In addition, an increased need for phototherapy after delayed clamping exists. Altogether, we could find no disencouraging evidence to collect UCB, which could be processed into an easily available RBC product for paediatric transfusion in resource-restricted countries.

[Need for blood transfusion in premature infants in 2 Dutch perinatology centres particularly determined by blood sampling for diagnosis]. / Bloedtransfusiebehoefte bij prematuren in 2 Nederlandse perinatologische centra sterk bepaald door bloedafname voor diagnostiek.

OBJECTIVE: Determination of factors related to the need for transfusion in premature infants. DESIGN: Descriptive. METHOD: The need for transfusion in premature infants was determined in 2 academic centres: University Medical Center Utrecht and Leiden University Medical Center, The Netherlands. The data had been acquired in another study. The factors under study were: hospital, pregnancy duration, birth weight, gender, time of clamping of the umbilical cord, total volume of blood sampled for diagnostic purposes, number of days of mechanical ventilation, total duration of admission and duration of the admission to the Neonatal Intensive care unit. Both hospitals followed the national interdisciplinary practice guideline 'Blood transfusion'. RESULTS: The total volume ofsampled blood for diagnosis, the duration of the mechanical ventilation and the admission period were related to a greater need for transfusion. On the other hand, the chance of transfusions diminished with longer pregnancy duration or increased birth weight. The difference in need for blood transfusion between both centres was significant. The total volume of transfused erythrocytes showed a strong correlation with the volume sampled for diagnostic procedures. CONCLUSION: Anaemia in neonates is strongly related to the amount of blood taken for diagnostic procedures. Alternatives for blood transfusions in premature infants, and consequently for the reduction of the number of donors per child, are to be sought in delayed clamping of the umbilical cord, use of erythropoietin and use ofautologous umbilical cord blood.