Subject(s)
Cyclosporine/pharmacology , Immunologic Memory/drug effects , Immunosuppressive Agents/pharmacology , Killer Cells, Natural/drug effects , Aged , Aged, 80 and over , Drug Resistance , Humans , Immunologic Memory/immunology , Infant, Newborn , Killer Cells, Natural/immunology , Transplantation, HomologousSubject(s)
Aging/immunology , Cyclosporine/pharmacology , Graft Rejection/immunology , Immunosuppressive Agents/pharmacology , Isoantigens/immunology , T-Lymphocytes, Cytotoxic/drug effects , Acute Disease , Adult , Aged , Drug Resistance/physiology , Female , Histocompatibility , Humans , Immunity, Cellular/physiology , Infant, Newborn , T-Lymphocytes, Cytotoxic/immunologyABSTRACT
The Bristol Cord Blood Bank was established as a pilot project within existing health services to establish cost-effective recruitment, collection and processing suitable for use in the NHS should cord blood become a routine source of haemopoietic stem cells for transplantation in the UK. An important aim of the project was to evaluate the feasibility of establishing a midwifery-based collection network, thus utilising expertise already in place. Collection was performed on the delivery suite immediately after the placenta was delivered. The clinical experience of the midwife collector/counsellors allowed rapid pre-collection assessment of the condition of the cord and placenta. This prevented collection attempts from diseased or otherwise damaged placentas, leading to conservation of resources by preventing collection of most small volume donations. The bank was established within the National Blood Service, Bristol Centre to achieve Good Manufacturing Practice standards and ensure that processing was subject to the same stringency required for other sources of haemopoietic stem cells. Cord blood is an expensive resource. By utilising existing expertise in district Obstetric and National Blood Services, the Bristol Cord Blood Bank may serve as a model for health economic evaluation of cord blood banking of volunteer donations within the NHS.
Subject(s)
Blood Banks/organization & administration , Fetal Blood , Blood Banks/economics , Blood Banks/trends , Blood Preservation/methods , Blood Preservation/standards , Costs and Cost Analysis , Counseling/methods , Cryopreservation/methods , Cryopreservation/standards , Delivery, Obstetric , Family Health , Fetal Blood/microbiology , Fetal Blood/virology , Forecasting , Health Workforce , Hematopoietic Stem Cell Transplantation , Humans , Midwifery , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/standards , Pilot Projects , Placenta , Quality Control , Specimen Handling/methods , Time Factors , Tissue Donors , United KingdomABSTRACT
Recent reports have shown that low nucleated cell dose significantly decreases survival after cord blood transplantation. Prior to starting clinical cord blood banking we investigated the impact of obstetric factors on cell dose and volume of cord blood donations. Cord blood was obtained from 114 normal full-term deliveries. Mean volume collected was 93.5 ml, mean total nucleated cell count (TNC) was 13.1 x 108. Statistical analysis was by backwards stepwise regression. Significant factors affecting nucleated cell yield were volume of blood collected (P < 0.001), length of gestation (P < 0. 0001), time from delivery of the infant to cord clamping (P = 0.018) and total length of labour (P = 0.002). In clinical cord blood banking we have successfully used these findings for pre-collection assessment of placentae. Out of 476 cord blood donations subsequently collected for banking, only 29 (6.1%) have been discarded due to low volume. The mean TNC of the 409 banked units following volume reduction was 10.1 x 108. Despite careful optimization of collection, processing and storage techniques, cell dose still limits cord blood transplantation to smaller recipients.
