Abstract
Blood banking is a long and complex process requiring an accurate screening of potential donors and high-quality control systems. Previous studies in literature investigated factors potentially determining a higher cell levels with the aim of optimizing donors’ selection and improving banking process. This study aims to identify factors associated with the concentration of stem cells in umbilical cord blood, so increasing the probability of bankability, focusing on the possible implications in terms of obstetric and resources management. This is a retrospective study conducted in the Obstetric Units of two Italian Hospitals in Montebelluna and Castelfranco Veneto. Study has been conducted on cord blood units banked between 1999 and 2015. Data on medical histories and clinical characteristics of mother and baby have been retrieved via a retrospective examination of medical records. A total of 869 cord blood units were studied. At multivariable analysis, in agreement with literature, birthweight and placental weight have been found to be associated with higher concentration of total nucleated cells. As additional factor, amount of fluid infused was associated with cord blood units’ count. This study is the first one to clearly identify the role of fluid infusion on cord blood units’ counts in addition to placental weight and delivery. Some non-modifiable features can help in predicting bankability from pre-natal aspects to factors more related with obstetric management is suggested.
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References
Akyurekli C, Chan JYS, Elmoazzen H et al (2014) Impact of ethnicity on human umbilical cord blood banking: a systematic review. Transfusion 54:2122–2127. https://doi.org/10.1111/trf.12630
Allergy Immunology (2007) Cord blood banking for potential future transplantation. Pediatrics 119:165–170. https://doi.org/10.1542/peds.2006-2901
Al-Sweedan SA, Musalam L, Obeidat B (2013) Factors predicting the hematopoietic stem cells content of the umbilical cord blood. Transfus Apheres Sci 48:247–252. https://doi.org/10.1016/j.transci.2013.01.003
Aroviita P, Teramo K, Hiilesmaa V et al (2004) Birthweight of full-term infants is associated with cord blood CD34+ cell concentration. Acta Paediatr 93:1323–1329. https://doi.org/10.1111/j.1651-2227.2004.tb02931.x
Ballen KK, Wilson M, Wuu J et al (2001) Bigger is better: maternal and neonatal predictors of hematopoietic potential of umbilical cord blood units. Bone Marrow Transplant 27:7–14. https://doi.org/10.1038/sj.bmt.1702729
Bassiouny MR, El-Chennawi F, Mansour AK et al (2015) Optimal method for collection of umbilical cord blood: an Egyptian trial for a public cord blood bank. Transfusion 55:1263–1268. https://doi.org/10.1111/trf.12978
Chandra T, Afreen S, Kumar A, Singh U (2011) Correlation of umbilical cord blood volume with CD34+ cells concentration. Int J Blood Transfus Immunohematol 1:11. https://doi.org/10.5348/ijbti-2011-3-OA-3
Chandra T, Afreen S, Kumar A et al (2012) Does umbilical cord blood-derived CD34+ cell concentration depend on the weight and sex of a full-term infant? J Pediatr Hematol Oncol 34:184–187. https://doi.org/10.1097/MPH.0b013e318249adb6
Chivu M, Nastasia S, Sultana C et al (2007) Optimizing donor selection in order to establish a cord blood banking facility: maternal and obstetric factors impact. cent.eur.j.med 2:180–189. https://doi.org/10.2478/s11536-007-0018-2
Clark RB, Thompson DS, Thompson CH (1976) Prevention of spinal hypotension associated with Cesarean section. Anesthesiology 45:670–673
Cobellis L, Castaldi MA, Trabucco E et al (2013) Cord blood unit bankability can be predicted by prenatal sonographic parameters. Eur J Obstet Gynecol Reprod Biol 170:391–395. https://doi.org/10.1016/j.ejogrb.2013.07.038
Dawood F, Dowswell T, Quenby S (2013) Intravenous fluids for reducing the duration of labour in low risk nulliparous women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007715.pub2
Dlgs 191/07 (2007) Attuazione della direttiva 2004/23/CE sulla definizione delle norme di qualita’ e di sicurezza per la donazione, l’approvvigionamento, il controllo, la lavorazione, la conservazione, lo stoccaggio e la distribuzione di tessuti e cellule umani
Donaldson C, Armitage WJ, Laundy V et al (1999) Impact of obstetric factors on cord blood donation for transplantation. Br J Haematol 106:128–132. https://doi.org/10.1046/j.1365-2141.1999.01507.x
Eslamian L, Marsoosi V, Pakneeyat Y (2006) Increased intravenous fluid intake and the course of labor in nulliparous women. Int J Gynecol Obstet 93:102–105. https://doi.org/10.1016/j.ijgo.2006.01.023
European Parliament and Council (2004) Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells
FDA (1997) Guidance for industry; screening and testing of donors of human tissue intended for transplantation. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/screening-and-testing-donors-human-tissue-intended-transplantation
Filkaszova A, Chabada J, Stencl P et al (2014) Ultrasound diagnosis of macrosomia. Bratisl Lek Listy 115:30–33
Foundation for the Accreditation of Cellular Therapy (FACT) (2016) Cord Blood Bank Standards. http://www.factwebsite.org/cbstandards/. Accessed 10 Oct 2018
Garite TJ, Weeks J, Peters-Phair K et al (2000) A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women. Am J Obstet Gynecol 183:1544–1548. https://doi.org/10.1067/mob.2000.107884
George TJ, Sugrue MW, George SN, Wingard JR (2006) Factors associated with parameters of engraftment potential of umbilical cord blood. Transfusion 46:1803–1812. https://doi.org/10.1111/j.1537-2995.2006.00971.x
Goldman JM (1994) A special report: bone marrow transplants using volunteer donors– recommendations and requirements for a standardized practice throughout the world–1994 update. The WMDA Executive Committee. Blood 84:2833–2839
Harrell FE (2015) Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis, 2nd edn. Springer, Cham
Harris DT (2008) Cord blood stem cells: worth the investment. Nat Rev Cancer 8:823. https://doi.org/10.1038/nrc2418-c2
Hussein AA, Bawadi RM, Tahtamouni LH et al (2014) Feasibility of collecting umbilical cord blood in Jordan and the effect of maternal and neonatal factors on hematopoietic stem cell content. Mediterr J Hematol Infect Dis. https://doi.org/10.4084/MJHID.2014.019
Ichim TE, Solano F, Glenn E et al (2007) Stem cell therapy for Autism. J Transl Med 5:30. https://doi.org/10.1186/1479-5876-5-30
Ilic D, Miere C, Lazic E (2012) Umbilical cord blood stem cells: clinical trials in non-hematological disorders. Br Med Bull 102:43–57. https://doi.org/10.1093/bmb/lds008
Jan R-H, Wen S-H, Shyr M-H, Chiang B-L (2008) Impact of maternal and neonatal factors on CD34+ cell count, total nucleated cells, and volume of cord blood. Pediatr Transplant 12:868–873. https://doi.org/10.1111/j.1399-3046.2008.00932.x
Jones J, Stevens CE, Rubinstein P et al (2003) Obstetric predictors of placental/umbilical cord blood volume for transplantation. Am J Obstet Gynecol 188:503–509. https://doi.org/10.1067/mob.2003.19
Keersmaekers CL, Mason BA, Keersmaekers J et al (2014) Factors affecting umbilical cord blood stem cell suitability for transplantation in an in utero collection program. Transfusion 54:545–549. https://doi.org/10.1111/trf.12340
Lavergne M, Vanneaux V, Delmau C et al (2011) Cord blood-circulating endothelial progenitors for treatment of vascular diseases. Cell Prolif 44(Suppl 1):44–47. https://doi.org/10.1111/j.1365-2184.2010.00722.x
Lim FTH, Scherjon SA, van Beckhoven JM et al (2000) Association of stress during delivery with increased numbers of nucleated cells and hematopoietic progenitor cells in umbilical cord blood. Am J Obstet Gynecol 183:1144–1151. https://doi.org/10.1067/mob.2000.108848
Mancinelli F, Tamburini A, Spagnoli A et al (2006) Optimizing umbilical cord blood collection: impact of obstetric factors versus quality of cord blood units. Transpl Proc 38:1174–1176. https://doi.org/10.1016/j.transproceed.2006.03.052
Manegold G, Meyer-Monard S, Tichelli A et al (2008) Cesarean section due to fetal distress increases the number of stem cells in umbilical cord blood. Transfusion 48:871–876. https://doi.org/10.1111/j.1537-2995.2007.01617.x
Manegold-Brauer G, Borner B, Bucher C et al (2014) A prenatal prediction model for total nucleated cell count increases the efficacy of umbilical cord blood banking. Transfusion 54:2946–2952. https://doi.org/10.1111/trf.12676
Marin JA, Calomfirescu M, Bohalţea R, Ionescu Targoviste C (2011) Impact of maternal and placental pathology on successful umbilical cord blood sampling and cryopreservation
McGuckin CP, Basford C, Hanger K et al (2007) Cord blood revelations—the importance of being a first born girl, big, on time and to a young mother! Early Hum Dev 83:733–741. https://doi.org/10.1016/j.earlhumdev.2007.09.001
National Institute for Health and Care Excellence (NICE) (2008) Antenatal care for uncomplicated pregnancies
Nunes RD, Zandavalli FM (2015) Association between maternal and fetal factors and quality of cord blood as a source of stem cells. Rev Bras Hematol Hemoter 37:38–42. https://doi.org/10.1016/j.bjhh.2014.07.023
Omori A, Takahashi K, Hazawa M et al (2008) Maternal and neonatal factors associated with the high yield of mononuclear low-density/CD34+ cells from placental/umbilical cord blood. Tohoku J Exp Med 215:23–32. https://doi.org/10.1620/tjem.215.23
Omori A, Manabe M, Kudo K et al (2010) Influence of obstetric factors on the yield of mononuclear cells, CD34+ cell count and volume of placental/umbilical cord blood. J Obstet Gynaecol Res 36:52–57. https://doi.org/10.1111/j.1447-0756.2009.01109.x
Omori A, Hirai M, Chiba T et al (2012) Quality-assessments of characteristics of placental/umbilical cord blood associated with maternal age- and parity-related factor. Transfus Apheres Sci 46:7–13. https://doi.org/10.1016/j.transci.2011.10.030
Ouerghi S, Bougacha MA, Frikha N et al (2010) Combined use of crystalloid preload and low dose spinal anesthesia for preventing hypotension in spinal anesthesia for cesarean delivery: a randomized controlled trial. Middle East J Anaesthesiol 20:667–672
Page KM, Mendizabal A, Betz-Stablein B et al (2014) Optimizing donor selection for public cord blood banking: influence of maternal, infant and collection characteristics on cord blood unit quality. Transfusion 54:340–352. https://doi.org/10.1111/trf.12257
R Core Team R (2014) R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2012. ISBN 3-900051-07-0
Rabe F, Kadidlo D, Orsow LV, McKenna D (2013) Establishment of an unrelated umbilical cord blood bank qualification program: ensuring quality while meeting Food and Drug Administration vendor qualification requirements. Transfusion 53:2243–2247. https://doi.org/10.1111/trf.12085
Roura S, Bagó JR, Soler-Botija C et al (2012) Human umbilical cord blood-derived mesenchymal stem cells promote vascular growth in vivo. PLoS ONE. https://doi.org/10.1371/journal.pone.0049447
Shlebak AA, Roberts IA, Stevens TA et al (1998) The impact of antenatal and perinatal variables on cord blood haemopoietic stem/progenitor cell yield available for transplantation. Br J Haematol 103:1167–1171. https://doi.org/10.1046/j.1365-2141.1998.01093.x
Solves P, Moraga R, Saucedo E et al (2003) Comparison between two strategies for umbilical cord blood collection. Bone Marrow Transplant 31:269–273. https://doi.org/10.1038/sj.bmt.1703809
Solves P, Perales A, Moraga R et al (2005) Maternal, neonatal and collection factors influencing the haematopoietic content of cord blood units. AHA 113:241–246. https://doi.org/10.1159/000084677
Surbek DV, Visca E, Steinmann C et al (2000) Umbilical cord blood collection before placental delivery during cesarean delivery increases cord blood volume and nucleated cell number available for transplantation. Am J Obstet Gynecol 183:218–221. https://doi.org/10.1067/mob.2000.105744
Szaryńska M, Kmieć Z, Preis K, Zabul P (2014) The presence of a supporting person during delivery affects cord blood haematopoietic stem cells. J Obstet Gynaecol 34:245–247. https://doi.org/10.3109/01443615.2013.844111
Urciuoli P, Passeri S, Ceccarelli F et al (2010) Pre-birth selection of umbilical cord blood donors. Blood Transfus 8:36–43. https://doi.org/10.2450/2009.0081-09
Wen S-H, Zhao W-L, Lin P-Y, Yang K-L (2012) Associations among birth weight, placental weight, gestational period and product quality indicators of umbilical cord blood units. Transfus Apheres Sci 46:39–45. https://doi.org/10.1016/j.transci.2011.10.031
Wu S, Xie G, Wu J et al (2015) Influence of maternal, infant, and collection characteristics on high-quality cord blood units in Guangzhou Cord Blood Bank. Transfusion 55:2158–2167. https://doi.org/10.1111/trf.13126
Acknowledgements
We are grateful to all the midwives of the Centers for the work of recruitment and for the collection of the cord blood units, the entire staff of the Cord Blood for the processing, and preservation of the umbilical cord blood. We thank the families of the donors for the altruistic choice to donate the cord blood.
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Di Tullio, I., Azzolina, D., Piras, G.N. et al. Factors associated with blood cord unit bankability: an analysis of a 15-year-long case series. Cell Tissue Bank 21, 77–87 (2020). https://doi.org/10.1007/s10561-019-09799-y
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DOI: https://doi.org/10.1007/s10561-019-09799-y