The number of CD34+ cells harvested in a single leukapheresis can be predicted by measurement of the preceding day peripheral-blood circulating CD34+ concentration, and on the basis of these data a table of probable CD34+ cell yield has been constructed. This correlation may facilitate the efficient organization of leukapheresis procedures.

Summary:blood, but their numbers can be dramatically, albeit transiently, increased following treatment with conventional chemotherapy and administration of haemopoietic growth An essential prerequisite for successful procurement of sufficient autologous peripheral blood progenitor cells factors such as granulocyte colony-stimulating factor (G-CSF). 4,5 After mobilisation the PBPC are removed from the (PBPC) for engraftment is the optimal timing of collection. A number of surrogate markers of peripheral patient's circulation by apheresis and the adequacy of the collection is assessed by the product's content of nucleated blood progenitor cells were analysed to identify a single test which could predict the optimum time to harvest, cells, mononuclear cells, granulocyte-macrophage colonyforming units (CFU-GM) or CD34 + cells. providing at least 2 × 10 6 CD34 + cells/kg patient body weight. The study comprised 95 patients undergoingThere is a tremendous variation in the yield of haemopoietic progenitor cells obtained from patients following varied mobilisation regimens with chemotherapy and G-CSF for both solid tumours and haematological mobilisation which results in some patients requiring only one leucapheresis whereas others require two, three or even malignancies. One hundred and fifty-seven PBPC harvests were collected. Full blood counts (FBC) and four procedures. A number of different protocols are used to mobilise PBPC and the decision as to when to commence CD34 ؉ cell enumeration was performed on blood samples taken during the mobilisation period and the apheresis procedure is generally based on the patient's white cell count (WCC). Obviously the successful procureimmediately prior to leucapheresis (pre-harvest). All PBPC collections were assayed for colony-forming cells ment of sufficient PBPC to ensure haemopoietic engraftment is essential. To ensure that this goal is achiand CD34 ؉ cells in addition to a FBC. The white cell count on the day of harvest showed only weak correeved, with the least number of leucapheresis procedures, the optimal time for collection must be predicted as acculation with the total number of CD34 ؉ cells in the collection (r = 0.30). In contrast, the absolute number of circurately as possible. This is not only advantageous for the patient but also for both operational and financial lating CD34 + cells strongly correlated with the CD34 ؉ cell and CFU-GM yield of the corresponding apheresis efficiency. This study involved the analysis of the WCC, monoproduct. Provided the mobilisation sample contained у20 × 10 6 CD34 ؉ cells/ml, 94% of single collections, nuclear cell count (MNC), CD34 + cells and colony-forming units (CFU) on samples obtained from 95 patients with both performed the following day, contained у2 × 10 6

Summary:Clinical evidence indicates that placental/umbilical cord blood (CB) is an alternative source of haematopoietic stem cells for bone marrow reconstitution. To establish a CB bank large panels of frozen, HLA-typed CB units need to be stored. Cryopreserved, unprocessed CB units require vast storage space. This study describes a method, using the Optipress II Automated Blood Component Extractor (Opti II) from Baxter Healthcare Corporation, to reduce the volume of the CB collection, preserving the quantity and quality of the progenitor cells, in a closed system. The CB collection was transferred to a triple bag system, centrifuged to produce a buffy coat layer and processed using a standard Opti II protocol to separate the whole blood into three components: plasma, buffy coat and buffy coat-depleted red cell concentrate. The buffy coat volume was standardised to 25 ml; mean reduced volume of 24.5 ml (s.d. 1.5 ml) with 53% red cell depletion. Good recovery of cells was observed: 92%, 98%, 96% and 106% recovery of nucleated, mononuclear, CD34 ϩ and total colonyforming cells, respectively. Using this method for processing CB units reduces storage requirement by two-thirds but preserves the quantity and quality of the progenitor cells. Keywords: cord blood; cord blood bank; processing; volume reduction; progenitor cells; transplantation Cord blood (CB) is increasingly used as an alternative source of stem and progenitor cells for the reconstitution of BM and sustaining long-term haemopoietic recovery in both unrelated and related recipients. 1-3 It offers several advantages over BM in that it is obtained without risk to either mother or infant, it has a decreased likelihood of transmitting infections -particularly pertinent for cytomegalovirus -and it can be stored fully tested and HLA typed, in the frozen state, available for immediate use. Recent clinical data 1-3 indicate that CB transplants may result in reduced severity of acute GVHD, allowing the use of parCorrespondence: S Armitage, London Cord Blood Bank, Deansbrook Road, Edgware, Middx HA8 9BG, UK Received 7 September 1998; accepted 24 September 1998 tially HLA-matched units and thus increasing the chance of finding donors for patients.To achieve a viable bank, providing a broad range of HLA-typed CB units, the storage of a large number of units is essential. The major logistical problem with such longterm banking is the required storage space, particularly when the CB units are stored unprocessed. Several different methods have been employed to reduce the volume of the CB unit, prior to cryopreservation of the cells, while minimising loss of either nucleated cells (NC) or progenitor cells: density gradient separation -standard 4 or modified techniques 5 -sedimentation of red cells by gelatin, 6 rouleaux formation induced by hydroxyethyl starch and centrifugation to reduce both erythrocytes and plasma 7,8 and differential centrifugation with manual 9 or automated 10 expression of RBC and plasma. The majority of these methods are not performed in a closed...

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Continuity of patient care between hospital and community is becoming increasingly important with a trend to shorter hospital stays and more care in the community. This paper describes how community nurses determine patient care provision after hospital discharge. The research presented is a component of a larger study exploring the interface of hospital and community nursing services. Semi-focused interviews were conducted with twelve community nurses to elicit their perceptions and experiences of discharge planning. The findings revealed that although discharge planning influenced continuity of care, community nurses make autonomous decisions about the provision of care to patients in the community setting.