Autologous Placental Blood Transfusion for the Therapy of Anaemic Neonates

Abstract

Almost 65% of all premature neonates with a birth weight <1,500 g receive at least one erythrocyte transfusion during their first weeks of life. In the present study, we examined the feasibility of autologous transfusions in neonates, using placental blood. Placental blood was obtained from 131 of 141 preterm and term infants using a special placental blood collecting system. Approximately 20 ml of placental blood per kilogram body weight could be harvested, irrespective of birth weight. One placental blood sample was contaminated with maternal erythrocytes; aerobe or anaerobe contamination was observed in any of the stored placental blood products (n = 119) after 35 days of storage. 19 of the 141 newborns needed allogeneic erythrocyte transfusions during the first 12 weeks of life. In 5 of these 19 patients, the amount of placental blood collected would have been enough to dispense with further allogeneic blood transfusions. After completion of the preclinical study, we transfused a total of 22 children, using autologous placental blood. 8 of the 10 infants with a birth weight between 1,000 and 2,000 g and 3 of 5 infants requiring surgical intervention directly after birth needed no further allogeneic blood transfusions. We, therefore, conclude that the collection and preparation of placental blood is feasible for clinical use. The target groups of neonates who are most likely to benefit are infants with a birth weight between 1,000 and 2,000 g and neonates requiring surgical intervention directly after birth.

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“…31 Moreover, increased RBC fragility and an increase in the potassium concentration also have been reported; however, these occurred at levels similar to those observed in adult RBCs under the same storage conditions. 31 Similarly, in our study, we observed decreased values of pH, hematocrit concentration, and hemoglobin levels, as well as considerably increased levels of sodium and potassium ion and glucose concentration in the CB just before transfusion versus that shown in the RBC concen trate. However, differences were not statistically significant.…”

“…These results are similar to those obtained by Brune and associates, who collected approximately 20 mL of CB/kg of body weight, irrespective of birth weight. 31 In addition, Jansen and associates reported on the volume of CB collected in relation to the transfusion needs of 288 premature infants with gestational age between 24 and 36 weeks. They found that the collection of CB is most effective and efficient for premature infants between 29 and 31 weeks of gestation.…”

“…Various authors have shown that the quality of stored CB is comparable to that of stored adult blood. 31 Although a decrease in intracellular ATP concentration and pH was observed after long-term storage of CB, erythrocytes are capable of regenerating these properties within 24 hours after transfusion. 31 Moreover, increased RBC fragility and an increase in the potassium concentration also have been reported; however, these occurred at levels similar to those observed in adult RBCs under the same storage conditions.…”

“…31 Although a decrease in intracellular ATP concentration and pH was observed after long-term storage of CB, erythrocytes are capable of regenerating these properties within 24 hours after transfusion. 31 Moreover, increased RBC fragility and an increase in the potassium concentration also have been reported; however, these occurred at levels similar to those observed in adult RBCs under the same storage conditions. 31 Similarly, in our study, we observed decreased values of pH, hematocrit concentration, and hemoglobin levels, as well as considerably increased levels of sodium and potassium ion and glucose concentration in the CB just before transfusion versus that shown in the RBC concen trate.…”

Is autologous cord blood transfusion effective and safe in preterm infants?

“…Placental vessels contain a quarter to a third of the newborn blood volume, and the fetal blood left in the placental vessels may serve as a source of autologous blood 7,8 . Although studies have shown that the collection and the storage of UCB are feasible for transfusion in newborn infants, the use of UCB for transfusion in preterm infants is reported in few studies 5,[8][9][10][11][12] . We previously tested the safety and feasibility of the collection and storage method of the autologous blood 13 .…”