The use of cord blood for transfusion purposes: current status

Abstract

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.

Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates

“…Earlier studies by Golden et al demonstrated bacteriologic safety of this practice when the blood is used within 4 h of delivery 94 95. We predict that as better means are developed for harvesting and administering autologous fetal blood from extremely preterm deliveries, the benefits of using this blood, rather than donor blood, for early transfusions will outweigh the risks,103–106 and that this will become one of a number of means of reducing the need for donor blood for certain VLBW neonates.…”

Comparison of Stored Umbilical Cord Blood and Adult Donor Blood: Transfusion Feasibility

“…In a recent review Khodabux and Brand reported that the preservative solution used, not the manipulation of UCB, might contribute to storage damage. This has been suggested by some other studies that reported better results using the storage solution PAGGSM that contained additional phosphate and guanosine than those obtained using SAG-M [34]. …”

Open cardiac surgery in the first hours of life using autologous umbilical cord blood☆

“…Nonetheless, we identified a few limitations of our method such as a limited volume of autologous UCB and applicability of this approach only to neonates with prenatally diagnosed congenital malformations. Risk of bacterial contamination is described in the majority of the observational studies [4,7]. Some studies mentioned that the extensive training and experience could significantly lower the contamination rates [22,23].…”

“…However, the safety of such low hematocrit is still not determined [14]. At the same time, numerous studies in neonatology have proven the feasibility, effectiveness, and safety of autologous UCB transfusion in premature neonates and those requiring surgical intervention at or near the time of delivery [4][5][6][7]. UCB conserved by CDPA can be used for as long as 3 weeks after harvesting and even longer if separated into components.…”

“…Bloodless cardiopulmonary bypass (CPB) strategies in infants are proposed but they have limited application because of hemodilution, particularly in neonates with weight less than 4 kg [3]. Possibility and effectiveness of autologous umbilical cord blood transfusion in neonates were proved [4][5][6][7]. However, the use of umbilical cord blood (UCB) in neonatal open cardiac surgery has not been studied.…”