Allogeneic Umbilical Cord Blood Red Cell Concentrates: An Innovative Blood Product for Transfusion Therapy of Preterm Infants

Abstract

Background: Preterm infants often receive blood transfusions early in life. In this setting, umbilical cord blood (UCB) might be safer than adult blood (A) with respect to infectious and immunologic threats. Objectives: To evaluate, as a first objective, the feasibility of fulfilling transfusion needs of preterm infants with allogeneic UCB red blood cell (RBC) concentrates and, as a secondary objective, to assess the safety of allogeneic cord blood transfusions. Methods: At the Neonatal Intensive Care Unit and the UNICATT Cord Blood Bank of ‘A. Gemelli' Hospital in Rome, a prospective study was carried out over a 1-year period, enrolling newborns with gestational age ≤30 weeks and/or birth weight ≤1,500 g requiring RBC transfusions within the first 28 days of life. At first transfusion, patients were assigned to receive UCB-RBCs or A-RBCs depending on the availability of ABO-Rh(D)-matched UCB-RBC units. The same regimen (UCB-RBC or A-RBC units) was thereafter maintained, unless ABO-Rh(D)-matched UCB-RBC units were not available. Results: Overall, 23 UCB-RBC units were transfused to 9 patients; the requests for UCB-RBC units were met in 45% of patients at the first transfusion and in 78% at the subsequent transfusions. At a median follow-up of 57 days (range 6-219), no acute or delayed transfusion-related adverse events occurred. Hematocrit gain after transfusion and time intervals between transfusions were similar in the UCB-RBC and A-RBC group, as well. Conclusions: Transfusing allogeneic UCB-RBC units in preterm infants appears a feasible and safe approach, although the transfusion needs of our study population were not completely covered. More data are necessary to validate this novel transfusion practice. © 2014 S. Karger AG, Basel

Umbilical cord blood as a source for red‐blood‐cell transfusion in neonatology: a systematic review

“…These data were also confirmed in a study evaluating the storage of whole UCB . Moreover, a more pronounced lactate increase and pH and glucose decrease were reported . Two experiences on UCB fractionation and short‐term storage (14 days) carried out at our institution in 2012 and in 2015 (Bianchi M. and Teofili L.,), confirmed these findings.…”

“…Our group reported an experience in extremely low birth weight (ELBW) neonates in a tertiary‐care hospital . In all studies, transfusions were performed using whole cord blood, except in two papers published by Hassall and Bianchi where RBC concentrates were obtained from cord blood fractionation.…”

“…reported an experience in a selected population of ELBW neonates in the first 4 weeks of life. For the study design, patients received cord blood or adult donor RBCs at same doses (20 ml/Kg) according to the availability of ABO and Rh matched cord blood units . The preterm infants receiving cord blood RBCs or adult RBCs had a similar sex and age distribution, gestational age, birth weight, Apgar scores, haematocrit and haemoglobin levels at birth; the triggers for transfusion were also similar between groups.…”

“…Bhattacharya and Hassall reported data about UCB transfusion performed in low‐income countries in several different conditions such as thalassemia , autoimmune disease , cancer , renal failure , diabetes , infectious diseases and anaemia in adult and childhood . Our group reported an experience in extremely low birth weight (ELBW) neonates in a tertiary‐care hospital . In all studies, transfusions were performed using whole cord blood, except in two papers published by Hassall and Bianchi where RBC concentrates were obtained from cord blood fractionation.…”

“…Using UCB for transfusion purposes, one should consider various peculiar issues connected with the low volume, fetal erythrocytes fragility, eventual presence of clots and possible contamination. In Table , we show main studies illustrating fractionation and production of RBC concentrates as well as quality controls . Fractionation of whole UCB allows to obtain RBC concentrates with similar baseline characteristics as units from adult donors, although the storage of cord RBC units was associated with increased supernatant potassium, higher rate of haemolysis and decreased intracellular ATP .…”