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

Bianchi, Maria; Papacci, Patrizia; Valentini, Caterina Giovanna; Barbagallo, Ombretta; Vento, Giovanni; Teofili, Luciana

doi:10.1111/vox.12720

Cited by 25 publications

(21 citation statements)

References 104 publications

(241 reference statements)

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“…Simplified, automated methods to obtain RBC concentrates from umbilical blood, as well as biochemical characteristics of these units during storage, have already been reported. 7,32 Their transfusion strategy has been found feasible and safe. 6,8 Here, we provide robust evidence that this transfusion strategy is effective to prevent the fetal Hb loss.…”

Section: Discussionmentioning

confidence: 99%

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Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

et al. 2020

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Repeated red blood cell (RBC) transfusions in preterm neonates are associated with poor outcome and increased risk for prematurity-associated diseases. RBC transfusions cause the progressive replacement of fetal haemoglobin (HbF) by adult haemoglobin (HbA). We monitored HbF levels in 25 preterm neonates until 36 weeks of post-menstrual age (PMA); patients received RBC units from allogeneic cord blood (cord-RBCs) or from adult donors (adult-RBCs), depending on whether cord-RBCs were available. Primary outcome was HbF level at PMA of 32 weeks. Twentythree neonates survived until this age: 14 received no transfusions, two only cord-RBCs, three only adult-RBCs and four both RBC types. HbF levels in neonates transfused with cord-RBCs were significantly higher than in neonates receiving adult-RBCs (P < 0Á0001) or both RBC types (P < 0Á0001). Superimposable results were obtained at PMA of 36 weeks. Every adult-RBCs transfusion increased the risk for an HbF in the lowest quartile by about 10-fold, whereas this effect was not evident if combined adult-and cord-RBCs were evaluated. Overall, these data show that transfusing cord-RBCs can limit the HbF depletion caused by conventional RBC transfusions. Transfusing cord blood warrants investigation in randomised trials as a strategy to mitigate the severity of retinopathy of prematurity (NCT03764813).

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Section: Discussionmentioning

confidence: 99%

“…Likewise, umbilical blood can also be processed to recover red blood cell (RBC) concentrates suitable for transfusion. [6][7][8] Therefore, we designed the CB-TrIP study (Cord Blood Transfusion in Preterm neonates) to explore the efficacy of cord blood RBCs to limit the HbF depletion caused by top-up transfusions in these patients.…”

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confidence: 99%

Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

et al. 2020

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“…For pre‐term infants, however, autologous transfusion of stored cord blood has been less successful due to the large volumes typically required (Khodabux et al , ). Alternatively, allogeneic cord blood transfusion effectively reduces exposure to adult donor RBCs, and may have a role in neonatal transfusion practice in the future (Bianchi et al , , ).…”

Section: Preventive Strategies For Anaemia Of Prematuritymentioning

confidence: 99%

Management of anaemia in pre‐term infants

Saito-Benz

Flanagan²,

Berry

2019

Br J Haematol

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Pre-term infants have one of the highest transfusion requirements within the hospital-setting. The vast majority of blood transfusions performed in Neonatal Intensive Care Units (NICUs) are for medically stable pre-term infants with anaemia of prematurity, with the aim of improving oxygen delivery to the vital organs during the crucial phase of growth and development. However, despite the frequency of transfusion in this population, the potential benefits and harms of 'top up' transfusion are not fully understood, leading to practice variation between clinicians, institutions and countries. Significant advances have been made in the prevention of anaemia of prematurity, with recent emphasis on optimising infants' circulatory volume at birth via placental transfusion and preserving infants' own blood volume through innovative minimal sampling techniques. More research is urgently needed to establish optimal transfusion thresholds for these high-risk pre-term infants, for whom benefits as well as adverse outcomes may have consequences that extend for decades throughout the recipients' life-course. In this review, we will discuss some of the consensus and controversies regarding optimal management of anaemia in pre-term infants and highlight potential areas for future research.

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“…The oxidative stress and immunological effects of allogeneic adult blood transfusion are implicated in the pathophysiology of major neonatal morbidities such as chronic lung disease, retinopathy of prematurity, necrotising enterocolitis, intraventricular haemorrhage and periventricular leucomalacia. [4][5][6][7][8] Transfusion of autologous umbilical cord blood (UCB), in lieu of adult blood, avoids these risks. Moreover, haematopoietic stem cells and progenitor cells in the UCB could potentially reconstitute marrow haematopoiesis in premature infants who lack marrow reserves.…”

Section: Introductionmentioning

confidence: 99%

Autologous umbilical cord blood for red cell concentrate transfusion in preterm infants in the era of delayed cord clamping: An uncontrolled clinical trial

Abiramalatha

Radhakrishnan

Panicker

et al. 2020

Transfusion Medicine

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Objective: To assess the utility of autologous umbilical cord blood (UCB) for red cell concentrate (RCC) transfusion in preterm infants. Methods: We recruited preterm infants born at ≤30 weeks' gestation or have an estimated fetal weight <1,200 g. We intended to perform delayed cord clamping (DCC) and to collect UCB following DCC. The quality parameters used included blood culture performed once, and biochemical and haematological parameters assessed weekly. Results: Of the 46 recruited neonates, DCC could be performed for 1 minute in 11 (23.9%) and for 30-59 seconds in 10 (21.7%) infants. The success rate of UCB collection was significantly lower in infants who underwent DCC for 1 minute (27%) compared to those who underwent DCC for 30-59 seconds (70%) or immediate cord clamping (72%) (p value 0.031). Twenty-five UCBs were stored after eliminating three that had positive culture. UCB had satisfactory quality for transfusion from day 3 (when blood culture report was available) to 14 (after which pH decreased to <6.5). Thirteen infants required 27 RCC transfusions. Autologous UCB could be used for only five (18.5%) transfusions. Conclusion: The success rate of UCB collection after DCC for 1 minute is low. Autologous UCB meets less than one-fifth of transfusion requirements. Hence, autologous UCB transfusion is not a workable option in preterm infants.

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

Cited by 25 publications

References 104 publications

Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

Management of anaemia in pre‐term infants

Autologous umbilical cord blood for red cell concentrate transfusion in preterm infants in the era of delayed cord clamping: An uncontrolled clinical trial

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