Influence of maternal, infant, and collection characteristics on high-quality cord blood units in Guangzhou Cord Blood Bank

Evaluation of factors affecting total nucleated cells in umbilical cord blood collected for the Calabria Cord Blood Bank

BACKGROUND

Total nucleated cell (TNC) count is the most important biological feature to consider in assessing the quality of umbilical cord blood (UCB) for hematopoietic stem cell (HSC) transplantation. Certain obstetric factors have been reported to increase TNC count in UCB units collected for transplantation. The aim of our study was to analyze how various maternal, neonatal and obstetric factors affected TNC count in the UCBs we collected for our cord blood bank in southern Italy.

METHODS

We performed a retrospective analysis of 634 medical records of UCBs collected by Calabria Cord Blood Bank (CCBB), Reggio Calabria, Italy, between January 1, 2010, and December 31, 2016. We analyzed various maternal, neonatal and obstetric variables factors and related this factor with the characteristic of TNC.

RESULTS

We found that the average number of TNCs was significantly greater in vaginal delivery than in caesarean delivery. We also found that TNCs were higher in the 40th week of pregnancy and when Apgar 1' scores were ≤9. The effect of a newborn's gender was less evident on TNC count.

CONCLUSIONS

Knowledge of factors predictive of a higher TNC count would help cord blood banks more efficiently identify donors likely to yield high-quality UCBs for transplantation.

[Harvest of Stem Cells from Umbilical Cord Blood: Relevance of Perinatal Factors for the Quality of Umbilical Cord Transplant Units]

Einleitung Nabelschnurblut (NSB) enthält hämatopoetische Stammzellen mit therapeutischem Potenzial und einzigartigen zellulären Eigenschaften. Aufgrund der begrenzten Anzahl an Stammzellen im NSB (Surrogatmarker total nucleated cells, TNC) eignet sich nur jede fünfte Spende für eine Transplantation. Ziel dieser Studie war es, zu untersuchen, ob prädiktive Faktoren für eine TNC-Zahl über der 99. Perzentile existieren.

Material und Methodik Retrospektive Datenanalyse der 100 größten NSB-Spenden (Top100-Kohorte) aus 2299 registrierten Einheiten. Unterschiede zwischen maternalen, fetalen und geburtshilflichen Faktoren wurden analysiert und mit einer standardisierten Kohorte von 731 NSB-Spenden verglichen.

Ergebnisse Das mütterliche Alter und der BMI in der Top100-Kohorte waren höher als in der Vergleichskohorte (32 vs. 31 Jahre, p=0,007; 30 kg/m2 vs. 29 kg/m2, p=0,024). Es gab mehr Erstgebärende (76,0 vs. 62,8%, p=0,013) und Gestationsdiabetikerinnen (5,00 vs. 1,65%, p=0,044). Die Schwangerschaftswoche, das Geburtsgewicht, der Anteil vaginal-operativer Geburten und sekundärer Sectiones war in der Top100-Kohorte höher (40+4 vs. 40+1 SSW, p=0,002), (3700 vs. 3450 g, p<0,001), (53,0 vs. 22,7%, p<0,001) (10 vs. 6,2%, p=0,014).

Fazit Für eine erfolgreiche Transplantation ist die Höhe der TNC-Zahl entscheidend. Vaginal-operative Entbindungen, sekundäre Sectiones und ein Geburtsgewicht über 3700 g sind günstige Faktoren. Gerade bei Geburten mit einem pathologischen Verlauf sollte nach sicherer Versorgung von Mutter und Kind nicht auf eine Entnahme verzichtet werden.

[Influence of maternal and infant factors on CD34+ hematopoietic stem/progenitor cells in umbilical cord blood]

OBJECTIVE

To study the association of different maternal and infant factors with the number of total nucleated cells and CD34⁺ hematopoietic stem/progenitor cells in umbilical cord blood, and to provide a reference for reasonable selection of umbilical cord blood in the cord blood bank.

METHODS

A prospective study was performed for the umbilical cord blood samples of 130 neonates who were born in Dalian Women and Children's Medical Center from June 2019 to January 2020, with a male/female ratio of 1:1. Related perinatal information was collected, including maternal age and blood type, presence or absence of gestational diabetes or gestational hypertension, pregnancy method, mode of delivery, singleton pregnancy/twin pregnancy, body weight and sex of neonates, Apgar score after birth, and the conditions of placenta, amniotic fluid, and umbilical cord.

RESULTS

The neonates were grouped according to maternal blood type, gestational diabetes, gestational hypertension, pregnancy method, mode of delivery, singleton pregnancy/ twin pregnancy, sex of neonates, Apgar score after birth, placental morphology, meconium staining of amniotic fluid, and umbilical cord around the neck. The comparison between groups showed no significant differences in the numbers of total nucleated cells and CD34⁺ cells in umbilical cord blood (P > 0.05). Maternal age and neonatal body weight were not correlated with the number of total nucleated cells in umbilical cord blood (P > 0.05), and neonatal body weight was not correlated with the number of CD34⁺ cells (P > 0.05), while maternal age was positively correlated with the number of CD34⁺ cells (P < 0.05).

CONCLUSIONS

The number of CD34⁺ cells in umbilical cord blood increases with the increase in maternal age, and therefore, umbilical cord blood in the cord blood bank may be selected based on maternal age.

Factors associated with blood cord unit bankability: an analysis of a 15-year-long case series

Blood banking is a long and complex process requiring an accurate screening of potential donors and high-quality control systems. Previous studies in literature investigated factors potentially determining a higher cell levels with the aim of optimizing donors' selection and improving banking process. This study aims to identify factors associated with the concentration of stem cells in umbilical cord blood, so increasing the probability of bankability, focusing on the possible implications in terms of obstetric and resources management. This is a retrospective study conducted in the Obstetric Units of two Italian Hospitals in Montebelluna and Castelfranco Veneto. Study has been conducted on cord blood units banked between 1999 and 2015. Data on medical histories and clinical characteristics of mother and baby have been retrieved via a retrospective examination of medical records. A total of 869 cord blood units were studied. At multivariable analysis, in agreement with literature, birthweight and placental weight have been found to be associated with higher concentration of total nucleated cells. As additional factor, amount of fluid infused was associated with cord blood units' count. This study is the first one to clearly identify the role of fluid infusion on cord blood units' counts in addition to placental weight and delivery. Some non-modifiable features can help in predicting bankability from pre-natal aspects to factors more related with obstetric management is suggested.

Estimated fetal weight percentile as a tool to predict collection of cord blood units with higher cellular content: implications for prenatal selection of cord blood donors

BACKGROUND

The need for high-cellular-content cord blood units (CBUs) for allogenic transplantation is evident to improve clinical outcomes. In our environment and with current donation programs, very few collected units meet suggested clinical thresholds, making collection programs highly inefficient. To increase the clinical conversion rate, we have assessed factors influencing the cellular content of the cord blood collection and established the estimated fetal weight percentile (EFWp) as a tool to predict which deliveries will obtain higher cellular counts.

STUDY DESIGN AND METHODS

We conducted a retrospective analysis of 11,349 collected CBUs. An analysis of diagnostic efficiency (receiver operating characteristic [ROC] curve) was performed to establish the cutoffs of several obstetric and perinatal variables from which we would obtain more than 1500 × 106 total nucleated cells and 4 × 106 CD34 cells. We then calculated the optimal EFWp cutoff to increase efficiency.

RESULTS

In the univariate analysis, factors positively and significantly associated were a greater neonatal and placental weight and longer weeks of gestation. In the multivariate analysis only neonatal and placental weight remain significant (p < 0.001). The ROC curve analysis showed that the optimal EFWp cutoff is 60, which has the maximum area under the curve. Applying this, donations meeting clinical cellular numbers will increase more than 30% with respect to not using any threshold.

CONCLUSION

The EFWp predicts the quality of the collected CBUs and can be used to make a prenatal selection of the donors, therefore increasing the efficiency of umbilical cord blood collection programs.

Associated factors of umbilical cord blood collection quality

After 30 years of hematopoietic stem cell use for various indications, umbilical cord blood is considered as an established source of cells with marrow and postmobilization peripheral blood. The limited number of cells still remains a problematic element restricting their use, especially in adults who require to be grafted with a higher cell number. Improving the quality of harvested cord blood, at least in terms of volume and amount of cells, is essential to decrease the number of discarded units. In this review, we examine several variables related to parturient, pregnancy, labor, delivery, collection, the newborn, umbilical cord, and placenta. We aim to understand the biologic mechanisms that can impact cord blood quality. This knowledge will ultimately allow targeting donors, which could provide a rich graft and improve the efficiency of the collection.

The role of policies and networks in development of cord blood usage in China

Research regarding the use of cord blood (CB) has focused on antigen match and the number of stem cells, with policies and networks related to its use being under researched. This article is based on fieldwork in China from 2013 to 2015 and examines ways that the studied CB bank enhances CB usage in China. This article identifies that in addition to finding a match, CB use is linked to the policies and networks, release fee and public awareness that enable CB usage development.

Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial

OBJECTIVE

The objective of the study was to measure the effects of a 5-min delay (DCC) versus immediate cord clamping (ICC) on residual placental blood volume (RPBV) at birth, and hemoglobin and serum bilirubin at 24 to 48 h of age.

STUDY DESIGN

In this prospective randomized controlled trial, 73 women with term (37 to 41 weeks) singleton fetuses were randomized to DCC (⩾5 min; n=37) or ICC (<20 s; n=36).

RESULTS

Maternal and infant demographics were not different between the groups. Mean cord clamping time was 303±121 (DCC) versus 23±59 (ICC) s (P<0.001) with 10 protocol violations. Cord milking was the proxy for DCC (n=11) when the provider could not wait. Infants randomized to DCC compared with ICC had significantly less RPBV (20.0 versus 30.8 ml kg^-1, P<0.001), higher hemoglobin levels (19.4 versus 17.8 g dl^-1, P=0.002) at 24 to 48 h, with no difference in bilirubin levels.

CONCLUSION

Term infants had early hematological advantage of DCC without increases in hyperbilirubinemia or symptomatic polycythemia.

The circadecadal rhythm of oscillation of umbilical cord blood parameters correlates with geomagnetic activity - An analysis of long-term measurements (1999-2011)

Recently, we have shown that the contents of total nucleated cells (TNCs) and CD34⁺ hematopoietic stem and progenitor cells (CD34⁺ HSPCs) as well as the cord blood volume (CBV) in umbilical cord blood (UCB) show a circadecadal (~10 years) rhythm of oscillation. This observation was based on an analysis of 17,936 cord blood donations collected during 1999-2011. The aim of the present study was to investigate whether this circadecadal rhythm of oscillation in TNCs, CD34⁺ HSPCs and CBV is related to geomagnetic activity. For the analysis, the yearly averages of TNCs, CD34⁺ HSPCs and CBV in UCB were correlated with geomagnetic activity (Dcx index). Our analysis revealed that (i) all three UCB parameters were statistically significantly correlated with the level of geomagnetic activity, (ii) CBV showed a linear correlation with the Dcx index (r = 0.5290), (iii) the number of TNCs and CD34⁺ HSPCs were quadratic inversely correlated with the Dcx index (r = -0.5343 and r = -0.7749, respectively). Furthermore, (iv) CBV and the number of TNCs were not statistically significantly correlated with the number of either modest or intense geomagnetic storms per year, but (v) the number of CD34⁺ HSPCs was statistically significantly correlated with the number of modest (r = 0.9253) as well as intense (r = 0.8683) geomagnetic storms per year. In conclusion, our study suggests that UCB parameters correlate with the state of the geomagnetic field (GMF) modulated by solar activity. Possible biophysical mechanisms underlying this observation, as well as the outcome of these findings, are discussed.