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Kondo AT, Alvarez KCA, Cipolletta ANF, Sakashita AM, Kutner JM. Nucleated red blood cell: a feasible quality parameter of cord blood units. Hematol Transfus Cell Ther 2024; 46:221-227. [PMID: 36935342 PMCID: PMC11221323 DOI: 10.1016/j.htct.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/20/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Umbilical cord blood is an alternative source of hematopoietic progenitor cells for bone marrow transplantation; however, it is associated with a higher graft failure rate. The presence of a high rate of nucleated red blood cells (NRBCs) seems to be related to a greater capacity for engraftment, although is also associated with fetal distress conditions. We analyzed the correlation of the NRBC with quality parameters and its association with the utilization score of a cord blood unit. STUDY DESIGN AND METHOD Data of 3346 units collected in a public cord blood bank from May 2010 to December 2017 were analyzed, retrospectively, to identify factors associated with an increased number of nucleated red blood cells and its correlation with the engraftment capacity measured through total nucleated cells (TNCs) and CD34 positive cells. We also evaluated the utilization score of these units and identified an NRBC cutoff associated with a higher score. RESULTS The median volume collected was 104 mL (42-255), the pre-processing TNC count was 144.77 × 107 (95.46-477.18), the post-processing TNC count was 119.44 × 107 (42.7-477.18), the CD34 count was 4.67 × 106 (0.31-48.01), the NRBC count was 5 (0-202) and the utilization score was 0.0228 (0.00143-0.9740). The NRBC showed a correlation with the collected volume, TNC and CD34 positive cells and a higher utilization score and the receiver operating characteristic (ROC) curve analysis identified the five NRBC/100 leukocytes cutoff that correlates better with the probability of use. No association with pathological conditions and the NRBC rate was observed. CONCLUSIONS The NRBC is a feasible parameter for the screening of the cord blood unit (CBU) and the minimum cutoff of five NRBC/100 leukocytes can be a strategy in conjunction with the TNC to identify better units for cord blood bank sustainability.
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Shin S, Lee HR, Yoon JH, Kim BJ, Kim N, Park H, Roh EY. Increased Nucleated RBCs in Cord Blood: Not an Exclusion Criterion but a Quality Indicator for Hematopoietic Progenitor Cell Transplantation. Transfus Med Rev 2021; 35:53-59. [PMID: 34226061 DOI: 10.1016/j.tmrv.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Increased nucleated red blood cell (NRBC) counts have been reported to be associated with adverse fetal outcomes, and cord blood units (CBUs) with increased NRBC counts require a 2nd questionnaire to determine their suitability for transplantation. However, a recent study demonstrated a positive correlation of NRBCs with CD34+ cells and total nucleated cells (TNCs). We evaluated the association between the NRBC count and hematopoietic progenitor cell (HPC) content (TNC and CD34+ cell counts) in Korean full-term newborn CBUs. In addition, we assessed whether an increased NRBC count is associated with newborn health problems that impair CBU safety. Among the 32,876 units processed from May 2006 to December 2018, a total of 23,385 CBUs with a TNC count ≥ 7 × 108 and reliable perinatal information were analyzed to assess the association of the NRBC count with CBU parameters, and the newborns associated with 457 CBUs that required the 2nd questionnaire due to an increased NRBC (≥ 15 NRBCs/100 WBCs) were assessed at one year for health problems that threatened CBU safety. The majority of the CBUs that required the 2nd questionnaire due to an increased NRBC count (96.9%) were determined to be suitable for transplantation. Those with an increased NRBC count showed significantly higher CD34+ cell and TNC counts and a higher rate of transplantation (P < 0.001, < 0.001 and 0.025, respectively). NRBCs showed a significant positive correlation with TNCs and CD34+ cells and a significant negative correlation with birth weight (all P < 0.001; adjusted r = 0.185, 0.369 and - 0.029, respectively). In the multiple linear regression analysis, NRBCs showed independent and positive correlations with TNCs and CD34+ cells after adjustments for birth weight and gestational age (all P < 0.001; β = 0.182, adjusted R2 = 0.053 and β = 0.367, adjusted R2 = 0.418). An increased NRBC count in full-term normal delivery is a surrogate marker of HPCs in CBUs rather than an exclusion criterion for CBU safety. Moreover, providing the NRBC count together with the NRBC-corrected TNC count will be useful for clinicians to select CBUs for transplantation.
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Affiliation(s)
- Sue Shin
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Seoul Metropolitan Government Public Cord Blood Bank (ALLCORD), Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Ryun Lee
- Department of Laboratory Medicine, National Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Yoon
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Seoul Metropolitan Government Public Cord Blood Bank (ALLCORD), Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byoung Jae Kim
- Seoul Metropolitan Government Public Cord Blood Bank (ALLCORD), Seoul, Republic of Korea; Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Namhee Kim
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Seoul Metropolitan Government Public Cord Blood Bank (ALLCORD), Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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