Cord blood banking: what nurses and healthcare providers should know

Although the use of embryonic stem cells to treat disease has caused much controversy, one type of stem cell treatment has slowly and steadily shown promise but has not engendered negative ethical media attention: the use of umbilical stem cells. Umbilical cord blood (UCB) contains stem cells that have already successfully treated a variety of diseases, including leukemias, lymphomas, hemoglobinopathies, immunodeficiencies, and disorders of metabolism; ongoing research continues to explore additional diseases for potential treatment. Cord blood can be stored in private banks or public banks. Private cord blood banks save cord blood for use by the family only, at a cost. Public cord blood banks accept donations and the cord blood is then used for the general public and/or research. A review of the literature finds that public banking is the preferred recommendation over private unless there is a known family member with a disease that can currently be treated with cord blood. This article discusses cord blood banking options as well as the ethical issues and barriers facing both healthcare providers and patients when dealing with cord blood banking.     

Cord blood stem cell banking: a snapshot of the Italian situation

BACKGROUND: In Italy, the law does not permit the setting up of private banks to preserve cord blood (CB) stem cells for personal use. However, since 2007 the right to export and preserve them in private laboratories located outside Italy has existed, and an increasing number of women are requesting this collection of umbilical CB at delivery to enable storage of stem cells for autologous use. STUDY DESIGN AND METHODS: Since private banks recruit clients mainly via the Internet, we examined the content of 24 Italian‐language websites that offer stem cells storage (from CB or amniotic fluid), to assess what information is available. RESULTS: We found that the majority of private banks give no clear information about the procedures of collection, processing, and banking of CB units and that the standards offered by private CB banks strongly differ in terms of exclusion or acceptance criteria from the public banks. These factors may well influence the overall quality of the CB units stored in private CB banks. Of note, during the period 2007 to 2009, the number collected for autologous use did not create a downward trend on the number of units stored in public CB banks for allogeneic use. CONCLUSION: CB is a valuable community resource but expectant parents should be better informed as to the quality variables necessary for its storage, both by institutions and by professionals. Currently, most of the advertising is insufficient to justify the expense and the hopes pinned on autologous use of CB stem cells.     

Cord blood banking: volume reduction using "Procord" Terumo filter

Cryopreserved cord blood (CB) banking, space storage, and ABO major incompatibility transfusion as well as potential progenitor cell loss during processing, are the subjects of this study. We evaluate processing of fresh and thawed CB on "Procord" (Terumo Corp., Japan). On 16 freshed CBs, mean NC, CD34, CFU-GM yields were, respectively, 54% (SD +/- 20), 75% (SD +/- 25), and 171% (SD +/- 168) in a final volume of 20 ml. Final product was enriched in mononuclear cells (mean 69% granulocytes depletion) with reproducible erythrocyte and platelet depletions means of 97% (SD +/- 1.5) and 93% (SD +/- 8). On seven previous whole frozen CB units, Procord gave comparable red blood cell (98%) depletion with 53% (SD +/- 30) mean CD34 recovery. Procord is an efficient method for erythrocyte depletion of CB, and recoveries of NC and progenitor cells are comparable to those obtained with similar processing. Nevertheless, as all existing methods, it is associated with cell and progenitor cell loss.     

Stem cells from cord blood: legal and ethical questions of transplantation and banking

Transplantation and banking of stem cells from cord blood raise different legal and ethical questions. Who owns the cord blood? Does transplantation infringe the physical integrity of the neonate? And if so, who has to give her or his consent? In any case, legal representation by the neonate's guardians has to be guided by the "welfare of the child". Banking stem cells from cord blood may be private or public. Private banking causes difficulties concerning the right to health care and the issues of justice and equity. Public banking too raises complex legal issues, e.g. protection of potential recipients from life-threating illnesses at the one hand and the right of the donor to autonomy in disclosing information at the other.     

Zika virus and its implications on cord blood banking and transplantation

• Umbilical cord blood is an important cellular therapy product used for hematopoietic stem cell transplantation, but the US Food and Drug Administration guidance regarding donor screening to reduce the risk of Zika transmission has decreased the number of licensed, eligible cord blood units available for transplantation.
• There is a crucial need for updated travel risk assessment for Zika virus transmission, validated screening tests for Zika virus in umbilical cord blood, and further research on Zika virus transmissibility due to umbilical cord blood products to ensure that umbilical cord blood and related tissues are safe and available for transplantation.

     

Factors affecting banking quality of umbilical cord blood for transplantation

BACKGROUND: The most important objective for cord blood banks is to store cord blood units of high quality, which is determined by total nucleated cells (TNCs) and CD34+ cells. Determining the factors affecting the stored life‐saving cells would be beneficial to the field. STUDY DESIGN AND METHODS: A total of 4930 cord blood units were collected between January 2007 and October 2009 and processed using a double extraction technique to sediment red blood cells with variable centrifugation time determined by the formula CT = KL – M, where CT is centrifuge time, K is 7.7227, M is 29.742, and L is ln (volume of cord blood with anticoagulant). The recovery rate of TNCs and other relevant factors affecting banking quality were analyzed. RESULTS: The mean recovery rate of TNCs was 97.7 ± 2.5% with 0.04% (2/4930) units below 80% and 10.8% (532/4930) units below 95%. The TNCs per unit was affected by gestation duration (p < 0.01), sex of infant (p < 0.01), mode of delivery (p < 0.01), collection method (p < 0.01), and ethnicity (p < 0.001). The number of postprocessing CD34+ cells was affected only by sex of the infant (p < 0.05). The viability of nucleated cells after processing was 94.8 ± 4.8% and was affected by the number of hours between collection and processing (p < 0.01). In contrast, the viability of CD34+ cells was 99.5 ± 1.0% (n = 30) when samples with low viability of TNCs were assessed. The results did not reveal a significant correlation (r = 0.07, p = 0.38). CONCLUSION: The double extraction technique provides a high and consistent recovery of TNCs, which ensures that more life‐saving cells will be banked for transplants.     

The first 5 years after the dissertation.

To succeed in academia, nursing faculty members must devote the first 5 years following the dissertation to achieving a standard to tenure characteristic of the profession. Most institutions in the country adhere to the American Association of University Professors' guidelines for tenure. These guidelines mandate excellence in teaching, scholarship, and service. A fourth characteristic, leadership, is increasingly considered in tenure decisions. The expectations of an academic career in nursing serve as the foundation for a framework to evaluate the likelihood of success in a particular setting. A detailed 5-year plan for achieving tenure is proposed.     

Establishing a cord blood banking and transplantation program in Mexico: a single institution experience

BACKGROUND: Over the past decade, umbilical cord blood (UCB) banking and transplantation have increased significantly worldwide. The experience in developing countries, however, is still limited. In January 2005 the Mexican Institute of Social Security (IMSS) initiated its UCB banking and transplantation program. This study reports on the experience generated at this institution during the first 2 years of activities. STUDY DESIGN AND METHODS: A public UCB bank was established at La Raza Medical Center, IMSS, in Mexico City. Good manufacturing practices and standard operating procedures were used to address donor selection, as well as UCB collection, processing, and cryopreservation. Based mainly on human leukocyte antigen (HLA) and total nucleated cell (TNC) content, specific UCB units were thawed, processed, and released for transplantation. RESULTS: Based on stringent selection criteria, 360 UCB units were collected from January 2005 to December 2006. A total of 201 (56%) units (minimum volume, 50 mL without anticoagulant) were processed and stored. Median values for specific parameters were as follows: volume, 89.9 mL; viability, 94.8%; TNCs, 0.91 x 10(9); CD34+ cells, 3.13 x 10(6); and colony-forming cells, 1.20 x 10(6). During this period, 10 units had been released for transplantation to seven patients (six children and one adult). Engraftment was observed in five patients; four of them were still in remission (114-293 days after transplant). In spite of showing sustained engraftment, one patient died on Day +88. Two patients showed no engraftment and died 29 to 30 days after transplant. CONCLUSION: The results obtained during this initial period are encouraging and indicate that the UCB banking and transplantation program at IMSS will help to improve already existing hematopoietic cell transplant programs in Mexico. The experience generated at IMSS may be helpful to other institutions, particularly those in developing countries.     

脐血移植合并巨细胞病毒感染相关性溶血一例

患者,女,25岁.2009年4月出现反复发热,血常规淋系、粒系、巨核系三系偏低,经MICM分型确诊为急性淋巴细胞白血病L2型,B淋巴细胞系抗原表达,后予以CDOLP(环磷酰胺+柔红霉素+长春地辛+左旋门冬酰胺酶+泼尼松)方案化疗后完全缓解,后又经CAT(环磷酰胺+阿糖胞苷+6-巯基嘌呤)方案巩固化疗1次.