Programma regionale
Donazione del sangue di cordone ombelicale
DIPARTIMENTO REGIONALE
INTERAZIENDALE
DI MEDICINA TRASFUSIONALE
Corso annuale di aggiornamento CDR SCO
Civitanova Marche, 29 settembre 2014
CDR di: Civitanova M., Ascoli Piceno,
S. Benedetto del Tronto, Fermo
Incremento annuo
611.379 Unità SCO
47 Banche
32 Nazioni
Settembre 2014
DISTRIBUZIONE DELLE UNITA’ DI SCO
BANCATE PER CONTINENTE
(totale 611.379 Unità)
Asia
15,18%
Altro
3,94%
Europa
38,53%
Australia
4,59%
USA+Canada
37,77%
BMDW
settembre 2014
ITCBN
Centro Nazionale Sangue
Banche di sangue di cordone ombelicale – Report 2013
308 Centri di Raccolta attivi suddivisi per ciascuna banca
50
40
40
29
30
20
19
29
23
15
19
14
8
10
13
11
5
14 12 14
10
18
9
6
Verona
Treviso
Padova
Firenze
Pisa
Sciacca
Cagliari
SG Rotondo
Torino
Pavia
Milano
Genova
Roma (Gemelli)
Roma (Umberto I)
Roma (S. Eugenio)
Bologna
Napoli
Reggio Calabria
Pescara
0
Centro Nazionale Sangue
Banche di sangue di cordone ombelicale – Report 2013
2013
2014*
Banche che hanno inviato i dati 19/19
16/19
Unità raccolte (R)
5.247
4.386
Unità bancate (B)
488 (9.3%) 414 (9.4%)
Unità distribuite
24
13
N°parti
nd
70.138
* Dati incompleti
Centro Nazionale Sangue
Banche di sangue di cordone ombelicale – Report 2013
TNC delle SCO ITCBN utilizzate
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
87%
10%
40%
0%
10%
96%
42%
SCO utilizzate
inventario
0%
SCO utilizzate
inventario
2012
2013
SCO con TNC >120
SCO con TNC <120
PROGRAMMA REGIONALE DONAZIONE SCO
RIUNIONE CDR REGIONE MARCHE
Ancona - 15 maggio 2012
Fattori predittivi per la raccolta - Letteratura
Factors affecting banking quality of umbilical cord blood for transplantation. Hongyou Yang, Mona
R. Loutfy, Stephanie Mayerhofer, Paul ShuenIssue. Transfusion, Volume 51, Issue 2, pages 284–
292, February 2011
Influence of obstetric factors on the yield of mononuclear cells, CD34+ cell count and volume of
placental/umbilical cord blood. Omori A, Manabe M, Kudo K, Tanaka K, Takahashi K, Kashiwakura
I. J Obstet Gynaecol Res. 2010 Feb;36(1):52-7.
Donors selection and retrieval of units in an umbilical cord blood bank. Solves Alcaina P, Perales
Marín A, Mirabet Lis V, Brik Spinelli M, Soler García MA, Roig Oltra R. Med Clin (Barc). 2007 Oct
27;129(15):561-5.
Maternal, neonatal and collection factors influencing the haematopoietic content of cord blood
units. Solves P, Perales A, Moraga R, Saucedo E, Soler MA, Monleon J. Acta Haematol.
2005;113(4):241-6.
Optimizing donor selection in a cord blood bank.
Solves P, Perales A, Mirabet V, Blasco I, Blanquer A, Planelles D, Larrea L, Monleon J, CarbonellUberos F, Angeles Soler M. Eur J Haematol. 2004 Feb;72(2):107-12.
PROGRAMMA REGIONALE DONAZIONE SCO
Ancona - 15 maggio 2012
FATTORI OSTETRICO NEONATALI CON IMPATTO SU RACCOLTA
PARAMETRO
PREDITTIVITÀ
Età gestazionale
Predittività positiva
Parità
Predittività negativa
Tipo di parto
Studi contraddittori
Lunghezza del travaglio
Predittività positiva
Tempo di clampaggio*
Predittività negativa
Peso stimato del neonato
≥ 3,2 Kg
Peso stimato della placenta
≥ 0,6 Kg
Dimensione dei vasi, spiralizzazione e lunghezza del cordone
ombelicale
Sesso del neonato
Predittività positiva
Presenza di meconio (M1/M2 in assenza di segni di sofferenza fetale)
**
Predittività positiva
Studi contraddittori
*NB: secondo l’orientamento della Società Italiana di Neonatologia, su richiesta CNS/CNT, i termini di sicurezza
del clampaggio sono di 60 secondi dopo la nascita.
Le procedure della banca chiedono di non modificare in alcun modo le modalità e i tempi di clampaggio
adottati da ogni singolo Punto Nascita/Operatore. Tuttavia, nel caso in cui venga adottato il clampaggio tardivo,
è preventivabile che la raccolta possa essere di scarso contenuto cellulare.
** NB: gli altri casi sono un criterio di esclusione alla raccolta.
Quality rather than quantity: the cord blood bank dilemma.
S. Querol, et al.
BMT. 2010; 45(6): 970–78
A review of factors influencing the banking
of collected umbilical cord blood units
D. Allan et al.
Stem Cell International, 2013
Impact of Selection of Cord Blood Units from the United States
and Swiss Registries on the Cost of Banking Operations
T. Bart, et al.
Transfus Med Hemother. 2013 February; 40(1): 14–20.
We suggest significantly raising the TNC
level used to determine a bankable unit. A
level of 1,25x109 TNCs, maybe even 1,5x109
TNCs, might be a viable banking threshold.
This would improve the return on inventory
investments while meeting transplantation
needs based on current selection criteria.
A prenatal prediction model for total nucleated cell
count increases the efficacy of umbilical cord blood
banking.
Manegold-Brauer G1, Borner B, Bucher C, Hoesli I,
Passweg J, Girsberger S, Schoetzau A, Gisin S, Visca E.
Transfusion. 2014
Department of Obstetrics and Gynecology, University Hospital Basel,
Basel, Switzerland.
BACKGROUND: The most important factor for the selection of an umbilical cord
blood unit (CBU) for hematopoietic stem cell transplantation is the total
nucleated cell (TNC) count as a surrogate marker for stem cell content in the
CBU. At present, about one in five donors can provide a CBU with a sufficient
TNC count for umbilical cord blood (UCB) banking. It is labor-intensive to
obtain consent of all eligible donors and optimization of the selection is
needed. The purpose of this study was to investigate prenatal clinical
predictors for TNC count that would help to identify successful UCB donors
already on admission to the delivery unit.
STUDY DESIGN AND METHODS: This study was a retrospective analysis of
758 cryopreserved CBUs, collected from 2002 to 2006. Maternal and fetal
factors analyzed were maternal age, gravidity, parity, weight, height,
diabetes, premature rupture of membranes, gestational age, fetal sex, and
birthweight. The impact on a high TNC count (<150 × 107 vs. ≥150 × 107 ) of
the CBU was modeled in a multivariate analysis model.
RESULTS: Fetal birthweight was the strongest predictor (p < 0.001) of
TNC count of at least 150 × 107. With a composite score of parity, gestational
week, maternal weight and height, fetal sex, and birthweight, a normogram
was developed that increased banking rates from 22.7% to 31.9% .
CONCLUSIONS: Our prenatal prediction model increases the efficacy of
obtaining informed consent for UCB banking while still allowing relevant numbers
of CBUs to be banked.
Factors affecting umbilical cord blood
stem cell suitability for transplantation
in an in utero collection program.
Keersmaekers CL1, Mason BA,
Keersmaekers J, Ponzini M, Mlynarek RA.
1Department
of Obstetrics and Gynecology, St John Hospital and
Medical Center, Detroit, Michigan.
Transfusion. 2014 Mar;54(3):545-9.
BACKGROUND: The greatest limiting factor in the use of umbilical cord blood
(UCB) for transplantations is the number of stem cells available in any given
collected unit. This study examines maternal, neonatal, and obstetric factors that
influence the suitability for banking and transplantation of UCB units collected in
utero.
STUDY DESIGN AND METHODS: This study examined 7839 UCB units collected
in utero at two hospitals from August 1, 2008, to August 31, 2011. The variables
were collected from cord blood records, patient charts, delivery records, and data
processed by StemCyte, Inc. (Covina, CA), our parent bank. The mean total
nucleated cell (TNC) count between units selected for transplant and those banked
but not selected for transplant were also compared.
RESULTS: Of the 11 variables evaluated, six had a significant influence on the
acceptable banking TNC count of at least 90×10e7 . Of these, cord blood
volume was the best predictor. The other variables that were predictors of the
acceptable TNC count of significance were gestational age, infant race, parity,
birthweight, and infant sex (females). The minimal bankable TNC count for
banking is considerably lower than the mean TNC count of units actually selected
for transplantation.
CONCLUSION: Maternal, neonatal, and obstetric factors can all influence the
acceptability of a cord blood unit collected in utero for banking. Furthermore, units
with high TNC counts are more likely to be selected for banking. Identifying these
variables in potential donors can likely increase the number of adequate
collections.
Fig. 1. Receiver operating curve (ROC) analysis of femur length (FL) showed an area under the
curve of 0.846 [95% confidence interval (CI) 0.712–0.981, p < 0.0001]. The cut-off value of 72.5 mm
has sensitivity of 79% and specificity of 91%.
ROC analysis of abdominal circumference (AC) showed an area under the curve of 0.794 (95% CI
0.656–0.932, p < 0.001). The cut-off value of 345 mm has sensitivity of 65% and specificity of 91%.
L. Cobellis et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 170
(2013) 391–395 393
Table 1 Ultrasound prenatal parameters, gestation and biometric parameters
of the 219 singleton pregnancies associated with volume, total nucleated cell
(TNC) count and CD34+ count, and cord blood unit (CBU) bankability.
Stima peso neonato !!!!!