Programma regionaleDonazione del sangue di cordone ombelicale

Corso annuale di aggiornamento CDR SCO

Civitanova Marche, 29 settembre 2014

CDR di: Civitanova M., Ascoli Piceno,

S. Benedetto del Tronto, Fermo

DIPARTIMENTO REGIONALEINTERAZIENDALE

DI MEDICINA TRASFUSIONALE

611.379 Unità SCO47 Banche32 Nazioni

Settembre 2014

Incremento annuo

DISTRIBUZIONE DELLE UNITA’ DI SCO BANCATE PER CONTINENTE

(totale 611.379 Unità) BMDW settembre 2014

Europa 38,53%

Altro 3,94%Asia

15,18%

Australia 4,59%

USA+Canada 37,77%

ITCBN

1915

2329

814

511

40

1319

14 12 1410

18

29

9 6

0

10

20

30

40

50

Pes

cara

Reg

gio

Cal

abria

Nap

oli

Bol

ogna

Rom

a (S

. Eug

enio

)

Rom

a (U

mbe

rto

I)

Rom

a (G

emel

li)

Gen

ova

Mila

no

Pav

ia

Torin

o

SG

Rot

ondo

Cag

liari

Sci

acca

Pis

a

Fire

nze

Pad

ova

Trev

iso

Ver

ona

308 Centri di Raccolta attivi suddivisi per ciascuna banca

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

Centro Nazionale Sangue Banche di sangue di cordone ombelicale – Report 2013

* Dati incompleti

TNC delle SCO ITCBN utilizzate

SCO con TNC >120SCO con TNC <120

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SCO utilizzate inventario

96% 42%

2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SCO utilizzate inventario

87%

40%

2012

Centro Nazionale Sangue Banche di sangue di cordone ombelicale – Report 2013

Fattori predittivi per la raccolta - LetteraturaFactors 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, Carbonell-Uberos F, Angeles Soler M. Eur J Haematol. 2004 Feb;72(2):107-12.

PROGRAMMA REGIONALE DONAZIONE SCO RIUNIONE CDR REGIONE MARCHE

Ancona - 15 maggio 2012

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

Predittività positiva

Sesso del neonato Studi contraddittori

Presenza di meconio (M1/M2 in assenza di segni di sofferenza fetale) **

Predittività positiva

*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.

FATTORI OSTETRICO NEONATALI CON IMPATTO SU RACCOLTA

PROGRAMMA REGIONALE DONAZIONE SCOAncona - 15 maggio 2012

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

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.

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.

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. 2014Department 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 !!!!!