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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 3  |  Page : 235-238

To study the effectiveness of umbilical cord blood transfusion in neonates at tertiary health care centre


1 Department of Paediatrics, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
2 Department of Pediatrics, Shyam Shah Medical College, Rewa, Madhya Pradesh, India

Date of Submission12-Aug-2021
Date of Acceptance21-Feb-2022
Date of Web Publication15-Sep-2022

Correspondence Address:
Dr. Shoaib Beg Mirza
Department of Paediatrics, Shyam Shah Medical College, Rewa, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_125_21

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  Abstract 


Introduction: Blood transfusions (BTs) are often required by neonates for different indications. There is usually a deficiency of available blood because of the non-availability of donors, lack of awareness, irrational demand, poor supply chain management system, etc., especially in developing countries. This study was done to determine the usefulness of umbilical cord blood (UCB) as an alternative to adult blood (AB) in neonates and to compare the change in haematological parameters after transfusion and compare outcomes. Materials and Methods: It was a prospective interventional study of UCB transfusions given to neonates requiring blood. UCB was collected in the labour room, under all aseptic precautions, and pretesting was done in the blood bank. Neonates fulfilling inclusion criteria were included. UCB and AB were given as per availability and consent. Post blood analysis was done after 6 h of transfusion watched for reactions. Outcomes such as death, discharge and duration of hospital stay were analysed. Results: A total of 91 BTs were performed, out of which 34 received UCB and 57 with AB. The mean rise of haemoglobin in UCB transfused patients was 2.01 g/dl. Conclusions: In neonates requiring BT, whole UCB is a good and safe alternative to whole AB.

Keywords: Neonatal transfusion, placental blood, umbilical cord blood


How to cite this article:
Mirza SB, Dwivedi D, Yadav SS, Bajaj N. To study the effectiveness of umbilical cord blood transfusion in neonates at tertiary health care centre. Adv Hum Biol 2022;12:235-8

How to cite this URL:
Mirza SB, Dwivedi D, Yadav SS, Bajaj N. To study the effectiveness of umbilical cord blood transfusion in neonates at tertiary health care centre. Adv Hum Biol [serial online] 2022 [cited 2022 Dec 3];12:235-8. Available from: https://www.aihbonline.com/text.asp?2022/12/3/235/356101




  Introduction Top


Neonates often require blood transfusion (BT) for various indications, but there is usually a deficiency of available blood because of the non-availability of donors, lack of awareness, irrational demand, poor supply chain management system, etc., especially in developing countries. In India, there is an annual requirement of 1 million units of blood for neonatal care, but there is a significant gap between demand and supply.[1] Till today, there is no substitute for human blood. Even after all efforts for voluntary blood donation and blood component therapy, there is a substantial gap between demand and supply. After birth, the placenta is commonly discarded, which has 80 ml to 150 ml whole human blood that can be saved, stored and used as a replacement of adult whole human blood.[2],[3],[4] On average, 100 million deliveries occur worldwide from which this blood can be harvested, and many lives can be saved.[5] Hence, this study was done to assess the efficacy of umbilical cord blood (UCB) as an alternative to adult human blood adult blood (AB), which can be used to fill this gap.


  Materials and Methods Top


This prospective interventional study was carried out at a level III neonatal care unit of an institutional hospital in Central India between June 2019 and June 2020. This study was reviewed and approved by the institutional ethical review board of our institute (9389/SS/PG/MC/2019). The first aim of our study was to evaluate, during a 1-year period, the feasibility of fulfilling transfusion needs of the newborn (>34 completed weeks) admitted to the neonatal intensive care unit (NICU) with allogeneic UCB units within the first 28 days of life. As a secondary objective, we focused on the safety of allogeneic cord BTs. Those parents who were not willing for the procedure, neonates who had a history of BT before admission in this NICU, clinically diagnosed syndromic neonates, those with congenital anomaly and neonates with the haemolytic disease were excluded from the study [Figure 1]. Cord blood was collected in labour room, under all aseptic precautions from healthy mothers and healthy placenta in the obstetrics and gynaecology department done in citrate-phosphate-dextrose (an anti-coagulant and preservative) bags of 100-ml capacity.[6] Healthy mothers were defined as mothers who did not have any antenatal complications such as pre-eclampsia, sepsis and foul-smelling liquor. Placenta was examined after birth by the researcher and was looked for any abnormality. If any abnormality was detected, then the sample collected was discarded. Cord blood was collected from the healthy placenta of normal vaginal deliveries. Prior consent of patient or attender was taken. Soon after delivery of the baby, delayed cord clamping was done as per Neonatal Resuscitation Program protocol, then the placenta was delivered out and kept in a sterile tray. The distal end of the cord was swabbed with Betadine gauge and cleaned with a spirit swab, then the cord was held between two hands, and the umbilical vein was pierced by a needle connecting to the bag. 80–120 ml of cord and placental blood was collected in the bag through gravity. All aseptic precautions were taken while collecting the sample. If collected blood was <60 ml, or positive for infections or immunologically unfit (defined as ABO haemolytic disease of newborn because of the presence of anti-AB in serum of the cord blood), then the unit was discarded. All necessary pretesting (ABO, Rh typing, HIV, hepatitis B, hepatitis C, malaria and syphilis) were done in the blood bank. Fit blood units were stored in an institutional blood bank and were transfused to any neonate who required BT as per institutional guidelines and was not only restricted to the donor infant. Those fulfilling the inclusion criteria were given cord blood as per the availability of cross-matched blood. AB was taken from the blood bank as per institutional guidelines. The new British Committee for Standards in Haematology transfusion guidelines for neonates is followed for transfusion, suggesting the transfusion thresholds summarised in [Table 1].
Figure 1: Flow chart showing the study methodology.

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Table 1: Indications for blood transfusion in both umbilical cord blood and adult blood group

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Before transfusion, a pre-BT blood sample was drawn for complete blood count (CBC), vitals including temperature, heart rate, respiratory rate, oxygen saturation and random blood sugar were monitored. Vitals were monitored after starting transfusion at the interval of 10 min, 30 min, 1 h and 2 h and at the completion of transfusion. If there was any significant change in vitals, it was noted. Blood was given to all patients at a rate of 10 ml/kg in 5 h with an infusion pump. Six hours after transfusion, post-BT CBC was done, while routine monitoring was done till the baby was discharged. Then, the whole cohort was divided into two groups, group 1 (UCB) and group 2 (AB), based on the type of blood they received. Then, both groups were compared for haematological parameters such as haemoglobin, mean corpuscular volume, packed cell volume (PCV) and total red blood cell (TRBC). The rate of change (ROC) of haematological parameters was also compared between the two groups. Babies were followed till the time of discharge from the hospital. Discharge outcomes such as death and duration of hospital stay were compared between two groups.

Statistical analysis

SPSS IBM Corp. Released 2012. (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY) was used to analyse data. Data were examined for normality. We used the Chi-square test and Fischer's exact test for categorical variables. Independent student t-test was used for continuous variables, as appropriate. P < 0.05 was considered statistically significant, and all tests were two-tailed.


  Results Top


A total number of fifty UCB units were collected from the healthy placenta of normal deliveries. Out of fifty cord blood units, forty units were found to be fit for transfusion (six units were not used during the study period) and ten units were unfit for transfusion. Out of ten units, four units were rejected because of less quantity of blood collected (<60 ml) and two units due to technical problems consisted of clots and one unit was positive for hepatitis B and three units on immunological grounds [Table 2]. The baseline characteristics of the two groups were comparable [Table 3].
Table 2: Characteristics of umbilical cord blood units processed and released for transfusion

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Table 3: Baseline characteristics of the two groups were comparable

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In the study, a total of 91 neonatal BTs were performed, out of which 34 received UCB [Figure 1] and 57 with AB, the mean volume of blood collected in UCB was 78 ± 12 ml. The average rise in haemoglobin in UCB transfused patients was 2.01 g/dl [Figure 2]. The mean ROC in haemoglobin, PCV and TRBC was statistically significant (P < 0.05), whereas other haematological parameters were not statistically significant as compared to AB [Table 4]. There were no transfusion-related adverse reactions such as immunologic, metabolic and infectious complications recorded in both groups receiving a BT. In the UCB group, out of 34 neonates, 33 were successfully discharged, there was 1 death due to birth asphyxia-related complication. The average duration of hospital stay is 9.64 ± 5.5 standard deviation (SD), whereas in the AB group, out of 57 neonates, 55 were successfully discharged, there were 2 deaths. The average duration of hospital stay was 9.01 ± 4.5 SD (P value 0.5).
Figure 2: Showing change in haemoglobin after umbilical cord blood transfusion.

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Table 4: Clinical and haematological findings of enrolled patients

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  Discussion Top


In a study done by A. Ballin et al.[7] UCB was transfused in neonates, and they showed that the foetal blood left in the placental vessels might serve as a source of blood for autotransfusion. The authors concluded that placental blood could be used for autologous transfusion for sick neonates. It has been shown in previous studies that cord blood stem and progenitor cells may reconstitute marrow haematopoiesis.[8] UCB, enriched with self-haematopoietic growth factors and progenitor cells, may be beneficial to premature infants who frequently suffer from leucopenia and thrombocytopenia caused by a lack of marrow reserve.

In the present study, 34 cord BTs were given to neonates. The mean rise in Hb in UCB transfused patients was 2.01 g/dl, whereas in the AB group, it was 1.45 g/dl. In 2015, Maria Bianchi et al.[9] showed that change in PCV in the UCB group was 11.9 ± 5, whereas in the AB group was 13 ± 5 against the present study in which it was 6.56 ± 4.5 and 4.16 ± 1.9. This difference may be because multiple transfusions were performed with the cord blood in those patients.

Hassall et al.,[10] monitored adverse events and measured haemoglobin levels 24 h and 28 days after transfusion. Overall, the concentration of haemoglobin increased from pretransfusion levels, by a median of 26 g/L (interquartile range 21–31) 24 h after transfusion, and by 50 g/L (10–68) around 28 days after transfusion, with only a few severe adverse effects recorded. In the present study, 34 cord BTs were given in neonates requiring blood and did not find any immunological, non-immunological or infective reactions. We could not do haemoglobin after 28 days of transfusion.

In the present study, the volume of the cord blood ranges between 60 ml and 120 ml with the mean volume of 78 ml ± 12 ml SD. Other studies were also able to harvest a similar volume of blood from the placenta.[9],[10]

The present study is a clinical trial of allogeneic cord BT in patients with varying diseases. In one study, Bhattacharya et al.[4] did such type of study, while in other studies, researchers had worked on a selective group of patients. It has been reported by various authors previously that cord blood is a rich source of cytokines and growth factors that are poorly present in AB.[8] Stems cells in cord blood are 0.01% of the cellular population, which is ten times greater than the AB (0.001%) while it was 0.1% in the bone marrow. Stem-cell therapy along with growth factors and cytokines can be provided to the patients simply by cord BT, which is helpful in various clinical conditions. As mismatched stem cells are rejected immunologically by the host, but cord blood stem cells which are hypoimmunogenic and immunologically innocent can be accepted by natural matching. In our study and the studies mentioned above, it is obvious that umbilical whole cord blood is safe for transfusion and a genuine alternative to whole human AB.

Limitations

The present study had several limitations. First, the present study had a relatively small number of patients included. More multicentric studies with a larger sample size may prove a better utility of this intervention. Second factors, including the role of cytokines cord blood oxygen-carrying capacity, were not evaluated in the present study. Third, we used whole blood for transfusion in spite of components due to the unavailability of a component separator for a small volume of blood. Neonates were followed only till discharge.


  Conclusions Top


From this study, it can be concluded that UCB is a genuine, valuable and safe alternative to AB in routine and emergencies in neonates requiring BT. In the present study, UCB was better in improving haemoglobin levels as compared to AB. This can form a bridge and fill the gap between demand and supply of blood in neonatal ICU. Further large-scale studies should be done to establish UCB as a reliable source for transfusion in neonates.

Acknowledgement

We are thankful to all the physicians, blood bank staff of SGMH Hospital, Rewa India, Head of Department and Dr. Lokesh Tripathi assistant professor Department of Pathology for their cooperation in this study.

Financial support and sponsorship

Self.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
National AIDS Control Organization | MoHFW | GoI. Available from: http://naco.gov.in/. [Last accessed on 2019 Oct 26].  Back to cited text no. 1
    
2.
Eichler H, Schaible T, Richter E, Zieger W, Voller K, Leveringhaus A, et al. Cord blood as a source of autologous RBCs for transfusion to preterm infants. Transfusion 2000;40:1111-7.  Back to cited text no. 2
    
3.
Jansen M, Brand A, von Lindern JS, Scherjon S, Walther FJ. Potential use of autologous umbilical cord blood red blood cells for early transfusion needs of premature infants. Transfusion 2006;46:1049-56.  Back to cited text no. 3
    
4.
Bhattacharya N, Mukherijee K, Chettri MK, Banerjee T, Mani U, Bhattacharya S. A study report of 174 units of placental umbilical cord whole blood transfusion in 62 patients as a rich source of fetal hemoglobin supply in different indications of blood transfusion. Clin Exp Obstet Gynecol 2001;28:47-52.  Back to cited text no. 4
    
5.
Delivery Care. UNICEF DATA. Available form: https://data.unicef.org/topic/maternal-health/delivery-care/. [Last accessed on 2019 Oct 26].  Back to cited text no. 5
    
6.
Sharma DC, Agrawal N, Bindal J, Woike P, Tomar AS, Arya A. A study of 120 umbilical cord whole blood transfusions in 77 patients with different clinical conditions. IOSR J Dent Med Sci 2017;16:05-12.  Back to cited text no. 6
    
7.
Ballin A, Arbel E, Kenet G, Berar M, Kohelet D, Tanay A, et al. Autologous umbilical cord blood transfusion. Arch Dis Child Fetal Neonatal Ed 1995;73:F181-3.  Back to cited text no. 7
    
8.
Hata T, Kawamura T, Inada K, Fujiwaki R, Ariyuki Y, Hata K, et al. Cord blood cytokines and soluble adhesion molecules in vaginal and cesarean delivered neonates. Gynecol Obstet Invest 1996;42:102-4.  Back to cited text no. 8
    
9.
Bianchi M, Giannantonio C, Spartano S, Fioretti M, Landini A, Molisso A, et al. Allogeneic umbilical cord blood red cell concentrates: An innovative blood product for transfusion therapy of preterm infants. Neonatology 2015;107:81-6.  Back to cited text no. 9
    
10.
Hassall OW, Thitiri J, Fegan G, Hamid F, Mwarumba S, Denje D, et al. Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: An open-label single-arm trial. Lancet Haematol 2015;2:e101-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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