Effect of cord blood processing on transplantation outcomes after single myeloablative umbilical cord blood transplantation.

Variations in cord blood manufacturing and administration are common, and the optimal practice is not known. We compared processing and banking practices at 16 public cord blood banks (CBB) in the United States and assessed transplantation outcomes on 530 single umbilical cord blood (UCB) myeloablative transplantations for hematologic malignancies facilitated by these banks. UCB banking practices were separated into 3 mutually exclusive groups based on whether processing was automated or manual, units were plasma and red blood cell reduced, or buffy coat production method or plasma reduced. Compared with the automated processing system for units, the day 28 neutrophil recovery was significantly lower after transplantation of units that were manually processed and plasma reduced (red cell replete) (odds ratio, .19; P = .001) or plasma and red cell reduced (odds ratio, .54; P = .05). Day 100 survival did not differ by CBB. However, day 100 survival was better with units that were thawed with the dextran-albumin wash method compared with the "no wash" or "dilution only" techniques (odds ratio, 1.82; P = .04). In conclusion, CBB processing has no significant effect on early (day 100) survival despite differences in kinetics of neutrophil recovery.

Vitamin D effect on umbilical cord blood characteristics: a comparison between African Americans and Caucasians.

BACKGROUND: Umbilical cord blood (UCB) units collected from African Americans (AAs) have lower total nucleated cell (TNC) and CD34+ cell counts and are more likely to disqualify for banking compared to other ethnic groups. Furthermore, AAs have higher prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency. Given the importance of 25(OH)D in hematopoiesis, we examined the racial differences in UCB unit 25(OH)D content and its correlation with UCB cellular characteristics. STUDY DESIGN AND METHODS: A total of 119 UCB units that did not meet the TNC count banking criteria were analyzed. Fifty-one UCB units were collected from AA mothers and 68 from Caucasian mothers. We analyzed UCB volume, hematocrit (Hct), TNCs, mononuclear cells (MNCs), CD34+ cells, plasma 25(OH)D concentration, and progenitor clonogenic capacity measured by colony-forming cell (CFC) assay. RESULTS: Compared to Caucasians, AAs had significantly lower UCB 25(OH)D levels (p<0.0001), TNCs (p=0.002), MNCs (p=0.026), and CD34+ cells (p=0.026). Severe deficiency (25(OH)D<10 ng/mL) was only detected in AAs. No difference in median CFC count/10,000 MNCs was detected between AAs and Caucasians. Independent of race, a significant association was detected between 25(OH)D level and TNCs (r=0.193 p=0.035) and Hct (r=0.196 p=0.033). CONCLUSION: These results indicate the importance of 25(OH)D level as a racially independent predictor of UCB cellular characteristics and support further investigation of bioactive vitamin D and other predictors of hematopoiesis on cord blood quality.

Universal donor education and consent: what we know and where we should go.

Each day thousands of blood donors across the country are given educational materials and sign a consent form, thus fulfilling two blood collection accreditation requirements. Very few donors will experience a documented adverse event, although a disproportionate number of these events occur in the youngest donor cohort. The literature reflects this disproportion and suggests mitigation strategies. Studies describe subjective, undocumented donor reactions and decreased donor return rates after a documented or subjective reaction. Additionally, studies have shown donor consent form variability among blood collection facilities and that donor comprehension of the educational materials and consent is limited. There are few standardized donor education materials or consent documents. Current accreditation standards for educational materials are limited to aspects of transfusion-transmitted diseases and for donor consent process and documentation are vague and nonspecific. Recent experiences with young donors and current research compel our community to engage in creating standardized, expanded donor educational materials and standardized donor consent processes and documents.

Clinical consequences of iron overload from chronic red blood cell transfusions, its diagnosis, and its management by chelation therapy.

Iron overload from chronic transfusion therapy can be extremely toxic. Excess transfusional iron is deposited in the liver, heart, and other organs as free iron, which can cause organ dysfunction and damage over time. Increased awareness of the risk of iron overload in patients requiring chronic transfusion therapy is needed, and such patients should be screened for hyperferritinemia. Those with serial serum ferritin levels exceeding 1000 ng/mL and a total infused red blood cell volume of 120 mL/kg of body weight or more should be treated with chelation therapy and then monitored to ensure that treatment adequately reduces iron levels.

Attitudes, Practices, and Training on Informed Consent for Transfusions and Procedures: A Survey of Medical Students and Physicians.

OBJECTIVES: While many studies have demonstrated problems with informed consent in current practice, there remains controversy on how to address this. The aim of this study was to evaluate the opinions, attitudes, practices, and training for informed consent. METHODS: Medical students, residents, advanced practice providers, and attending physicians at an academic institution were invited to complete a survey on informed consent for transfusions and procedures through an electronic platform. RESULTS: Most (94%, n = 304) respondents indicated previous training in informed consent, only 60% (n = 192) felt the training was adequate, and 35% (n = 92) indicated difficulties with informed consent. When asked what would aid in obtaining consent, 59% (n = 189) selected a written guideline, and 36% (n = 117) selected patient simulation. CONCLUSIONS: Only 60% of respondents felt their informed consent training was adequate. Multiple areas of difficulty in obtaining proper informed consent were identified that should be addressed with focused training or written guidelines.