Biomedical Engineering Reference
In-Depth Information
19.7 CONTEMPORARY CLINICAL EXPERIENCE AND SAFETY
STUDIES OF CORD BLOOD TRANSFUSION
Millions of people are saved every year as a result of blood transfusions. At the
same time, particularly in developing countries, many still die because of an inad-
equate supply of safe blood and blood products. A reliable supply of safe blood is
essential to improve health standards at several levels, especially for women and
children, and particularly in the poorer sections of society anywhere in the world.
Half-a-million women still die of complications related to pregnancy and child-
birth, and 99% of these are in developing countries. Hemorrhage accounts for
25% of the complications and is the most common cause of maternal death. In
children, other than complicated diseases, malnutrition, thalassaemia and severe
anemia are prevalent diseases that require blood transfusion. Over 80 million
units of blood are collected every year, but the tragedy is that only 39% of this is
collected in the developing world which contains 82% of the global population.
The authors' clinical research over the past ten years has shown that cord
blood can be used safely as a blood substitute. Moreover, this blood has higher
hemoglobin content and growth factors, which have the potential to benefi t
patients in varying diseases.
A brief survey of the work done by the present research group will illustrate
this point. In one instance, seventy-eight units of placental umbilical cord whole
blood (from 1 April 1999 to 30 April 2005), collected after lower uterine cesarean
section (LUCS) from consenting mothers (56 ml - 138 ml mean 82 ml +/
−
5.6 ml SD,
median 84 ml, mean packed cell volume 49.7 +/
−
4.2 SD, mean percent hemoglo-
bin concentration 16.6 g/dl +/
1.5 g/dl SD) was transfused to diabetes patients
with microalbuminuria and severe anemia, necessitating transfusion.
After collection, the blood was transfused, in most cases immediately after
completion of the essential norms of transfusion. In rare cases, it was kept in the
refrigerator and transfused within 72 hours of collection to a suitable recipient.
For inclusion in this study, the patient's percent plasma hemoglobin had to be
8 g/dl or less (the pretransfusion hemoglobin in this series varied from 5.2 g/dl
to 7.8 g/dl) in the background of Type II diabetes (fasting sugar 200 mg or more),
along with features of microalbuminuria (albumin excretion 30-299 mg/g creati-
nine). There were 39 informed consenting patients. The patients were randomized
into two groups: Group A (control cases N = 15), and Group B (study group
N = 24). In Group A, the rise of hemoglobin (Hbg) after two units of adult blood
transfusion was 1.5 to 1.8 g/dl, as seen after a 72-hour blood sample assessment.
The rise of Hbg in Group B as noted after 72 hours of two units of freshly col-
lected cord blood transfusion was .6 g/dl to 1.5 g/dl.
Each patient received two of four units of freshly-collected cord blood
transfusion (two units at a time), depending on availability and compatibility.
Microalbuminuria was assessed in both groups after one month of treatment with
transfusion and other identical support. The mean result for Group A was
152 +/
−
18 mg SD of albumin per gram of creatinine excreted through 24-hour
urine (pre-transfusion mean excretion was 189 +/
−
−
16 mg in this group) and
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