Objective: To minimise donor blood exposure in neonatal intensive care medicine, human placental blood as a potential source for autologous transfusion of the critical ill neonate was evaluated. The possibility to transfuse HbF to the neonate would be an additional benefit. Methods: Blood, obtained by puncture of the umbilical vein following cord clamping after 10 caesarean sections, was drawn in the first bag of a sterile two bag system. 0.124 ml citrate- phosphate- dextrose- adenin (CPDA l)per gram placental blood where added as anticoagulant. After one hour, leukocyte depletion was performed with filtration by hydrostatic pressure through an in line leukocyte adhesion filter placed between the primary and secondary collection bag. The filtered blood units were stored at +4 C for 30 days. Samples were taken before and immediately after filtration after 24h and every 4 days thereafter. Resluts: In median 106 ml (range 77-166 ml) placental blood were obtained, following filtration blood units containing 65 ml (median, range 30-120 ml) CPDA1 blood where achieved. Cell removal was significant with white cell depletion from 8,8 K/ul in median (range 5,77 - 14,8 K/ul)to 0,014 K/ul in median (range 0,007 - 0,021 K/ul) after filtration. During storage neither coagulation parameters (aPTT, TZ, Fib, TZ, Plasminogen, Protein C, PAI1, F Vil, F VIII, F XII) nor levels of Na, Ça, CL, Fe, CK, GOT, OPT, total protein, and bilirubin changed significant over a period of 30 days. However, significant rising potassium levels after day 5 ( 7,2 mmol/1 median, range 5,9 - 7,2 mmol/1; up to 24 mmol/1 in median, range 14,8 - 27,5 mmol/1 at day 29) as well as an marked increase in lactate and free haemoglobin ( 39 mg/dl median, range 26 - 70 mg/dl; up to 133 mg/dl in median, range 62 - 286 mg/dl at day 29)indicated significant haemolysis. Conclusion: Placental blood represents a source for autologous HbF transfusion of the critical ill neonate. In leukocyte depleted whole blood, significant rising potassium levels allow storage only for 5-7 days. Washed erythrocytes or packed red cells gained from the source however, might be an option.
|Issue number||11 PART II|
|Publication status||Published - 1 Dec 2000|