Programma regionale Donazione del sangue di cordone ombelicale Corso annuale di aggiornamento CDR SCO Civitanova Marche, 29 settembre 2014 CDR di: Civitanova.

Presentazione sul tema: "Programma regionale Donazione del sangue di cordone ombelicale Corso annuale di aggiornamento CDR SCO Civitanova Marche, 29 settembre 2014 CDR di: Civitanova."— Transcript della presentazione:

1 Programma regionale Donazione 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 REGIONALE INTERAZIENDALE DI MEDICINA TRASFUSIONALE

2 611.379 Unità SCO 47 Banche 32 Nazioni Settembre 2014 Incremento annuo

3 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%

4 ITCBN

5 308 Centri di Raccolta attivi suddivisi per ciascuna banca Centro Nazionale Sangue Banche di sangue di cordone ombelicale – Report 2013

6 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

7 TNC delle SCO ITCBN utilizzate SCO con TNC >120 SCO con TNC <120 96%42% 2013 87% 40% 2012 Centro Nazionale Sangue Banche di sangue di cordone ombelicale – Report 2013

8 Fattori predittivi per la raccolta - Letteratura PROGRAMMA REGIONALE DONAZIONE SCO RIUNIONE CDR REGIONE MARCHE Ancona - 15 maggio 2012

9 PARAMETROPREDITTIVITÀ Età gestazionalePredittività positiva ParitàPredittività negativa Tipo di partoStudi contraddittori Lunghezza del travaglioPredittività 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 neonatoStudi 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 SCO Ancona - 15 maggio 2012

10 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

11 We suggest significantly raising the TNC level used to determine a bankable unit. A level of 1,25x10 9 TNCs, maybe even 1,5x10 9 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. T. Bart

12 A prenatal prediction model for total nucleated cell count increases the efficacy of umbilical cord blood banking. Manegold-Brauer G Manegold-Brauer G 1, Borner B, Bucher C, Hoesli I, Passweg J, Girsberger S, Schoetzau A, Gisin S, Visca E. Transfusion. 2014Borner BBucher CHoesli I Passweg JGirsberger SSchoetzau AGisin SVisca E Transfusion. Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland.

13 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 × 10 7 vs. ≥150 × 10 7 ) 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 × 10 7. 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.

14 Factors affecting umbilical cord blood stem cell suitability for transplantation in an in utero collection program. Keersmaekers CL Keersmaekers CL 1, Mason BA, Keersmaekers J, Ponzini M, Mlynarek RA.Mason BA Keersmaekers JPonzini MMlynarek RA 1 Department of Obstetrics and Gynecology, St John Hospital and Medical Center, Detroit, Michigan. Transfusion.Transfusion. 2014 Mar;54(3):545-9.

15 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.

16

17 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

18 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.

19 Stima peso neonato !!!!!