Acute foetal distress and umbilical cord blood banking

Transfusion Medicine, 2007, 17, 207

doi: 10.1111/j.1365-3148.2007.00742.x

LETTER TO THE EDITOR

Acute foetal distress and umbilical cord blood banking Dear Sir We have appreciated the interest shown by Solves et al. (2005) to our recent published manuscript ÔDiagnosis of acute foetal distress does not preclude banking of umbilical cord blood unitsÕ (Picardi et al., 2006). We agree with the Valencia Cord Blood Bank (CBB) that the conclusions of our study should be supported by a larger analysis; however, we would specify that the size of cord blood units (CBU) sample was limited by the short period of accrual in our study, although the percentage (10%) of meconium liquid staining (MLS) reported was similar to the analysis performed by Solves et al. (13
8%) in a period of 6 years. The standards of Italian Group for Collection and Amplification of Haematopoietic Stem Cell (GRACE), including acute foetal distress (AFD) as obstetrical exclusion criteria for CB collection, the lack of Foundation for Accreditation of Cellular Therapy guidelines on CB collection when AFD occurs during labour (Migliaccio et al., 2001; Warkentin, 2003) and, finally, the difficulties of ACOG Committee Opinion to define clinical diagnosis of AFD (ACOG Committee Opinion, 2004) have led us to consider the opportunity to improve the diagnosis of AFD when MLS and/or foetal hearth rate (FHR) abnormality occurred during labour. In fact, in our study, conditions such as MLS and/or FHR abnormality patterns significantly reduced our CB collection activity (10% each year), suggesting that these conditions should be reviewed as obstetrical exclusion criteria. Therefore, the aim of our study was to investigate the relationship between MLS and/or FHR alterations with the newborns metabolic balance and the infant Apgar score in order to define whether and how these factors were related to a real condition of AFD. Our clinical results, together with the biological characteristics of the CBU enrolled in the study, have shown that all but one case had normal value of gas analysis and Apgar score, suggesting that an overinterpretation of AFD often occurs in the obstetrical clinical practice. From this point of view, our data are

in line with previous papers (Solves et al., 2005) that have shown as foetal distress could ameliorate the haematopoietic progenitor content of CBU; in fact, the absence of asphyxia and metabolic acidaemia of the CB units enrolled in our trial could explain the similar values of nucleated cells and the percentage of CD341 cells found in the two groups. In conclusion, our study may constitute a support both to define as ÔfeasibleÕ the CB collection in presence of MLS and/or FHR abnormality and to introduce the use of CB gas analysis to better diagnose the AFD. A. PICARDI,* P. FABRITIIS,* A. CALUGI† & S. AMADORI* *Department of Hematology and †Department of Obstetrics and Gynecology, University Tor Vergata, St Eugenio Hospital, Rome, Italy

REFERENCES ACOG Committee Opinion N 303, (2004). Inappropriate use of the terms fetal distress and birth asphyxia. Obstetrics and Gynecology, 104, 903–904. Migliaccio, A.R., Campisi, S., Lecchi, L. International Standards for cord blood collection, processing, testing, banking, selection and release. Italian translation of the second edition (2001) of the standard jointly developed and published by NETCORD and FAHCT. Rapporti ISTISAN 02/23. Picardi, A., Tamburini, A., Carovita, T. et al. (2006) Diagnosis of acute foetal distress does not preclude banking of umbilical cord blood units. Transfusion Medicine, 16, 349–354. Solves, P., Perales, A., Moroga, R., Saucedo, E., Soler, M.A., Monleon, J. (2005) Maternal, neonatal and collection factors influencing the haematopoietic content of cord blood units. Acta Haematologica, 113, 241–246. Warkentin, P.I. (2003) Foundation for the Accreditation of Cellular Therapy. Voluntary accreditation of cellular therapies: Foundation for the Accreditation of Cellular Therapy (FACT). Cytotherapy, 5, 299–305.

Correspondence: Alessandra Picardi, Department of Hematology, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. Tel.: 139 062 090 3179; fax: 139 062 090 3157; # 2007 The Authors Journal compilation # 2007 British Blood Transfusion Society

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