Directed/Related Cord Blood Collectionby NHS Blood and TransplantJacqui ThompsonClinical Scientist Section Head of Specialist ProceduresStem Cells and Immunotherapies DepartmentNational Blood Service, NHSBTBirminghamNHS Blood and Transplant

Why collect cord blood?Blood left in the placenta & umbilical cord after the baby hasbeen deliveredConsidered a waste bi-productRich in haematopoietic stem cells with life saving potential forpatients with leukaemia and other blood related malignancies.Alternative to bone marrow for a transplant, mainly used to treatchildren due to the small size of the donation and therefore cellnumbers collected.Advantage is that matched stem cells from cord blood areimmediately availableNHS Blood and Transplant

What is a Stem Cell?NHS Blood and Transplant

Types of Cord Blood BankingUnrelated cord blood bankingVoluntary donations for altruistic use eg NHS CBBDirected/related cord blood bankingcollection for a specific recipient or potential recipientrequiring a transplantCommercial/Private bankingBanking for private autologous use in the futureNHS Blood and Transplant

Network of NHSBT Laboratoriesinvolved with Cellular TherapiesDirected Cord Blood:OxfordBristolBirminghamLeedsUnrelated Banking:NHS CBBMoved from London to BristolIn 2009NHS Blood and Transplant

The NHS CBBNHS Cord Blood Bank started in Feb 1996Unrelated bankingvoluntary donations for patient used world-wide3rd largest Single Public CBB in the worldNationally & Internationally accredited20,000 donations banked. Aiming for 50,000 by 2022Currently 484 units have been issued to over 33countries.NHS Cord Blood BankNHS Blood and Transplant

Directed cord blood collectionDefined by the EBMT classification of transplant procedures(BMT 37 2006 439)Existing sibling suffers from malignant ornon-malignant disorder requiring a transplantThe collection is intended for future children ofsame parents at risk of a specific genetic diseaseRequests initiated by hospitals caring for existing/previoussibling and maternal consent obtained.NHS Blood and Transplant

Quality AssuranceHuman Tissue AuthorityJACIE FACT-NETCORD accreditationGuidelines for Blood Transfusion Services in UK.NHS Blood & Transplant QA Dept.NHS Blood and Transplant

HTA regulations from 5th July 2008Maternity units that collect cord blood need to act under an HTAprocurement licence.Cord Blood must be traceable from collection to use.Collection staff should have training in collecting cord blood.Procedures should be in place to help avoid medical attention beingdrawn away from the mother and ttreatment/cordbloodprocurementfaqs.cfm#oneNHS Blood and Transplant

RCM and RCOG Advice for CB collectionSupport CB collection for medical & research purposesDo not support commercial cord blood collectionSupport HTA licensing and regulation for collection and storageCollection must not interfere with health of mother & babyCollection should take place by a trained collector,after the placenta has been delivered, in an area away fromthe delivery roomNHS Blood and Transplant

Laboratory Aspects of DCB collectionA referral is made to the NHSBT SCI Dept. by a transplant unitMaternal screening for mandatory markers by NHSBTObstetrician s consent is obtainedSCI laboratory liaises with the Midwifery DepartmentA kit is delivered by the NHSBT to the Midwifery Department.Collection is made by Midwifery Department or private collectorsSCI Receive & cryopreserve cells within 24 hoursObtain WBC, volume, CD34 count, tissue typing,RBC group, bacteriology and virology results.Prepare reports and request confirmation of storage.Costs met by referring hospitalNHS Blood and Transplant

Cord Blood Collection.The cord is cleaned with iodine and then blood is drainedinto a bag with anti-coagulant via a line and needleNHS Blood and Transplant

All cells are processed in a GMP clean room wherefiltered air and specialised clothing limit contaminationNHS Blood and Transplant

DCB collections by NHSBT under the HTAThe referring hospital and NHSBT both have a procurement licenseNHSBT has a Third Party Agreement with the Midwifery Deptor a private collection company eg Phlebotomy UK LtdNHSBT is legally responsible for complying with the HTASCI arranges training in consultation with the midwifery departmentor ensures the collection company staff are trained.Premises must be suitable for the purposeNHS Blood and Transplant

Collection detailsCells not usually excluded from storage or use until the bloodhas been processed and tissue typing completed28% were shown to be a match for HLA A, B, Cw, DR and DQ.Contamination comparable to unrelated cord blood banksMean volume and TNC counts comparable to unrelated banksFailed collection (2.9%) was mainly due to a damaged cordand/or placentaNHS Blood and Transplant

Collections by NHSBT1995-2005120 months2005-200830 months2009-201348 monthsTotal g. ALL)1265368(51%)(21%)(28%)Non-Malignant 1(e.g. b-Thal., SCD,DBA)684781(35%)(24%)(41%)Non-Malignant 2(e.g. 5(35%)NHS Blood and Transplant

Thank YouNHS Blood and Transplant

children due to the small size of the donation and therefore cell numbers collected. Advantage is that matched stem cells from cord blood are immediately available. NHS Blood and Transplant . Contamination comparable to unrelated cord blood banks Mean volume and TNC counts comparable to unrelated banks Failed collection (2.9%) was mainly due .