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NEWS EXTRA: Doug Payne Operations in Ireland cancelled because of blood shortages BMJ 2002; 324: 134c [Full text]

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Umbilical Cord Whole Blood Transfusion: A Suggested Strategy To Combat Blood Scarcity In Ireland

Dr Niranjan Bhattacharya MBBS,MD,MS,FACS(USA)   (28 January 2002)

Umbilical Cord Whole Blood Transfusion: A Suggested Strategy To Combat Blood Scarcity In Ireland 28 January 2002
Dr Niranjan Bhattacharya MBBS,MD,MS,FACS(USA), Surgeon and Superintendent, Bijoygarh State Hospital, Calcutta,INDIA Bijoygarh State Hospital, Calcutta-700032, INDIA Send response to journal: Re: Umbilical Cord Whole Blood Transfusion: A Suggested Strategy To Combat Blood Scarcity In Ireland	Dear Sir, In the 19th January issue of BMJ.com (2002;324:134), Doug Payne from Dublin reported in the 'News Extra' section that elective operations in Ireland had to be postponed due to the non-availability of blood. The author tried to explain the situation in terms of a less altruistic attitude and also a seasonal variation in collection,leading to a 46% increase in the price of blood bags ($199.32). I have a humble suggestion for my learned colleagues in Ireland.With the progressive global acceptance of cord blood stem cell transplantation as an alternative to bone marrow transplantation, many laboratories collect umbilical cord blood for stem cells only. Stem cells constitute .01% of the nucleated cells of umbilical cord whole blood.The rest of the blood (99.99%)is apparently discarded. However,the placental vessel at term contains 150ml of blood.(1). The cord blood contains three types of hemoglobin,viz.,HbF, HbA,and HbA2, of which HbF constitutes 50 to 85%.(2). HbF has a greater affinity to oxygen than HbA.(3). The oxygen tension at which the hemoglobin of cord blood is 50% saturated (P50) is 19-20 mm Hg, i.e., 6-8 mm Hg lower than that of adult blood. This shift to the left of the hemoglobin dissociation curve results from a poor binding of 2,3 diphosphoglycerate of HbF.(4). We have earlier published our initial report on 174 units of umbilical cord whole blood tansfusion as an alternative to adult whole blood transfusion in 62 volunteers suffering from varying diseases from the paediatric to the geriatric age groups, without any transfusion related problems.(5). Till date, we have transfused more than 350 units of freshly collected umbilical cord whole blood in different indications of adult blood transfusion, without encountering any immunological or non-immunological reactions so far. We believe that pregnancy specific immunological naivete/hypoantigenicity of the developing fetal system is a crucially important factor in fetal cell transplant acceptance.(6,7).We have been working on this project which is funded by the Department of Science and Technology, Govt. of West Bengal, India, since 1st April,1999. We all know that asceptically collected human cord blood is pure, that is, free from bacteria, virus, protozoal contamination, in case of healthy new born babies, as the cord blood passes through the finest biological sieve, i.e., the placenta. This blood has a much higher hemoglobin, platelet and leucocyte content than adult whole blood. Additionally, it has a high concentration of cytokine/growth factor in its plasma, which eventually helps in the gene-switching mechanism after the birth of the baby. This blood also has a much higher oxygen carrying capacity and hence, the transfusion of fetal hemoglobin rich cord blood may lead to better tissue perfusion of oxygen (vol/vol)to the recipients tissue than an identical volume of adult whole blood. The positive clinical implications may include cases of severe anaemia, renal failure and other conditions of less cardio-respiratory reserve or tissue hypoxic condition in any age group. This is specially important in high risk geriatric cases with varying degrees of bone marrow senescence or fall in T cell function, where CD34 stem cell rich umbilical cord whole blood transfusion will have the immediate benefit of better tissue oxygenation (vol/vol adult whole blood), with an additional delayed benefit of engraftment (?) of umbilical cord stem cells for the rejuvenation of the bone marrow. Finally, another interesting aspect is the possibility of augmentation of surgical wound healing by the growth factor/cytokine rich umbilical cord blood plasma. In fine, our suggestion is that blood scarcity can be combated in an emergency situation through the use of stem cell free or stem cell rich umbilical cord whole blood. Yours sincerely, Dr.Niranjan Bhattacharya(Principal Investigator in the project on Fetal Cell Transplantation in Adults) ; Dr.K.L.Mukherjee, Dr.M.K.Chettri, Dr.Tarashankar Banerjee, Dr.Abha Sarkar, Dr.Mahua Bhattacharya, Dr.Sanjukta Bhattacharya References: (1)Haselhorst G, Allmeling A,"Die gwichtszunahme von neugeborenen infolge postnataler transfusion",Z. Geburtshilfe Perinatol. 1930;98:103. (2)Oski FA, Naiman JL, "Hematological Problems in the New Born",3rd ed. Philadelphia, WB Saunders, 1992. (3)Davis JA, Dobbing J,"Scientific Foundations of Paediatrics", William Heineman Medical Books, London,1981. (4)Killmartin JV,"Interaction of Hemoglobin with Proteins, CO2 and 2,3 Diphosphoglycerate", Brit. Med. Bull. 1976;32 : 209. (5) Bhattacharya N, Mukherjee KL, Chettri MK,et al," A Study Report of 174 Units of Placental Umbilical Cord Whole Blood Transfusion in 62 Patients as a Rich Source of Fetal Hemoglobin Supply in Different Indications of Blood Transfusion",Clin. Exp. Obst.& Gyn., 2001;28(1):47-52. (6)Bhattacharya N,"Fetal Tissue Organ Transplant in HLA Randomized Adult Vascular Subcutaneous Axillary Fold : Preliminary Report of 14 Cases",Clin.Exp.Obst&Gyn., 2001; 28(4):233-9. (7)Bhattacharya N, Mukherjee KL, Chettri MK et al, "A Unique Experience with Human Pre-immune(12 weeks) and Hypo-immune (16 weeks) Fetal Thymus Transplant in a Vascular Subcutaneous Axillary Fold in Patients with Advanced Cancer: A Report of 2 Cases", Eur.J.Gynaec.Oncol., 2001; 22(4):273-7.