Nucleated red blood cell: a feasible quality parameter of cord blood units

Andrea Tiemi Kondo; Kelen Cristina Arcuri Alvarez; Andrea Neri Folchini Cipolletta; Araci Massami Sakashita; Jose Mauro Kutner

doi:10.1016/j.htct.2023.01.009

Nucleated red blood cell: a feasible quality parameter of cord blood units

Hematol Transfus Cell Ther. 2023 Mar 2:S2531-1379(23)00037-8. doi: 10.1016/j.htct.2023.01.009. Online ahead of print.

Authors

Andrea Tiemi Kondo¹, Kelen Cristina Arcuri Alvarez², Andrea Neri Folchini Cipolletta², Araci Massami Sakashita², Jose Mauro Kutner²

Affiliations

¹ Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Electronic address: andrea.kondo@einstein.br.
² Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

PMID: 36935342
DOI: 10.1016/j.htct.2023.01.009

Abstract

Introduction: Umbilical cord blood is an alternative source of hematopoietic progenitor cells for bone marrow transplantation; however, it is associated with a higher graft failure rate. The presence of a high rate of nucleated red blood cells (NRBCs) seems to be related to a greater capacity for engraftment, although is also associated with fetal distress conditions. We analyzed the correlation of the NRBC with quality parameters and its association with the utilization score of a cord blood unit.

Study design and method: Data of 3346 units collected in a public cord blood bank from May 2010 to December 2017 were analyzed, retrospectively, to identify factors associated with an increased number of nucleated red blood cells and its correlation with the engraftment capacity measured through total nucleated cells (TNCs) and CD34 positive cells. We also evaluated the utilization score of these units and identified an NRBC cutoff associated with a higher score.

Results: The median volume collected was 104 mL (42-255), the pre-processing TNC count was 144.77 × 10⁷ (95.46-477.18), the post-processing TNC count was 119.44 × 10⁷ (42.7-477.18), the CD34 count was 4.67 × 10⁶ (0.31-48.01), the NRBC count was 5 (0-202) and the utilization score was 0.0228 (0.00143-0.9740). The NRBC showed a correlation with the collected volume, TNC and CD34 positive cells and a higher utilization score and the receiver operating characteristic (ROC) curve analysis identified the five NRBC/100 leukocytes cutoff that correlates better with the probability of use. No association with pathological conditions and the NRBC rate was observed.

Conclusions: The NRBC is a feasible parameter for the screening of the cord blood unit (CBU) and the minimum cutoff of five NRBC/100 leukocytes can be a strategy in conjunction with the TNC to identify better units for cord blood bank sustainability.

Keywords: Bone marrow transplantation; Cord blood bank; Cord blood unit; Engraftment; Nucleated red blood cell; Quality parameters.