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In Utero Is Superior to Ex Utero Cord Blood Collection.

Elizabeth J. Shpall, Safa Karandish, Tara Sadeghi, Chitra Hosing, Christopher J. Garcia, Michael T. Cherry, Julia A. Walker, Corliss R. Denman, Rima M. Saliba, Richard E. Champlin, Marcelo Fernandez-Viña, Pedro Cano and John D. McMannis

Abstract

Cord blood (CB) cells are being used increasingly as a source of hematopoietic support in patients lacking human leukocyte antigent (HLA)-matched family or unrelated donors. 1124 CB units were collected, based on obstetrician preference, with the placenta either in utero or ex utero. If logistically feasible, both an in utero collection followed immediately by an additional ex utero collection once the placenta was delivered was performed. We compared the distribution of the collection parameters shown in the following table, using non-parametric tests [data expressed as median (range)]:

Athough the volume of CB collected was highest with the sequential in utero plus ex utero method, the number of total nucleated cells (TNCs) and CD34+ cells was similar for both the in utero procedures and higher than with the ex utero alone procedure. The number of CB units that had microbial contamination was similar for all three groups: ex utero-0 CB units, in utero-1 CB unit and in utero plus ex utero-1 CB unit. There were no clinical adverse events associated with any of the collection procedures.

Conclusion: In utero collections are safe and result in CB units with significantly higher volumes, TNCs and CD34+ cells than ex utero collections, with no difference in the microbial contamination rate.

CB ParametersEx Utero (N=390)In Utero (N=334)In+Ex Utero (N=400)In+Ex vs Ex (p)In+Ex vs In (p)In vs Ex (p)
Volume (ml)76.588.594<0.00010.03<0.001
(35–199)(45–185)(42–207)
Tot Nucleated cells (xE7)94115119<0.0010.4<0.001
(20–267)(36–399)(41–393)
CD34+cells (xE6)2.93.43.10.20.160.01
(0–30)(0–34)(0–55)