A prenatal prediction model for total nucleated cell count increases the efficacy of umbilical cord blood banking.
BACKGROUND
The most important factor for the selection of an umbilical cord blood unit (CBU) for hematopoietic stem cell transplantation is the total nucleated cell (TNC) count as a surrogate marker for stem cell content in the CBU. At present, about one in five donors can provide a CBU with a sufficient TNC count for umbilical cord blood (UCB) banking. It is labor-intensive to obtain consent of all eligible donors and optimization of the selection is needed. The purpose of this study was to investigate prenatal clinical predictors for TNC count that would help to identify successful UCB donors already on admission to the delivery unit.


METHODS
This study was a retrospective analysis of 758 cryopreserved CBUs, collected from 2002 to 2006. Maternal and fetal factors analyzed were maternal age, gravidity, parity, weight, height, diabetes, premature rupture of membranes, gestational age, fetal sex, and birthweight. The impact on a high TNC count (<150 × 10(7) vs. ≥ 150 × 10(7)) of the CBU was modeled in a multivariate analysis model.


RESULTS
Fetal birthweight was the strongest predictor (p < 0.001) of TNC count of at least 150 × 10(7). With a composite score of parity, gestational week, maternal weight and height, fetal sex, and birthweight, a nomogram was developed that increased banking rates from 22.7% to 31.9% while decreasing the number of banked CBUs from 149 to 79.


CONCLUSIONS
Our prenatal prediction model increases the efficacy of obtaining informed consent for UCB banking while still allowing relevant numbers of CBUs to be banked.
Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland.
Gwendolin
G
Manegold-Brauer
Barbara
B
Borner
Christoph
C
Bucher
Irène
I
Hoesli
Jakob
J
Passweg
Sabine
S
Girsberger
Andreas
A
Schoetzau
Simona
S
Gisin
Eva
E
Visca
D000328:Adult; D000367:Age Factors; D001724:Birth Weight; D001771:Blood Banks; D001782:Blood Donors; D015925:Cryopreservation; D005260:Female; D005312:Fetal Blood / Q000166:cytology*; D020073:Gravidity; D006801:Humans; D007958:Leukocyte Count; D008954:Models, Biological; D011237:Predictive Value of Tests; D011247:Pregnancy; D012737:Sex Factors; D013234:Stem Cells / Q000166:cytology*