title: How we handled the dextran shortage: an alternative washing or dilution solution for cord blood infusions.
abstract: Dextran 40 is the main component of the solution used to wash or dilute thawed cord blood unit (CBU) products for stem cell transplant. Dextran 40 became unavailable in the United States as of April 2014. Like many other cellular therapy laboratories in the United States, we found ourselves with limited dextran 40 inventory, a growing CBU transplant requirement, and no alternative solution. Since there are no published alternative washing solutions for cryopreserved CBU we had to develop and validate a new solution rapidly. We chose to validate hydroxyethyl starch (HES) due to its similar ability to stabilize red blood cells and reduce sudden changes in osmolality that occur during thawing. For the validation we used 3 CBUs and thawed and washed each unit with both dextran 40- and HES-based solutions; thus, each CBU served as its own control. We observed no significant differences between the two wash solutions for all the monitored variables including cell viability, cell recovery, or potency measured by colony-forming cell assay. Based on this initial validation we began using HES-albumin for CBU washing after our supply was exhausted. Our initial experience with the first 16 CBU transplants after validation indicates safe infusion and preliminary cord engraftment.
authors: Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors: Ronit
authors: R
authors: Reich-Slotky
authors: Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.|National Cord Blood Program, New York Blood Center, New York, New York.
authors: Lohith S
authors: LS
authors: Bachegowda
authors: Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors: Michael
authors: M
authors: Ancharski
authors: Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors: Lyubov
authors: L
authors: Mendeleyeva
authors: National Cord Blood Program, New York Blood Center, New York, New York.
authors: Pablo
authors: P
authors: Rubinstein
authors: Department of Pathology and Laboratory Medicine.
authors: Hanna
authors: H
authors: Rennert
authors: Department of Medicine, Weill Cornell Medical College, New York, New York.
authors: Tsiporah
authors: T
authors: Shore
authors: Department of Medicine, Weill Cornell Medical College, New York, New York.
authors: Koen
authors: K
authors: van Besien
authors: Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.|Department of Pathology and Laboratory Medicine.
authors: Melissa
authors: M
authors: Cushing
mesh_terms: D001772:Blood Cell Count; D001793:Blood Preservation; D002470:Cell Survival; D019343:Citric Acid / Q000494:pharmacology; D003114:Colony-Forming Units Assay; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D015925:Cryopreservation; D003911:Dextrans / Q000494:pharmacology / Q000600:supply & distribution*; D004573:Electrolytes / Q000494:pharmacology; D004912:Erythrocytes / Q000187:drug effects; D005947:Glucose / Q000031:analogs & derivatives / Q000494:pharmacology; D006085:Graft Survival; D006412:Hematopoietic Stem Cells / Q000166:cytology* / Q000187:drug effects; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D007552:Isotonic Solutions / Q000494:pharmacology; D009994:Osmolar Concentration
chemical_list: D003911:Dextrans; D004573:Electrolytes; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; C002113:acid citrate dextrose; D019343:Citric Acid; C048013:Plasmalyte A; D005947:Glucose