Quality of Red Blood Cells Isolated from Umbilical Cord Blood Stored at Room Temperature

Red blood cells (RBCs) from cord blood contain fetal hemoglobin that is predominant in newborns and, therefore, may be more appropriate for neonatal transfusions than currently transfused adult RBCs. Post-collection, cord blood can be stored at room temperature for several days before it is processed for stem cells isolation, with little known about how these conditions affect currently discarded RBCs. The present study examined the effect of the duration cord blood spent at room temperature and other cord blood characteristics on cord RBC quality. RBCs were tested immediately after their isolation from cord blood using a broad panel of quality assays. No significant decrease in cord RBC quality was observed during the first 65 hours of storage at room temperature. The ratio of cord blood to anticoagulant was associated with RBC quality and needs to be optimized in future. This knowledge will assist in future development of cord RBC transfusion product. 1. Introduction Fetal and neonatal anemias are among the most serious complications of pregnancy and postnatal development. The causes of fetal anemia include immune haemolytic disease [1], defects in hemoglobin structure and synthesis, fetomaternal or twin-to-twin hemorrhages, and parvovirus B19 infections [2]. Neonatal anemia, on the other hand, can either result from fetal anemia or develop after birth as a result of hemorrhage due to obstetric accidents, frequent drawing of blood for laboratory testing, or impaired red blood cell (RBC) production by bone marrow [2]. The most commonly used treatments for fetal and neonatal anemia are transfusions of red blood cells (RBCs), either intrauterine [1] or intravenous [3–6], to help replace the lost RBCs of the fetus or neonate. RBCs used in intrauterine and neonatal (intravenous) transfusions are derived from adult donors [1, 3–7]. Adult RBCs are different from those present in the blood of a fetus or neonate [2, 8–12]. Neonatal RBCs obtained from umbilical cord blood (cord RBCs) are usually discarded during isolation of stem cells from cord blood [13–15]. This waste product may offer a superior alternative for intrauterine and neonatal transfusions [16, 17]. Cord RBCs are unique cells that differ from adult RBCs in membrane composition and biophysical properties [2, 9], hemoglobin (Hb) structure [2, 8–12, 18], metabolism, and enzymatic profile [8, 10]. One of the most important physiological differences is the high concentration of fetal hemoglobin (HbF) in cord RBCs. This is practically absent in adult RBCs (normal adult HbF is <1%) [18]. HbF has a higher