Donation And Transplant Of Cord Blood

Donation and transplantation of cord blood: The intervention

What is the procedure of donating cord blood? Answer: the most simply of the world! At delivery, a priori any woman can donate cord blood. This donation is free and anonymous, it is safe for neither the mother nor the child.

If a pregnant woman wants to donate placental blood, the birth can only take place in a maternity hospital. Unfortunately, there are very few. In 2010: three maternity hospitals in Bordeaux, two in Besançon, one in Belfort, Dijon, Lyon, Grenoble, Montpellier, Poitiers, Créteil, and one at the Robert Debré hospital maternity hospital in Paris.

Before giving birth, a doctor will explain how this happens. You will give your consent of this gift in writing. A blood test is done to detect possible viral hepatitis, HIV infection ...

30 to 100 ml of blood are collected by puncturing the cord blood after birth, before or after delivery. It is of course painless .
Then, lab tests are performed on placental blood to control stem cells, identify their tissue grouping (HLA *), and so on.

Subsequently, the blood is frozen in pockets stored in placental blood banks.
The blood is thus kept, quarantined for three months.

Three months later, a blood test at the mother is performed to once again control a possible HIV infection or hepatitis passed unnoticed a few months ago. The baby must also be examined by a doctor, the sending of a photocopy of a certificate of this consultation, or the page of the health book of the child is enough.

For reasons of safety, precaution, insufficient quantity of stem cells, only 1/3 of donations will be used.

For the receiver

In case of leukemia, just before performing this transplant, the bone marrow of the patient is completely destroyed by chemotherapy or radiotherapy. It will then be reconstituted thanks to the transplant.

For this, the placental blood is transfused into the patient. One or two units of placental blood can be transfused. The stem cells of the cord pass into the blood of the patient, to gain the interior of the bones (the bone marrow). The time that the graft takes, that is to say that the stem cells are lodged in the bone marrow and produce new normal blood cells (red blood cells, white blood cells, platelets), the patient must remain in a sterile chamber ( like "bubble kids").

This hospitalization lasts about 3 weeks, is difficult because it is done in a very particular environment where many precautions are taken. Despite these precautions, there is a risk of microbial contamination.

Advantages

The placental stem cells are very "immature" even from an immunological point of view. As a result, these cells are much more easily compatible with a recipient. Thus, it is easier to ensure the "compatibility" between donor and recipient. This is the main difference with a "classical" bone marrow transplant.

In the case of a cord transplant, the recipient has fewer graft-versus-host immune responses after transfusion, and the outcome of the transplant is generally better than in the case of a "classical" marrow transplant.

Finally, in the case of a "classical" marrow transplant, the donor undergoes either a small surgery with general anesthesia to collect some bone marrow (in the pelvic bone), or injections of a drug to collect the stem cells in the blood. Of course, these acts do not take place in the placental blood transplant

The inconvenients

Compared with "classical" bone marrow transplantation, placental blood transplantation is delayed. The cord stem cells that will colonize the patient's bone marrow take a little longer to produce normal blood cells.

The risk of infection is increased (contamination by a virus, a bacterium, a fungus ...). The patient remains at least twenty days in a sterile room. This hospitalization can be long and difficult.

* Human leukocyt antigen corresponds to each person's antigen identity card (a bit like the blood type, but much more complex!).

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