Transfus Apher Sci
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This report describes the evolution of Cord Blood (CB) hematopoietic stem cell transplants (HSCTs) in Europe over time and its current status. There were 687 patients with a first CB HSCT and a total of 763 allogeneic CB HSCT but no autologous CB HSCT reported in the year 2008. The 687 first transplants correspond to 6% of the total 11,408 allogeneic HSCT. ⋯ Main indications for the 639 unrelated first CB HSCT were acute leukaemia (337;53%), non-malignant disorders (115;18%) and lymphoproliferative disorders (53; 8%). 159 teams out of the 368 teams performing allogeneic HSCT (43%) reported 1 to 37 CB HSCT (median 3). There were significant differences in use of CB in the participating European countries with a median CB transplant number of 6.5 (range 1-207), transplant rate (number of CB HSCT/10 million inhabitants) of 6.3 (range 0.1-234.6) and a proportion of CB amongst allogeneic HSCT from 0.7% to 18.2% (median 5.4%). These data document the established role of CB HSCT in Europe but point to significant differences in its use.
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There have been several retrospective studies reporting severe adverse events of mortality and morbidity associated with blood transfusions. Mortality and morbidity associated with posttransfusion infection, transfusion related acute lung injury (TRALI), and systemic inflammatory response syndrome (SIRS) have been reported in patients undergoing cardiac surgery, after massive transfusions for severe traumatic injuries, and after transfusions for elective and emergency indications. After 35 days of storage at 4 degrees C in additive solutions, RBC have 24-h posttransfusion survival values of 75% but do not function satisfactorily. ⋯ One of the easiest ways to prevent the severe adverse events that have been observed is to ensure that the transfused blood products survive and function at an optimum level and that the levels of antibodies to granulocytes and WBC HLA antigens and biologically active substances are eliminated or reduced. The best way to ensure this is to store liquid-preserved leukoreduced human red blood cells at 4 degrees C in additive solutions for no more than 2 weeks and leukoreduced platelets at room temperature for no more than 2 days. These liquid-preserved blood products can be used in conjunction with frozen RBC, platelets, and plasma stored in -80 degrees C mechanical freezers and will avoid the need for fresh whole blood and prevent the severe adverse events associated with the transfusion of blood products.