Avaliacão das características com maior influência na qualidade das unidades de sangue de cordao umbilical em um banco público
Arquivos
Data
2014-11-26
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Análises dos transplantes realizados com sangue de cordão umbilical e placentário (SCUP) demonstram que a probabilidade de enxertia e o tempo de recuperação hematopoética estão intimamente relacionados ao número total de células infundidas. Objetivos: Avaliar, entre as características maternas, neonatais e técnicas de coleta SCUP, quais os fatores que mais influenciam no volume e número de células nas unidades de SCUP. Comparar as diversas características entre as três diferentes instituições de coleta de SCUP. Investigar a possível relação do intervalo de tempo entre a coleta de sangue de cordão e o processamento com os resultados das células funcionais. Método: Foi analisada uma coorte histórica com 7.897 pacientes sequencialmente selecionadas em três instituições no período de 4 de outubro de 2004 a 31 de março de 2012, todas consideradas aptas para coleta de sangue de cordão. Resultados: As características maternas, neonatais e técnica de coleta que mais influenciaram no volume e número de células nucleadas (p<0,001) foram: idade materna, idade gestacional, tipo de parto, tipo de gravidez, gênero do RN, raça do RN, peso do RN e técnica de coleta SCUP. O volume de SCUP foi estatisticamente significante em relação à idade materna, tipo de parto, tipo de gravidez, raça do RN, peso do RN e técnica de coleta SCUP (p<0,001, respectivamente), idade gestacional (p= 0,005), gênero do RN (p=0,018). O TCN se associou à idade materna (p=0,017), idade gestacional, tipo de parto, tipo de gravidez, gênero do RN, peso do RN e técnica de coleta SCUP (p<0,001, respectivamente), bem como a raça/cor do RN (p=0,004). O número de CD34+ se associou à idade gestacional, gênero do RN, peso do RN (p<0,001, respectivamente), raça do RN (p=0,002) e técnica de coleta de SCUP (p=0,026). A Viabilidade por citometria de fluxo se associou à idade materna, tipo de parto e à raça do RN (p<0,001, respectivamente) e à idade gestacional (p=0,008). O Hospital Israelita Albert Einstein obteve o maior volume de sangue de cordão e a maior viabilidade das células em seus resultados, enquanto o Hospital Municipal M?Boi Mirim obteve a maior contagem de células CD34+ e LMN.O Hospital Municipal de Campo Limpo, no entanto, apresentou a menor contagem de TCN. Não foi observada associação entre o intervalo de tempo entre a coleta de sangue de cordão e o seu processamento com a quantidade de unidades formadoras de colônias (CFU) nas amostras estudadas. Conclusão: O estudo fornece elementos para a criação de um modelo que permita maior eficiência na seleção de doadoras SCUP, priorizando candidatas com maior probabilidade de aproveitamento do sangue de cordão.
Analyses of Umbilical Cord blood (UCB) transplants demonstrate that the probability of engraftment and the time for hematopoietic recovery is closely related to the total number of infused cells. Aims: To evaluate, among maternal and neonatal characteristics and UCB collection techniques, which factors have the greatest impact on UCB unit volume and total cell number (TCN). To compare characteristics from three different institutions that perform UCB collection. To investigate a possible relationship between cell function in UCB units with the time interval from blood collection until UCB processing. Method: We analyzed data from a historical cohort of 7,897 patients sequentially selected from three different institutions between October 4rd, 2004 and March 31st, 2012, all of whom considered apt for UCB collection. Results: The maternal, neonatal and collection characteristics that had a significant impact on volume and cell number were (p <0.001): maternal age, gestational age, mode of delivery, type of pregnancy, newborn gender, newborn ethnicity, birth weight and UCB collection technique. UCB volume was statistically associated with maternal age, type of birth, type of pregnancy, newborn ethnicity, birth weight and UCB collection technique (p <0.001, respectively), gestational age (p=0.005), and newborn gender (p=0.018). Likewise, TNC was correlated to maternal age (p=0.017), gestational age, type of birth, type of pregnancy, newborn gender, birth weight and UCB sampling technique (p<0.001, respectively), as well as newborn ethnicity (p=0.004). The number of CD34+ cells was associated with gestational age, newborn gender, birth weight (p<0.001, respectively), fetal ethnicity (p = 0.002), and UCB collection technique (p=0.026). Viability measured by flow cytometry was associated with maternal age, type of birth and fetal ethnicity (p<0.001, respectively) and gestational age (p=0.008). Hospital Israelita Albert Einstein had the highest final UCB volume and cell viability results, while Hospital Municipal M?Boi Mirim had the highest CD34+ cell and lymphomononuclear cell counts. Hospital Municipal de Campo Limpo, however, had the lowest TNC values. There was no association between the time from UCB collection until processing with colony forming units (CFU) outcomes in the sample studied. Conclusion: The study provides elements to create a model to optimize UCB donor selection efficiency, so that candidates with a higher probability of having their cord blood units can be prioritized.
Analyses of Umbilical Cord blood (UCB) transplants demonstrate that the probability of engraftment and the time for hematopoietic recovery is closely related to the total number of infused cells. Aims: To evaluate, among maternal and neonatal characteristics and UCB collection techniques, which factors have the greatest impact on UCB unit volume and total cell number (TCN). To compare characteristics from three different institutions that perform UCB collection. To investigate a possible relationship between cell function in UCB units with the time interval from blood collection until UCB processing. Method: We analyzed data from a historical cohort of 7,897 patients sequentially selected from three different institutions between October 4rd, 2004 and March 31st, 2012, all of whom considered apt for UCB collection. Results: The maternal, neonatal and collection characteristics that had a significant impact on volume and cell number were (p <0.001): maternal age, gestational age, mode of delivery, type of pregnancy, newborn gender, newborn ethnicity, birth weight and UCB collection technique. UCB volume was statistically associated with maternal age, type of birth, type of pregnancy, newborn ethnicity, birth weight and UCB collection technique (p <0.001, respectively), gestational age (p=0.005), and newborn gender (p=0.018). Likewise, TNC was correlated to maternal age (p=0.017), gestational age, type of birth, type of pregnancy, newborn gender, birth weight and UCB sampling technique (p<0.001, respectively), as well as newborn ethnicity (p=0.004). The number of CD34+ cells was associated with gestational age, newborn gender, birth weight (p<0.001, respectively), fetal ethnicity (p = 0.002), and UCB collection technique (p=0.026). Viability measured by flow cytometry was associated with maternal age, type of birth and fetal ethnicity (p<0.001, respectively) and gestational age (p=0.008). Hospital Israelita Albert Einstein had the highest final UCB volume and cell viability results, while Hospital Municipal M?Boi Mirim had the highest CD34+ cell and lymphomononuclear cell counts. Hospital Municipal de Campo Limpo, however, had the lowest TNC values. There was no association between the time from UCB collection until processing with colony forming units (CFU) outcomes in the sample studied. Conclusion: The study provides elements to create a model to optimize UCB donor selection efficiency, so that candidates with a higher probability of having their cord blood units can be prioritized.
Descrição
Citação
SANTOS, Sandra Valéria Francisconi. Avaliação das características com maior influência na qualidade das unidades de sangue de cordão umbilical e placentário. São Paulo, 2014. [93] p. Tese (Doutorado em Enfermagem) - Escola Paulista de Enfermagem (EPE), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2014.