Ex-Utero Plus in Utero Collection of Umbilical Cord Blood (CB) for Banking Yields Higher Total Nucleated Cell Counts (TNC) Compared to Either Procedure Alone

BACKGROUND: Collecting high quality cord blood units (CBU) is important because  the TNC and CD34+ cell dose of a CBU correlates with transplant outcomes. There are 2 techniques for collecting CBU: while the placenta is still in-utero by midwives/obstetricians or after placental delivery by trained personal (ex-utero). The MD Anderson Cord Blood Bank uses a combination of the 2 (in+ex utero) techniques whenever feasible. The aim of this analysis was to compare the 3 techniques (in-utero, ex-utero, in+ex-utero). METHODS:  CBUs collected between 04/2005 and 7/2011 were retrospectively analyzed. If logistically feasible, an in-utero collection followed immediately by ex-utero collection was performed. The total volume, pre- and post-processing TNC, viable CD34+ cells and microbial contamination was evaluated in the 3 groups. Analysis of variance methods was used to compare the 3 groups with respect to pre- and post-processing TNC and total viable CD34⁺ cells. Tukey’s honestly significant difference method was used for pair-wise comparisons of the 3 groups. Microbial contamination between the groups was compared using chi square test. RESULTS:  Total of 32,738 CBUs were collected and 23,968 units were processed. The pre-processing TNC was significantly higher in the in-utero vs. ex-utero collections.  There was also a significantly higher pre-processing TNC in the in+ex utero collection vs. the in-utero collection. Similar results were noted in the post-processing TNC. The median viable CD34+ cells collected were 5.03, 4.26, and 4.93 (x 10⁶) respectively in the in-utero, ex-utero and in+ex utero groups, respectively (P< 0.0001 for in-utero vs. ex-utero and ex-utero vs. in+ex-utero groups). There was no statistically significant difference in the microbial contamination in the in-utero vs. in+ex utero groups, however it was lower in the ex-utero collection as compared to either the in-utero or in+ex utero collections. CONCLUSION:  We conclude that in+ex utero collection of umbilical CB for banking is safe and results in significantly higher TNCs than either technique alone.

	In-Utero	Ex-Utero	In+Ex Utero	In-Utero vs. Ex-Utero	In-Utero vs. In+Ex Utero	Ex-Utero vs. In+Ex Utero
				P value	P-value	P-value
Volume (ml)      Median      (Range)	N=8,906 64.0 (0.5-225.3)	N=6,305 54.0 (0.2-289.0)	N=17,527 77.1 (2.0-289.1)	<0.0001	<0.0001	<0.0001
Pre-Processing TNC (x107)      Median      (Range)	N=6,133 108.8 (15.3-1144.8)	N=3,514 101.0 (13.7-829.5)	N=14,321 118.9 (9-1359.1)	< 0.0001	< 0.0001	< 0.0001
Post-Processing TNC (x107)      Median      (Range)	N=4,009 113.4 (13.4-602.0)	N=2,124 105.4 (3.8-459.8)	N=9,559 118.4 (28.9-679.7)	< 0.0001	< 0.0001	< 0.0001
Post-processing CD34+ cells ( x106)      Median      (Range)	N=3,857 5.03 (0.36-57.64)	N=2,009 4.26 (0-53.03)	N=9,069 4.93 (0.03-63.36)	< 0.0001	0.7670	< 0.0001
Microbial Contamination (%)	N=4,051 2.0	N=2,107 0.5	N=9,503 2.0	< 0.0001	0.8278	< 0.0001

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