RU2624253C1 - Method for preparation and application of autological erythrocytes from umbilical blood for anemia correction in newborns - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes the following steps: umbilical cord samples collection, processing, placement for storage and rejection of samples, a pre-transfusion processing for umbilical blood samples. At the pretransfusion preparation stage, the erythrocyte mass from the plasma is separated by centrifugation at acceleration of 3768 g for 15 minutes at a temperature of +4°C. Then the auto-erythromass samples pass the procedure of auto-erythrocytes washing from the preservative and hemolyzed cells formed during umbilical cord sample storage. To do this, 100 ml of sterile physiological sodium chloride solution is added to the packet with auto-erythromass in the umbilical erythromass and physiological solution ratio of 1:1 and centrifuged at 1971 g acceleration for 10 minutes at a temperature of +4°. After this, the supernatant is removed using a plasma extractor. The washed umbilical erythrocytes are filtered through a microaggregate filter. All samples of autologous erythrocytes of umbilical blood pass quality control: the degree of hemolysis and quantitative indicators of blood cells, hemoglobin and hematocrit are determined.

EFFECT: invention allows to correct anemia in newborns by a single blood transfusion, without occurrence of posttransfusion complications associated with donor blood components transfusion.

11 tbl, 3 ex

Description

The invention relates to medicine, in particular to obstetrics, neonatology and transfusiology.

The essence of the method is to collect cord blood into disposable plastic transfusion systems designed for this purpose, followed by storage of autologous cord blood for 21 days and then receiving and using autoerythrocytes from cord blood to treat anemia in newborns. This technique is the only affordable and safe method of auto donation in neanatology today (1, 2, 3, 4).

The proposed method is intended for obstetrician-gynecologists, neonatologists and transfusiologists working in perinatal centers, maternity hospitals, children's multidisciplinary hospitals, and in transfusiology departments of multidisciplinary medical institutions.

One of the main methods of treating anemia in newborns is the transfusion of donor erythrocyte-containing blood components. Blood transfusion therapy with donor blood components is associated with well-known risk factors for the transmission of blood-borne infections, the development of immune-mediated and post-transfusion complications. Blood transfusions of erythrocyte-containing components of donated blood in neonatology, in addition to the above risk factors, are compounded by the fact that the blood of adult donors differs in the cellular, biochemical and metabolic composition from the blood of newborns, causing great harm to the immune system and homeostasis of the child and negating the effects of other therapeutic effects (5, 6 , 7). The use of autohemotransfusions has proven itself in general medical practice in adults, and in the neonatal period it is impossible due to objective reasons associated with the technical limitations of collecting and processing small volumes of blood (7, 8, 9, 10).

Thanks to the interaction of various services and specialists in the conditions of the Federal Center for Obstetrics, Gynecology and Perinatology, it became possible to solve a wide range of problems in the study and use of components of autologous cord blood in surgical newborns. Cord blood is the only source of blood autocomponents in neonatology, cord autoerythrocytes isolated from whole cord blood are a safe and effective tool for stopping anemia of various origins in neonatology (11, 12, 13, 14, 15, 16, 20).

A known method of harvesting and clinical use of autologous umbilical cord red blood cells described by Imura K, Kawahara H, Kitayama Y, Hosono S, Mugishima H, Nakano Y., Murabayashi M., Shimada M., Minato M, Takahashi S., Harada K., Ikeda T ., Fukuzawa M., which consists in:

Stage 1 - PC collection

To collect umbilical cord blood during abdominal delivery and childbirth per vias naturales, the umbilical cord is clamped and traversed in the usual way as close to the baby as possible within 2-5 seconds from the moment of birth. Then, the distal end of the umbilical cord is treated with a gauze swab, abundantly soaked with octenisept solution for 10 cm at the site of the intended puncture, from the placenta to the clamp (from top to bottom). The umbilical cord vein is visually recognized as a single vessel with the largest diameter compared to the thinner umbilical arteries running parallel to each other.

The umbilical cord vein puncture is performed with a needle, which is part of the system for collecting and fractionating cord blood, after which the container is lowered 80-100 cm below the puncture level, placing it on a sterile tray. Also, to intensify the collection process, it is recommended to perform massaging movements along the umbilical cord in the direction from its placental end to the puncture site. The pronounced decline of the umbilical cord vein in the absence of blood flow into the container, despite the rotational movements of the needle and massaging movements, indicates the collection of the maximum possible amount of cord blood and the end of the manipulation.

Considering that the needle that is part of this system was developed taking into account the wall structure of the umbilical vein and has a significantly larger diameter than the needle of similar systems for the collection of donated blood, the collection time of the maximum volume (up to 150 ml) of blood does not exceed 1, 5-2 minutes.

When a cesarean section is performed, the umbilical vein is manipulated by a nurse or doctor at a considerable distance from the surgical wound and, when properly performed, do not in any way prevent surgeons from applying clamps to the uterus muscle in the incision area, the placenta from the uterus, until the umbilical cord blood collection is complete do not delete.

At the end of the collection, the line going from the needle to the primary container is blocked with the special valves available in the system, after which the sample is marked and transferred for further processing to the transfusion department or another specialized department certified for work on the preparation and storage of blood components.

Stage 2 - processing, storing and discarding samples

In the department involved in the processing and storage of blood components, the sample obtained from the maternity ward is weighed and recorded. Samples of whole blood weighing at least 60 g are considered suitable for obtaining an umbilical cord erythrocyte mass. Samples of a lower mass are recorded in a journal, after which they are disposed of.

The tube connecting the needle to the primary container is clamped using a manual mechanical seal and metal terminals or sealed with a dielectric seal at three points at a distance of at least 3 cm from the primary container.

After that, the sample is centrifuged at an acceleration of 2700 g for 6 minutes. Plasma is transferred into a parallel container, the tube of which is located on the upper part of the primary container, using a standard manual plasma extractor (fractionator of blood components), and the erythrocyte mass is transferred by gravity to the final container located in the lower part of the primary. The tube of the final container is filled with erythrocyte mass for at least 8 cm and clamped or sealed three times: once at a distance of at least 5 cm from the container, the second and third at a distance of 8-10 cm. Umbilical cord mass is weighed and discarded samples weighing less than 20 g.

In the case of the preparation of an autoerythrocyte mass of cord blood, plasma is a by-product, therefore, it is disposed of. However, obtaining a uniform bright red plasma, indicating hemolysis, may cause the disposal of the sample with the corresponding entry in the journal. The container with the finished umbilical cord erythrocyte mass is marked with a label. Labeled autologous red blood cell samples are stored in the designated refrigerator at a constant temperature of + 4 ° C for 21 days.

Stage 3 - pre-transfusion preparation

If necessary, transfusion of autoerythrocytes of the first day of storage, the sample is evaluated visually for the presence of macroscopically visible aggregates. In their absence, transfusion is carried out without any preparation. In the case of clots, physiological saline is added to the bag at the rate of 1 ml per 10 ml of erythromass, the sample is mixed and filtered through a microaggregation filter, followed by transfusion.

Starting from the 8th day of storage, samples of autoerythromass are washed by centrifugation. For this, 100 ml of physiological saline is added to the bag and centrifuged at an acceleration of 1500 g for 2 minutes. Then, using a plasma extractor, saline is removed, the washed red blood cells are filtered through a microaggregate filter, and the mass of the final product is determined.

After 21 days of storage, unclaimed samples are disposed of in the manner prescribed by this institution.

The disadvantages of the method:

1. At the second stage of fractionation during centrifugation and separation of a cord blood sample into umbilical cord blood cells and cord plasma, a large number of cord blood cells are mechanically destroyed: red blood cells, white blood cells and their subpopulations, and autoplasma is removed, which has a protective effect on umbilical cord blood cells, which is confirmed by high cord blood cells the percentage of hemolysis of the component.

2. At the III stage of pre-transfusion preparation, samples of autoermass from umbilical cord blood do not undergo proper processing in the form of washing and subsequent filtration, which must be performed regardless of the shelf life.

3. There is no necessary and proper quality control of harvested samples of umbilical cord blood red blood cells: at the stage of procurement, there are sterility controls and studies of the quantitative and qualitative composition of cord blood cells. At the stage of the finished sample of autoerythrocytes - control of the cellular composition and the percentage of hemolysis of the component.

The objective of the invention is to develop an effective, high-quality and safe method of harvesting autoerythrocytes from umbilical cord blood for the treatment of anemia in newborns, which involves reducing the use of donor blood components for newborns and mitigate the risk of post-transfusion complications.

Method Description:

I - The stage of collecting cord blood samples is similar to world standards and the method presented above. The introduced improvements relate to: storage of whole cord blood without fractionation until the need for transfusion of red blood cells from cord blood to a newborn with anemia; laboratory monitoring of harvested cord blood autocomponents: rapid study on sterility and study of the cellular composition of the harvested sample.

II - Stage - processing, laying for storage and rejection of umbilical cord blood samples.

A control weighing of a cord blood sample obtained from the maternity ward on an electronic balance and registration is carried out in the blood component preparation department. Suitable samples are whole blood weighing at least 60 g, past cell and bacterial control.

Before laying for storage, the line connecting the needle to the primary container is sealed with dielectric sealant at three points at a distance of at least 3 cm from the primary container. Controlled samples are labeled and stored in a specially designed

the medical refrigerator intended for this purpose in accordance with the group affiliation at a constant average temperature of + 4 ° C (from + 2 ° C to + 6 ° C) for 21 days. If this storage period expires, unclaimed cord blood samples are disposed of.

III - Stage - pre-transfusion processing of PC samples

In the event of a clinical situation requiring erythrocyte transfusion, the cord blood sample undergoes special pre-transfusion preparation and follow-up study, followed by transfer of the component to the department for autotransfusion to the newborn.

Fractionation of umbilical cord blood is carried out by centrifugation with acceleration of 3768 g for 15 minutes at a temperature of + 4 ° C. Plasma is transferred into a parallel container, the line of which is located on the upper part of the primary container, using a standard plasma extractor, and the autoerythrocyte mass is transferred by gravity to the final container located at the bottom of the blood storage system. Then the samples of autoerythromass are washed away from the preservative and hemolized cells formed during storage of the PC sample. To do this, add 100 ml of sterile physiological saline of sodium chloride to the bag in a ratio of erythromass to physiological saline 1: 1 and centrifuge at an acceleration of 1971 g for 10 minutes at a temperature of + 4 ° С. Then, using a plasma extractor, the supernatant is removed, and the washed red blood cells are filtered through a microaggregate filter. Further, the samples of washed autoerythrocytes from umbilical cord blood undergo the second stage of quality control - determining the degree of hemolysis of red blood cells in the sample by analysis for free hemoglobin on a blood analyzer, followed by calculation of the percentage. With a degree of hemolysis of more than 1%, the samples are discarded and disposed of.

When determining a low (<1%) degree of erythrocyte hemolysis, the samples were considered suitable for use. The line of the final container is filled with washed PC autoerythrocytes for at least 8 cm and sealed three times: once at a distance of at least 5 cm from the container, the second and third at a distance of 8-10 cm. The washed cord blood erythrocytes are marked with a label that contains : last name, first name, middle name of the mother, medical history number, blood group of the mother, blood group of the child, date and time of washing off the red blood cells, date of preparation of the component, weight of the product, signature of the doctor responsible for processing the sample. The shelf life of the component after pre-transfusion preparation is 24 hours.

IV - Stage - the clinical use of autologous washed umbilical cord red blood cells

Indications for transfusion of autologous washed red blood cells from umbilical cord blood in neonatology is the correction of anemia in newborns. The volume of autoerythrocytes necessary for blood transfusion is calculated by the formula 1:

where Hb _c - the target value of hemoglobin, Hb _a - the current value of hemoglobin.

The volume of transfused autoerythrocytes from cord blood in this case is from 10 to 20 ml / kg.

Before transfusion, the container with autologous washed red blood cells is visually assessed for the integrity of the package and the compliance of the blood product labeling data with the patient's passport data, including the blood group and Rh factor of the newborn baby. Then they carry out compatibility tests, according to the Order of the Ministry of Health of the Russian Federation No. 183n.

Before blood transfusion, a container with washed autologous red blood cells of a PC is heated to a temperature of 37 ° C in a device for defrosting and heating blood and components, and in a laminar cabinet, the component is taken into a disposable sterile syringe. Then the infusion system is connected to the syringe. Transfusion is carried out through a syringe infusion pump. According to Orders No. 363 and No. 183n, a three-time biological test is carried out (intravenous administration of 1-2 ml of autoerythrocytes) and, in the absence of pathological reactions to the administration, transfusion of washed autoerythrocytes from cord blood is carried out.

The infusion rate corresponds to that recommended in neonatal practice and is 5 ml / kg / hour. During the transfusion and the following hours after, hemodynamic parameters and oxygenation are monitored, visual and quantitative assessment of diuresis, thermometry. Within a day after the transfusion, but not earlier than five hours after its completion, control new blood and urine tests are performed in the newborn.

The effectiveness of the application of washed autoerythrocytes from umbilical cord blood should be evaluated according to clinical data (normalization of skin color, normalization of pressure, decrease in heart rate, stopping shortness of breath, normalization of diuresis), laboratory tests (increase in hemoglobin, hematocrit, increase in the number of red blood cells), information about the absence of red blood cells) complications and reactions to blood transfusion therapy during transfusion and after 1 day (hemolytic, allergic, anaphylactic and pie reactions, diuresis disorders, changes in color and amount of urine). Clinical data are also evaluated on the effective regeneration of a postoperative wound - healing by first intention, reduction of infectious load, reduction of hospitalization in comparison with ongoing blood transfusion therapy with donor blood components.

The following clinical examples clearly demonstrate the effectiveness and safety of the use of washed cord blood red blood cells in neonatology:

A clinical example of blood transfusion of autoerythrocytes in newborns No. 1:

Stories of the development of newborn K.

The child was in the department of surgery, resuscitation and intensive care of newborns from 11/17/11 to 12/16/11.

Diagnosis:

the main - Teratoma of the sacrococcygeal region of type II.

complications - Postoperative wound failure.

Posthemorrhagic anemia.

attendant - no.

Date of birth: 11/17/11. 19.57

Female gender.

Birth weight: 3540 g.

Length: 55 cm. Head circumference: 35 cm. Chest circumference: 33 cm.

Maternal obstetric history: I pregnancy.

Pregnancy: I trimester - b / o, II trimester - screening is normal, according to ultrasound - teratoma of the sacrococcygeal region from 26 weeks, exacerbation of chronic pyelonephritis, III trimester - b / o.

Childbirth: I timely operative childbirth according to indications from the child.

Apgar: 8/9 points.

Maternal blood type: A (II) second, Rh (+) positive.

Blood type of the child: A (II) second, Rh (+) positive. Rhesus system phenotype: CcDeeCw-Kotr.

The course of the early neonatal period:

Upon admission, the condition of the child is regarded as moderate due to the volumetric formation of the sacrococcygeal region. Feeding with Nutrilon milk formula has begun, and the absorption has been assimilated. Cardiopulmonary activity is satisfactory.

In the sacrococcygeal region, a volumetric formation of soft-elastic consistency, mixed cystic-solid structure, 100 × 80 × 80 mm in size, covered with skin with areas of thinning was found. Education painless on palpation.

Ultrasound scan of the perineum, MRI of the pelvis was performed, and the intralase component extends to the level of the iliac crests.

The child is prepared for surgical treatment.

11/22/11. Operation: Removal of teratoma of the sacrococcygeal region. Tailbone resection.

The postoperative period is smooth, on mechanical ventilation was within 26 hours after the intervention, there were no respiratory disorders after extubation. IT gets through a catheter inserted into the axillary vein on the left.

Nutrilon milk formula feeding was started from 1 postoperative day, it was digested, it was digested, there was no spitting up, and weight gain was satisfactory.

In connection with the phenomena of posthemorrhagic anemia on the 2nd day after the operation, a transfusion of washed autoerythrocytes from cord blood was performed. Blood transfusion therapy proceeded without complications and reactions to administration, the temperature did not increase, diuresis was normal. The effectiveness of the blood transfusion therapy is satisfactory: normalization of hemodynamic parameters was clinically observed, hemoglobin increase: hemoglobin - 116 g / l before transfusion; after - 141 g / l, hematocrit: up to - 33%, after - 38%, normalization of indicators was noted from a biochemical study, there was no increase in total and direct bilirubin, laboratory and macroscopic urine parameters without pathological changes.

In further therapy, blood transfusions in the newborn were not required.

The postoperative wound healed by first intention, the drainage from the retrorectal space was removed at 6 n / a day, the sutures were removed on the 13 postoperative day.

According to the results of ultrasound of the soft tissues of the perineum and pelvis, data on the accumulation of free fluid and volume formations were not found.

Currently, the condition of the child is satisfactory, stable. Does not temper. It is fed with breast milk and Nutrilon up to 130.0-160.0 ml, sucks well, does not spit up. The skin is pale pink, microcirculation is satisfactory. In the lungs, puerile breathing, no wheezing. BH = 40-45 per minute. Cardiac activity is satisfactory, heart rate = 130-135 per minute. The abdomen is not swollen, soft, painless. Liver +2.0 cm. Urination is free, diuresis is sufficient. The chair is independent, yellow, in sufficient quantity.

EXAMINED SURVEY:

5. Ultrasound of internal organs:

11/18/11 - 12/05/11 - internal organs without pathology. The kidneys are typically located, the contours are even, sizes by age, parenchyma 10 mm; HR is the norm. Liver, spleen, adrenal glands without pathology. There is no free fluid in the abdominal cavity.

Ultrasound of soft tissues: 11/18/11 - a teratoma consists of a large number of cystic formations of various diameters, a parenchymal component with a large number of vessels.

Ultrasound of soft tissues: 11/23/11/25/11/11 - a small amount of free fluid in the projection of drainage of the postoperative wound.

Ultrasound of soft tissues: 05/05/11 - the area of the postoperative wound without features. There is no free fluid in the abdominal cavity.

ECHO-KG (11/20/27/11/11): The heart has a 4-chamber structure. The course of the great vessels is correct. LLC - 4 mm. There is no data for the UPU.

6. Ultrasound of the brain: 11/18/05/12/11 - the structure of the brain is correctly located and formed. Figure furrows and convolutions by age. The liquor system is not expanded. Vascular plexus cysts on the right 3 mm. In CTV hematomas in the stage of cyst formation are 2-3 mm in diameter. Conclusion: moderate hypoxic changes in brain matter.

7. X-ray of the chest cavity and abdominal cavity (11/22/2011): Lungs of normal airiness, vascular pattern enhancement. The heart and large vessels are not displaced, not expanded. Intestinal pneumatization is common. Pleural cavity without visible fluid. A central venous catheter is typically located.

8. ECG21.11, 11.27.11 - Sinus rhythm. ECG within the age norm.

9. MP718.11.11. - Volumetric education in the presacral region should be regarded as a sacrococcygeal teratoma, communication with the dural sac is not traced.

10. Histological conclusion: benign mature teratoma of the sacrococcygeal region (immaturity 1), cystic-solid variant.

Condition at discharge: satisfactory.

Weight at discharge: 3818

A clinical example of the use of autoerythrocytes in another newborn No. 2:

Extract from the history of the development of newborn E.

The child was in the department from 01/13/2015 to 02/16/15

Clinical diagnosis:

Main: Gastroschisis. (Q79.3).

Complications: Viscero-abdominal imbalance. (Q43.8).

Associated: IVA IIA right. (P52.1). QI I. (P91.0). Mild asphyxia at birth. (P21.1). Small to gestational age. (P05.1).

Prematurity 36 weeks. (P07.3).

Date of birth: 01/13/14 00:30

Gender: Male

Body weight: 2085 g.

Length: 43 cm approx. head: 30.5 cm approx. bust: 28 cm, approx. shoulders: 32.

Maternal diseases: high myopia.

Obstetric history: I pregnancy, I birth.

Childbirth: premature operative labor at 36 weeks of gestation, cesarean section according to indications from the child.

Pregnancy: 1 trimester - without features, 2 trimester - mild anemia (maltofer), 3 trimester - at 34-35 weeks, congenital malformations were revealed - gastroschisis.

Amniotic fluid: light.

Apgar: 6/8 points.

Activities in the genus. Hall: sanitation of the upper respiratory tract, warming with radiant heat, placing the probe in the stomach, evacuated 100 ml of green discharge, a sterile dressing was applied to the intestinal loops, a clamp was placed on the umbilical cord.

Maternal blood type: AB (IV) fourth, Rh (+) positive

Blood type of the child: A (II) second, Rh positive

Rhesus system phenotype: CCeeC ^w- K neg ^.

The course of the early neonatal period: the condition is difficult at birth, due to the presence of a malformation - gastroschisis, an early period of adaptation, small size for gestational age, mild asphyxia at birth.

I did not need respiratory therapy. Hemodynamics remained stable without cardiotonic therapy. After preoperative preparation, 01/13/2015 at the age of 6 hours. surgical intervention was performed. Due to the phenomena of viscero-abdominal imbalance, the operation of forming a temporary abdominal cavity was performed, the organs are partially immersed in the abdominal cavity, partly in a sterile plastic container that is hemmed to the edge of the defect of the anterior abdominal wall.

The course of anesthesia is relatively smooth. Bleeding was noted, in connection with which transfusion of FFP was performed intraoperatively. Moved satisfactorily. In the postoperative period, there was a tendency to hypotension, Dopamine was included in the therapy, then Dobutrex in maximum doses of 10 and 5 μg / kg / min, respectively. In the future, doses of drugs with a decrease. Anesthetized adequately.

At 6 S. after preoperative preparation, 01/19/2015, the second stage of surgical intervention was performed - delayed plastic surgery of the anterior abdominal wall.

The course of anesthesia is relatively smooth. Bleeding was noted, in connection with which transfusion of FFP was carried out. The CBC hemoglobin level before surgery was 117 g / L. Given the increase in bleeding, the level of hemoglobin, blood transfusion of autoerythrocytes was performed intraoperatively. The therapy proceeded without complications and there are no reactions to the introduction, the temperature did not increase, diuresis is normal. The effectiveness of the blood transfusion therapy is satisfactory: normalization of hemodynamic parameters was clinically noted, the increase in hemoglobin: before transfusion, hemoglobin - 122 g / l; after - 149 g / l, hematocrit: up to - 35%; after - 42%, from a biochemical blood test: a decrease in the level of total and direct bilirubin, laboratory and macroscopic indicators of urine without pathological changes. Blood transfusions in the newborn were not required for further therapy.

In the postoperative period, the condition remained stable. Cardiotonic therapy with a decrease and subsequent cancellation of 9 / 3p. He was adequately anesthetized with Fentanyl, then Tramal with cancellation by 12/6 bp.

Antibacterial therapy started from birth. At 5 s.zh. persistent subfebrile condition was noted, in connection with which, by 6 pp. the antibacterial therapy was changed to Vancomycin + Sulperazone. At 14 ° C, given the episodes of hyperthermia, the negative dynamics according to the results of the examination, the antibacterial therapy was changed to Zivox + Tienam - with a positive effect.

In the postoperative period, gastrointestinal stimulation with Prozerin was performed. Auscultatory peristalsis was heard from 1 bp days. Chair received at 11/5 bp day.

On the 13th day of life, on the 7th postoperative day, an enteral load of glucose-salt mixture was started. Regurgitation was noted once. The load was continued. At 15 s./15/9 p. Enteral feeding of Nutrilon PG milk mixture was started at a 1:60 dilution through a tube. Assimilated. Enteral loading with expansion. At the moment, 30.0-40.0 ml of Nutrilon PG milk mixture is fed from the nipple, it is absorbed.

At 17 f./17/11 bp according to the NHA - VZHK IIa. In dynamics without progression.

At 22 S.J. / 22/16 bp was consulted by a neurologist. Diagnosed with muscle dystonia syndrome. QI I. Elkar has been added to therapy.

Currently, the condition is satisfactory, is fed with Nutrilon Pepti Gastro milk mixture of 70.0-80.0 ml after 3 hours, assimilates, does not burp, and adds weight. The surgical wound healed by first intention, the sutures were removed on the 27th day. The abdomen is moderately swollen, soft, active intestinal motility, the stool is yellow, k / shaped, independent up to 6 times a day. Diuresis is adequate, independent.

Ultrasound of the abdominal organs from 01.20.15: Liver: right lobe 61 mm, thickness of 1 segment about 40%, parenchyma of increased echogenicity. The gall bladder is closed, the wall is sealed. The common bile duct is not expanded. The pancreas is of normal structure and echogenicity. Free fluid is not detected. Spleen 47 × 28.5 mm, normal structure. Kidneys: left 41 × 24, ChLK 6.5 mm; right 45 × 25, ChLK 8 mm. The ureters are not visualized. The adrenal glands are not enlarged.

State at discharge: satisfactory

Weight at discharge: 3068 grams.

Clinical example No. 3:

Extract from the history of the development of newborn B.

The child was in the department from 03.16.2014 to 04.25.14

Diagnosis:

Primary: Gastroschisis (Q79.3).

Complications: Viscero-abdominal imbalance.

Concomitant: Congenital pneumonia.

VZhK2a-b

Hemorrhage into a large tank under the cerebellum QI II

Hypertension-hydrocephalic syndrome in the regression stage.

Muscular dystonia syndrome.

Anemia

Mild asphyxia at birth.

Small by gestational age.

Date of birth: 03.16.14 11:15

Gender: Male

Body weight: 2581 g.

Length: 47 cm approx. heads: 34 cm Okr. chest: 32 cm.

Maternal diseases: childhood infections, myopia degrees, hr. bronchitis.

Obstetric history: I pregnancy, I birth.

Delivery: timely operative delivery at 38 weeks of gestation, cesarean section according to indications from the child.

Pregnancy: 1 trimester - ARVI at 12 weeks without fever, 2 trimester - according to the ultrasound of the VLD - gastroschisis in the fetus, 3 trimester - anemia of pregnant women (iron preparations).

Amniotic fluid: yellow.

Apgar: 7/8 points.

Activities in the genus. Hall: sanitation of the upper respiratory tract, warming with radiant heat, placing the probe in the stomach (50 ml of yellow discharge), a sterile dressing is applied to the intestinal loops, a clamp is applied to the umbilical cord.

Maternal blood type: A (II) second, Rh positive

Blood type of the child: A (II) second, Rh positive

Rhesus system phenotype: ccDEeC ^w- K neg ^.

The course of the early neonatal period: a difficult condition at birth, due to the presence of a malformation - gastroschisis, an early period of adaptation, small size for gestational age, asphyxia at birth.

From 2 hours of life, negative dynamics in the condition of the child were noted. The phenomena of respiratory failure joined: the participation of auxiliary muscles in the act of breathing, with auscultation, moist and crepitious wheezing from both sides are heard. Ventilation started. Heart sounds are clear, the frequency of contractions = 130-140 in 1 minute.

The abdomen is soft, to the right of the umbilical ring is a defect in the anterior abdominal wall measuring 2.5 × 2.5 cm, through which loops of intestines of dark crimson color, not covered with fibrinous plaque, are looped, loops are separated, shiny moist. In the gastric tube, an abundant congestive discharge. After a cleansing enema, meconium in moderation was removed.

When examining the external genitalia - formed by the male type.

After preoperative preparation for 5 hours, the child was performed March 16, 2014. operation: revision of the abdominal cavity, the creation of a temporary abdominal cavity. Partial immersion of the intestinal loops in the abdominal cavity was performed. In connection with the phenomena of the viscero-abdominal proportion, it was not possible to completely immerse the intestinal loops in the abdominal cavity; a temporary abdominal cavity was formed from a sterile plastic container.

The postoperative period is severe, was on mechanical ventilation. Received antibacterial, symptomatic therapy. When dressings increased pressure on the conglomerate of the organs of the temporary abdominal cavity. Against the background of the treatment, the state of organs with pronounced positive dynamics, edema decreased, the volume of conglomerate decreased by two-thirds.

At 4 s.zh. / 4.p. performed the second stage of surgical treatment:

03/20/14 g Operation - Delayed plastic surgery of the anterior abdominal wall.

Loops of the intestine are immersed in the abdominal cavity. Produced plastic of the anterior abdominal wall.

The course of anesthesia is smooth. Mechanical ventilation in the standard ventilation mode for 8 days, after extubation, required oxygen subsidies of up to 45% during the day. In the future, respiratory failure did not increase, did not need additional oxygen.

In order to correct anemia in the early postoperative period, transfusion of washed autoerythrocytes from umbilical cord blood was performed with positive dynamics. The effectiveness of the blood transfusion therapy is satisfactory: normalization of hemodynamic parameters was clinically observed, hemoglobin increase: 98 g / l before transfusion, 111 g \ l after hematocrit, hematocrit: up to 29%, after - 33%, blood biochemical analysis: normalization was noted , no increase in total bilirubin was noted, laboratory and macroscopic urine parameters without pathological changes. Blood transfusions in the newborn were not required for further therapy.

At 9 S./9/5 p. negative dynamics in the clinical condition of the child was noted: the phenomena of the infectious process, respiratory failure associated with the course of congenital pneumonia, and CNS depression increased. Against the background of conservative therapy, the state of the lungs with positive dynamics, the phenomena of respiratory failure were completely stopped by 31/27 and / o days.

According to the NSG, an increase in the volume of the ventricular cavities was noted on 9/5 n / a day. The child was consulted by a neurologist, it was recommended to conduct an MRI of the brain, according to which signs of the consequences of high fatty acid, hemorrhage under the mark of the cerebellum, into the cavity of the large occipital cistern were revealed. An MP picture of mixed neocclusal hydrocephalus was observed. According to the CFM: single epi-activity discharges were determined along the left frontoparietal region. The diagnosis was established: Hypoxic hemorrhagic lesion of the central nervous system (CI II, IVH IIa, hemorrhage under the mark of the cerebellum, into the large occipital cistern). CNS depression syndrome. Hypertensive hydrocephalic syndrome. Neuroprotective therapy with cytoflavin has been started. In the future, the state of the child with positive dynamics. During the control EEG, typical epileptic activity was not registered. Subsequently, against the background of metabolic and nootropic therapy, a state with positive dynamics, with a follow-up examination by a neurologist, prolongation of therapy under the supervision of a specialist is recommended.

From 1 day of life receives parenteral nutrition. Passage through the intestines recovered by 14/10 p / o days. On the 15/11th day after the operation, an enteral load of the glucose-salt mixture was started, followed by nutrition with the Nutrilon Pepti Gastro mixture. In the dynamics of the volume of nutrition expressed breast milk and mol. with the Nutrilon Bezlaktosny mixture increased to 70.0 ml, assimilates, does not burp, and adds weight. Given the signs of central nervous system depression, the course of congenital pneumonia and the absence of a sucking reflex received probe feeding for a long time. The probe from the stomach was removed on 32/28 and / o day. In the future, it sucks on its own, slowly, fractionally, assimilates the volume, adds weight.

Inspected by an ophthalmologist 03/26/14, 04/16/14 - does not need drug therapy.

Currently, the condition is satisfactory, is fed with expressed breast milk and pier. with a mixture of Nutrilon Lactose-free 70.0-80.0 ml after 3 hours, assimilates, does not burp, adds weight. The surgical wound healed by first intention, the sutures were removed on the 27th day. The abdomen is moderately swollen, soft, active intestinal motility, the stool is yellow, k / shaped, independent up to 8 times a day. Diuresis is adequate, independent.

State at discharge: satisfactory

Weight at discharge: 3330 gr.

The proposed method of procurement and clinical use in neonatology of washed autoerythrocytes from umbilical cord blood allows efficient and safe blood transfusion therapy in newborns with anemia. The method is available for use in all obstetric and neonatal hospitals, in the presence of departments of transfusion and preparation of blood components, does not require additional equipment and is easy to reproduce technologically.

The use of umbilical autoerythrocytes allows you to effectively correct anemia in newborns with various pathologies, to carry out blood transfusions once, without causing systemic inflammatory reactions, and is also not a risk factor for post-transfusion complications associated with transfusion of donor blood components.

Information sources

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Claims (1)

A method for the preparation of autoerythrocytes from umbilical cord blood in newborns, which includes the following steps: a step for collecting cord blood samples, a processing step, bookmarking and storing samples, a pre-transfusion processing of cord blood samples, characterized in that at the pre-transfusion preparation, the erythrocyte mass is separated from the plasma by centrifugation at an acceleration of 3768 g for 15 minutes at a temperature of + 4 ° С, then samples of autoerythromass go through the procedure of washing autoerythrocytes from a preservative and hemolyzed cells formed during the storage of a cord blood sample, for this, 100 ml of sterile physiological sodium chloride solution in a ratio of umbilical erythromass to physiological saline 1: 1 is added to the bag and centrifuged at acceleration 1971 g for 10 minutes at a temperature of + 4 °, then using a plasma extractor, the supernatant is removed, and the washed umbilical cord red blood cells are filtered through a microaggregate filter, all samples of autologous cord blood red blood cells pass quality control: the degree of hemolysis and quantitative indicators of blood cells, hemoglobin and hematocrit are determined.