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Cord Blood Collection Guidelines

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					     CORD BLOOD COLLECTION




                 Maternity Guideline




Cordbloodcollection.doc.May 2010     Page 1 of 11
Multidisciplinary Guidelines Group
Guideline Summary
Non-directed donation
  • Should be through The NHS Cord blood bank which was set up to
      collect, process, store and supply cord blood. Alternatively, the Anthony
      Nolan Cord Blood Programme run by the Anthony Nolan Trust
      receives non-directed cord blood donations.

Directed donation in ‘At Risk’ families
   • Where a specific medical condition requires the collection of cord blood for
      stem cell harvest then the midwife must refer the woman to the Consultant
      in charge of care
   • Collection of directed donations in at-risk families should be arranged with
      established public sector cord blood banks by the Consultant in charge of
      care.
   • In the event that an obstetrician or midwife has been asked to collect the
      blood IT IS ESSENTIAL THAT THEY ARE APPROPRIATELY TRAINED
      TO MEET LEGISLATIVE REQUIREMENTS. The NHSBT will provide this
      training. You must complete:
          o A Request for Directed Cord Blood Collection (Form 2C). This form
              is forwarded to the NHSBT.
          o A Consent for Directed Cord Blood Collection (Form 2D) must be
              completed by the clinicians and the woman.
          o Arrangements should be made beforehand for a trained third
              party to be present in the labour ward to collect the cord blood.
          o A Third Party Agreement should be set up when the consent is
              completed
   • If the obstetrician or midwife have concerns and feel unable to collect the
      blood, then it is possible to book one of the Cord Blood Collectors from
      one of the designated hospitals indicated in this guideline.

Directed donation in ‘Low Risk’ families
   • For any privately arranged cord blood donation, cord blood collection
      should be arranged privately by the patient with recognised commercial
      services. The commercial service provider must arrange for a trained
      phlebotomist to be present at the time of delivery to collect the cord blood
      This is mandatory so as to comply with the Human Tissue Act 2004.




Cordbloodcollection.doc.May 2010                           Page 2 of 11
Multidisciplinary Guidelines Group
Introduction
Cord blood contains Haematopoietic stem cells(HSC).These proliferative cells
are similar to cells obtained from bone marrow or peripheral blood cells but have
greater proliferative and colony forming capacity and are more responsive to
growth factors.

Use of umbilical cord blood has become an established alternative to bone
marrow transplantation especially in haematological, immunological and
metabolic storage disorders in children and young adults.

Collections of non-directed and directed donations for at-risk families are
acceptable procedures through established public sector cord blood banks.
There is insufficient evidence to recommend directed cord blood collection and
stem cell storage in low risk families.

Collection of directed donations in low risk families can put a strain on medical
and midwifery staff because the collection procedure must be undertaken either
during the third stage or shortly thereafter. This could jeopardize the mother’s or
baby’s health if the normal practice of the third stage is altered or delayed or if
routine maternal or neonatal observations are neglected to promote cord blood
collection.

Each NHS Trust should therefore have its own policy on how to respond to
requests for cord blood storage in low risk families.

Definitions

Non-directed donations:
Cord blood collection in public cord blood banks set up alongside bone marrow
registries that participate in global collaborations to find matches for patients in
the UK and overseas.

Directed donations in at-risk families:
Cord blood collection and storage from siblings born into a family where there is
a known genetic disease amenable to HSC transplantation. Including malignant
and non-malignant disorders such as acute and chronic leukaemias,
haemoglobinopathies and immune deficiencies.

Directed donation in low risk families:
Cord blood collection for long term storage in case the child or his/her sibling
develops a disease that could be treated by autologous or related cord blood
stem transplantation.




Cordbloodcollection.doc.May 2010                             Page 3 of 11
Multidisciplinary Guidelines Group
GUIDELINES FOR NON-DIRECTED DONATION
The NHS Cord blood bank was set up in 1996 to collect, process, store and
supply cord blood. This is a public cord blood bank and donation is free and
anonymous. The donated cord blood is used to help any patient who is in need of
an unrelated cord blood transplant in the UK or anywhere in the world.
The cord blood is only collected in hospitals where there is dedicated and trained
staff. These hospitals are: Barnet General Hospital, Northwick Park Hospital, St
George’s Hospital, Tooting, Luton & Dunstable Hospital and Watford General
Hospital.
The website http://www.nhscordblood.co.uk has detailed information on
volunteering to donate cord blood.

Contact details for the NHS Cord Blood Bank

Telephone: 0800 783 5870 or 020 8437 1740

Email: cordblood.donation@nbs.nhs.uk

Write to:
NHS Cord Blood Bank
Deansbrook Road
Edgware
Middlesex
HA8 9BD

Alternatively, the Anthony Nolan Cord Blood Programme run by the Anthony
Nolan Trust receives non-directed cord blood donations.
Cord blood can only be donated at King’s College Hospital but the patient must
be booked for antenatal care there.
The Midwife Cord Blood Coordinator at King’s College Hospital Terie Duffy can
be contacted by phone on 020 3299 5623 or via email
terie.duffy@kingsch.nhs.uk
The Anthony Nolan Trust can be contacted on 020 7284 1234 for further details.

As the organisation storing the blood is part of the NHS there is no need for a
separate third party agreement to be set up (between the person taking the cord
blood and the company / blood bank intending to store it).


GUIDELINES FOR DIRECTED DONATION IN AT-RISK FAMILIES
Where a specific medical condition requires the collection of cord blood for
stem cell harvest then the midwife must refer the woman to the Consultant
in charge of care.
Collection of directed donations in at-risk families should be arranged with
established public sector cord blood banks by the Consultant in charge of care.



Cordbloodcollection.doc.May 2010                           Page 4 of 11
Multidisciplinary Guidelines Group
These banks are situated at Barnet General Hospital, Northwick Park
Hospital, Luton and Dunstable Hospital, St George’s Hospital, Tooting and
Watford General Hospital as mentioned above. Cord blood collections are
requested by the clinician in charge of care/haematologist/oncologist and
arranged by completing:
             A Request for Directed Cord Blood Collection (Form 2C). This form
             is forwarded to the NHSBT.
             A Consent for Directed Cord Blood Collection (Form 2D) must be
             completed by the clinicians and the woman.
             Arrangements should be made beforehand for a trained third
             party to be present in the labour ward to collect the cord blood.
             A Third Party Agreement should be set up when the consent is
             completed.

In the event that an obstetrician or midwife has been asked to collect the
blood it is essential that they are appropriately trained to meet with
legislative requirements. The NHSBT will therefore provide the following:

       A detailed training manual
       They will also send two collection kits. One kit will be used for the
       designated obstetrician/midwife to practice and the other will be used for
       the cord blood collection
       NHSBT will provide telephone support during the training period

If the obstetrician or midwife have concerns and feel unable to collect the
blood, then it is possible to book one of the Cord Blood Collectors from
one of the designated hospitals indicated above. This person should be
booked via the NHS Cord Blood Bank – contact details above.
It is important to remember that this individual is not a Trust employee and will,
therefore, require an Honorary Contract to come onto Trust premises to
undertake this task.

When blood has been collected
The NHSBT should be telephoned and they will send a courier to uplift the
specimen.


GUIDELINES FOR DIRECTED DONATION IN LOW RISK FAMILIES
For any privately arranged cord blood donation, cord blood collection
should be arranged privately by the patient with recognised commercial
services. The commercial service provider must arrange for a trained
phlebotomist to be present at delivery to collect the cord blood
This is mandatory so as to comply with the Human Tissue Act 2004.




Cordbloodcollection.doc.May 2010                           Page 5 of 11
Multidisciplinary Guidelines Group
When the baby is delivered, the midwife should pass the placenta to the trained
phlebotomist who should then take the placenta to the dedicated area on the
delivery suite to collect the cord blood.
There are various commercial services that provide umbilical cord blood storage
services such as Cells4life.

Contact details:

Cells4life Ltd
Sales and Marketing Division
Sussex Innovation centre
Science Park Square
Falmer
Brighton
BN1 9SB

Phone: 01273 234 676
Email: enquiry@cells4life.co.uk

OR

Smart Cells International
56-58 Bloomsbury St
London WC1B 3QT

Phone 08456045523
Website www.smartcells.com
Email: uk@smartcells.com


References:

Armitage S, Warwick R, Fehily D, Navarrete C, Contreras M. Cord blood banking
in London: the first 1000 collections. Bone Marrow Transplant 1999; 24:139-45.

Armitage S, Sheldon J, Pushpanathan P, Ellis J, Contreras M. Cord blood
donation, testing and banking: a guide for midwives. Br J Midwifery 2006;14:6-9.

Brand, A et al (2008) Cord Blood Banking. Vox Sanguinis.

Brunstein CG, Wagner JE. Umbilical cord blood transplantation and banking.
Annu Rev Med 2006; 57:403-17.




Cordbloodcollection.doc.May 2010                           Page 6 of 11
Multidisciplinary Guidelines Group
Gluckman E, Broxmeyer HA, Auerbach AD, Friedman HS, Douglas GW,
Devergie A, et al. Hematopoietic reconstitution in a patient with Fanconi's anemia
by means of umbilical-cord blood from an HLA-identical sibling. N Engl J Med
1989; 321:1174-8.

Gluckman E. Hematopoietic stem-cell transplants using umbilical-cord blood. N
Engl J Med 2001; 344:1860-1.

Hows JM. Status of umbilical cord blood transplantation in the year 2001. J Clin
Pathol 2001; 54:428-34.

Kögler G, Sensken S, Airey JA, Trapp T, Muschen M, Feldhahn N, et al. A new
human somatic stem cell from placental cord blood with intrinsic pluripotent
differentiation potential. J Exp Med 2004; 200:123-35.

McGuckin CP, Forraz N, Baradez MO, Navran S, Zhao J, Urban R, et al.
Production of stem cells with embryonic characteristics from human umbilical
cord blood. Cell Prolif 2005; 38:245-55.

National Blood Service. FRM1571/1.1 Request for a Directed Cord Blood
Collection. Form 2C

National Blood Service FRM/DDR/SB/007/02 Consent for Directed Cord
Blood Collection, Testing and Cryopreservation. Form 2D

National Blood Service         INF/DDR/SB/004/02     Guidance    for   Healthcare
Professionals. Form 2L

Proctor SJ, Dickinson AM, Parekh T, Chapman C. Umbilical cord blood banks in
the UK have proved their worth and now deserve a firmer foundation. BMJ 2001;
323:60-1.

Rocha V, Sanz G, Gluckman E; Eurocord and European Blood and Marrow
Transplant Group. Umbilical cord blood transplantation. Curr Opin Hematol 2004;
11:375-85.

Royal College of Obstetricians and Gynaecologists (2006) Umbilical Cord Blood
Banking. Scientific Advisory Committee Opinion Paper 2. London: RCOG

Cordbloodcollection.doc.May 2010                           Page 7 of 11
Multidisciplinary Guidelines Group
AUDIT and MONITORING
The audit process is set out in the annual maternity audit plan which reflects the
Trusts audit planning process and is agreed between the Clinical Programme
Group and the Trust Audit Committee.
Audits are planned with a single unit ethos but conducted separately on each
site, in the same time period, using a standard audit proforma tool. This tool has
been developed to reflect the auditable standards from the relevant national
bodies (e.g. CNST, NICE, RCOG) and ensures data collection on both sites is
relevant and comparable.
The audit projects are presented in March and October each year and are
followed by a twice-yearly Cross-site Audit Committee review of the audits
presented and their findings. The role of the multidisciplinary audit committee is
firstly to ensure that all audits have been completed and presented to an agreed
standard and secondly to agree formal action plans following the audits. The
Audit Committee will also monitor the action plans.
The action plans are coded as green (100% compliance, continue), yellow (75%
compliance achieved but plans to improve compliance further set in place), and
red (< 75% compliance- an urgent review will be conducted to address improving
compliance to yellow levels).
All compliance rates will be fed directly from the Audit Committee to Q&S on a
twice-yearly basis


AUDITABLE STANDARDS
  • Number of Directed Cord Blood Collections for ‘At Risk’ families
  • Person taking the blood
  • Consent forms A & C completed
  • Mode of delivery

DOCUMENTATION
Documentation should be clear and contemporaneous and completed according
to Imperial Maternity Documentation Guideline (2010)

EQUALITY IMPACT OF GUIDELINE
Is this guideline anticipated to have any significant equality-related impact on patients,
carers or staff?

       NO




Cordbloodcollection.doc.May 2010                              Page 8 of 11
Multidisciplinary Guidelines Group
IMPLEMENTATION
Training required for staff                Yes - to increase overall awareness during
                                           Midwifery mandatory training weeks and
                                           obstetric training days
If yes, who will provide training          Practice Development Midwives
                                           Obstetric Consultants
When will training be provided?            Ongoing
Date for implementation of guideline       September 2010

MONITORING / AUDIT
When will this guideline be audited?            In CPG audit programme
Who will be responsible for auditing this Obstetricians and Midwives
guideline?
Are      there   any      other   specific See auditable standards
recommendations for audit?


REVIEW
Who will review this guideline ?          Multidisciplinary Guidelines Group
Please indicate frequency of review:
As a guide:
   •   Drug related guidance should 2 yearly or sooner if new recommendations
       be reviewed every 2 years
                                      produced by RCOG, NICE, CEMACH
   •   Therapy    related    guidance
       should be reviewed every 5
       years
   •   Clinical treatment guidance
       should be reviewed every 3 – 5
       years
Date of next review                       May 2012



REFERENCES
References are listed in Harvard style at the end of the guideline




Cordbloodcollection.doc.May 2010                            Page 9 of 11
Multidisciplinary Guidelines Group
GUIDELINE DETAIL
Start Date:       3rd September 2010 (Chair’s Action)
(date of final
approval by CPG
Quality       and
Safety Board)
Dates   approved Maternity Guidelines Group (if applicable)         April 2010
by:
                      CPG Quality and Safety Committee              March 2010
                      Returned to Quality & Safety Committee        May 2010
                      Returned for Chair’s action                   Aug 2010
Have all relevant     Haematology Consultants
stakeholders          Obstetric Consultants
(Trust       sites,
CPGs            and   Obstetric Registrars
departments)          Midwives
been included in      Neonatologists
the development
                      Obstetric Anaesthetists
of this guideline?
                      Pharmacists
Who will you be Midwives
notifying of the Obstetric Consultants
existence of this
guidance?         Obstetric Registrars
                  Obstetric Anaesthetists
                  Neonatologists
                  Paediatricians
                  SHOs
                  Lindo Wing & Stanley Clayton Private Maternity Departments
                  A & E at SMH & QCCH
                  Physiotherapists
Related               Human Tissue Act 2004
documents:




Cordbloodcollection.doc.May 2010                         Page 10 of 11
Multidisciplinary Guidelines Group
Author/further       Osaeloke Osakwe (SpR, SMH)
information:         Karl Murphy (Consultant Obstetrician, SMH)
                     Megan Rowley (Consultant in Haematology and Transfusion
                     Medicine, SMH)
                     Beverly Donaldson (Clinical Effectiveness Midwife)
                     For further information contact:
                     Beverly Donaldson (Clinical Effectiveness Midwife)
                     CPG 5
                     Clinical Governance Office
                     4th Floor Hammersmith House
                     020 8383 5071 (QCCH)
                     020 7886 1358 (SMH)
                     Beverly.donaldson@imperial.nhs.uk
Document review Version 1 Imperial
history:
Next review due      May 2012
THIS                 QCCH guidance
GUIDELINE            New guideline for SMH
REPLACES:


INTRANET HOUSEKEEPING
Key words                              Cord blood
                                       Umbilical cord blood
                                       Cord samples
                                       Stem cells
                                       Human tissue
                                       Human Tissue Act
                                       Third Party Agreement


Which CPG does this belong to?         CPG5
Which subdivision of the guidelines Maternity
spine should this belong to?        IMPERIAL




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Multidisciplinary Guidelines Group

				
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