Red cell salvage and reinfusion in pediatric bone marrow donors

We evaluated the use of a semi-automated processing technique to salvage re d blood cells from pediatric bone marrow donors to minimize the risk of sev ere anemia following bone marrow harvest and ABO incompatibility in the rec ipient. Sixty healthy, HLA-matched, pediatric donors of bone marrow hematop oietic cells with a median age 8.0 years (2-19) were studied. Thirteen of t he donor-recipient pairs were ABO incompatible. There were 60 recipients wi th a median age of 8.6 gears (2 months to 20.8 years), Bone marrow was harv ested under general anesthesia, filtered in the operating room and then tra nsferred to the stem cell laboratory for processing. Samples were obtained for cell count, CD34(+) quantification, colony assay, viability, and bacter iologic cultures before and after processing. The cells were processed in a semi-automated closed system (Stericel, Terumo) by density gradient separa tion with Ficoll-Hypaque and then washed. Two aliquots were obtained: one c ontaining the mononuclear cell layer to be infused to the recipient and the other the washed red tells to be infused to the donor. The median volume h arvested was 608 +/- 40.42 ml (278-1409), while the final volume infused wa s 174 +/- 10.75 ml (30.2-380) P < 0.0001, representing a decrease of 72% of the volume infused. The nucleated cell count harvested was 1.6 x 10(10) +/ -- 0.1 (0.56-3.2), while the count infused was 6.9 x 10(9) +/- 0.1 (0.12-5. 4) P < 0.0001, The median mononuclear cell count (MNC) per kg harvested was 0.67 x 10(8) +/- 0.05 (0.18-2.0) vs an infused cell number of 1.3 x 10(8) MNC/g +/- 0.1 (0.6-33.6) P < 0.0001, The CD34+ cells harvested mere 2.8 x 1 0(6)/kg +/- 0.1 (0.25-10.2) vs an infused number of 6.0 x 10(6)/kg +/- 0.5 (0.84-31.0) P < 0.0001. The viability before and after processing was 99%. Red cell salvage performed in a semi-automated closed system is safe and re duces the risk of post-bone marrow harvest anemia in pediatric donors, decr eases the volume infused into the donor and enriches the mononuclear and CD 34(+) cell population, without affecting hematopoietic reconstitution.