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Crossmatch studies, which detect antibodies in recipient serum directed against proteins expressed by donor cells, are used to determine whether the antibody is specific or nonspecific. The importance of a positive crossmatch was demonstrated in a study of 522 patients in which there was a ninefold greater incidence of graft rejection among crossmatch-positive compared to crossmatch-negative recipients (Anasetti et al. 1989). More recent technology uses solid surfaces or beads coated with purified HLA molecules to detect donor-specific antibodies (DSA), resulting in enhanced sensitivity and specificity compared to cell-based assays.

The median doses of total nucleated cells (TNC), CD34+ cells, and CD3+ cells in UCB unit are approximately ten times lower than that of a bone marrow graft (Moscardo et al. 2004; Barker and Wagner 2003). Reduced cell numbers may be offset by a higher capacity for replication, as indicated by higher cell cycle rates and longer telomeres in UCB progenitor cells (Lewis and Verfaillie 2000; Mayani and Lansdorp 1998). Immune mediator cells in UCB have been characterized as relatively immature compared to marrow cells, including less mature T- and B-cell phenotypes, reduced response to alloantigen, and 29 lower capacity to generate inflammatory cytokines (Mayani and Lansdorp 1998; Garderet et al.

1997; Rubinstein et al. 1998). Based on the Eurocord results, the lower limit of an acceptable unit has generally been considered approximately 2 × 107 total nucleated cells (TNC) per kilogram recipient weight, as determined by TNC in the unit before cryopreservation (Migliaccio et al. 2000). In acknowledgement of the importance of cell dose, UCB banks subsequently made efforts to improve UCB volume at collection. However, until recently the problem of cell dose has limited UCB transplants to smaller patients; hence, most of the subsequent analyses have been performed in pediatric patients.

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Baby Huey

by James

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