In the under-resourced world, transfusion to advanced oncological patients involves two major problems, i.e., (a) transfusion transmitted disease, and (b) infrastructural deficiency. Many hospitals cannot cope with the specialized requirements of immunocompromised
cancer victims, for instance, leucoreduction, selective
apheresis, irradiation of the blood, viral inactivation of the blood by
solvent and/or
detergent treatment or photochemical inactivation using
psoralen or long wavelength ultraviolet light and cytomegalovirus safe blood. The exorbitant cost of red blood cell (RBC) substitutes like
hemoglobin-based
oxygen carriers or perflurocarbon
emulsions,
liposome encapsulated hemoglobin, is simply unacceptable for an average oncological patient in the developing world. Moreover, it should be underscored that none of the total blood functions are replaced by any available so-called
blood substitute, the primary function of which is
oxygen delivery and volume expansion only. A more accurate term should be
red cell substitute. Cord blood, because of its rich mix of fetal and adult
hemoglobin, platelet and white blood cell (WBC) count, and plasma filled with
cytokine and
growth factors--as well as its hypoantigenic nature and altered metabolic profile--has all the potential of a real and safe alternative to adult blood during emergencies or any etiology of blood loss. In the present series, the collection of cord blood varied from 54 ml-128 ml, mean 82 ml +/- 7.6 ml SD; mean packed cell volume 48 +/- 4.1% SD; mean percent
hemoglobin concentration 16.4 g/dl +/- 1.6 g/dl SD. Not a single case of immunological or non immunological reaction has been encountered so far after transfusion of cord blood to
cancer patients with percent of
hemoglobin 8 g/dl or less. It appears that the medical fraternity can safely use this precious gift of nature-- which is free from
infection, hypoantigenic with altered metabolic profile, filled with
growth factors and
cytokine-filled plasma, and has the potential of a higher
oxygen carrying capacity than adult blood--as an emergency source of blood for the management of advanced
cancer cases with
anemia.