Breaking the myth that addition of HES (Hydroxystarch) during cord blood processing is hazardous

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The process of isolating stem cells from a sample of umbilical cord blood collected from a baby at birth is called cord blood processing. Cord blood processing is the most crucial step in the process of cord blood banking. If the processing technique is not robust enough the number of stem cells harvested will be affected. Yes, cell recovery rates are the most essential bit to obtain a higher number of stem cells which would be directly proportional to the treatment outcome of a transplant. There are various types of stem cell processing technology. One of the most credible processing technology known is the Personalized Processing Technology. This technique is completely automated, safe and sterile, thus its ability to retrieve stem cells from the cord blood sample is maximal.

There are rumors prevalent in the industry that majority of the cord blood banks use HES (hydroxyethyl starch-Hetastarch or HES) during their cord blood processing. HES is a commonly used chemical in most laboratories to handle blood-related products. The fabricated myth about Hespan is widespread because as standard procedure patients were infused with large volumes of HES in the emergency rooms when they were going into shock resulting in a rapid drop in blood pressure. Thus, when patients are infused with HES, this substance temporarily replaces the loss in the blood volume till the doctors could work to set right the rapid loss of blood pressure in the meantime and find a matching blood unit from the nearest blood bank.

Despite the advantage of HES in the emergency room, it was found in various retrospective studies that in patients who have survived, there was a possibility of them developing a kidney failure later in life. This apprehension amidst the medical fraternity that infusion of HES intravenously was unsafe has led to the prevalent myth that addition of HES can be harmful. This apprehension of side-effects occurs only when HES is intravenously infused and this would not happen when HES is added to cord blood during processing. Thus, this widespread interpretation that adding of HES into cord blood during processing is unsafe,  is completely a  myth. Moreover, the volume used in during cord blood processing is absolutely negligible and is perfectly safe.

Let me explain, how the introduction of HES into Personalized Proprietary Technique(PPT) one of the most credible techniques of cord blood processing enables stem cell recovery. In (PPT) the Proprietary red cell depletion and plasma reduction technique is, of a customized volume and the collection is obtained, by employing differential centrifugation technology in a sterile triple closed bag system. In this technique, hydroxyethyl starch (HES) is only used for the density gradient during the centrifugation process.

This centrifuging process ensures median cord blood stem cell recoveries (TNCC recoveries) greater than 80% when compared with other automated techniques. Importantly, this technology also allows significantly higher red blood cells (RBCs) depletion resulting in much lower hematocrit concentration (left over RBCs) in the final product. The median hematocrit concentration of final product is approximately 5% when compared with 15-25% of other automated techniques. The RBC depletion post processing is more than 95% which makes this technology using (HES) the most preferred for atransplants, avoiding the need to perform a washing step that may lead to loss of precious stem cells. Only 0.1% of our samples have hematocrit values greater than 40%. The entire processing is performed in a completely closed system, along with bar coded interface thereby eliminating scope of error.

Thus, through evidence the claim of adding HES (Hydroxyethyl starch) during cord blood processing is unsafe is demystified, endorsing the fact that HES addition in cord blood processing is absolutely safe, also offering a  high-quality stem cell recovery that complements for a successful transplant.

Reference:

1.Zarychanski R. et al. 2013; JAMA 309(7):678-88. doi:10.1001/jama.2013.430

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022688/

3.https://parentsguidecordblood.org/en/bank/lifecell

4.https://parentsguidecordblood.org/en/faqs/it-true-hespan-poison-and-has-been-banned-cord-blood-processing

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