A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING

CORD BLOOD BANKING AMONG STAFF NURSES IN SELECTED HOSPITALS AT BANGALORE

M.Sc. Nursing Dissertation Protocol Submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

By

Ms.JAKHA LEENU.M

M.Sc Nursing 1st Year

2012-2014

Under the Guidance of

HOD, Department of OBG Nursing

Nightingale College of Nursing

Guruvanna Devara Mutt,

Near Binnyston Garden,

Magadi Road,

Bangalore-560023

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1: Name of the candidate and address (in

block letters)

MS.JAKHA LEENU.M

Ist YEAR M.Sc NURSING

NIGHTINGALE COLLEGE OF NURSING,

GURUVANNA DEVARA MUTT,NEAR

BINNYSTON GARDEN,MAGADI

ROAD.BANGALORE.-23

2: Name of the Institution NIGHTINGALE COLLEGE OF NURSING

MAGADI ROAD

BANGALORE.

3: Course of Study and Subject M. Sc. NURSING

OBG NURSING

4: Date of Admission to the Course 01/05/2012

5: TITLE OF THE STUDY:

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING CORD

BLOOD BANKING AMONG STAFF NURSES IN SELECTED HOSPITALS

AT BANGALORE.”

2

6

BRIEF RESUME OF THE INTENDED WORK

6.0 INTRODUCTION:

“A baby is God’s opinion that life should go on’’Carl Sandburg

Umbilical cord or funiculus umbilicalis is a long cord like structure, extending

from fetus to the placenta. It acts as a lifeline between placenta and fetus by providing oxygen

and nutrients to fetus and disposing waste products. Cord blood contains hematopoietic stem

cells, progenitor cells which can form red blood cells, white blood cells and platelets. Cord

blood banking consists of the collection, processing, and cryopreservation of the remaining

blood within the umbilical and placental circulation following the birth of a child and

typically prior to placental delivery. A cord blood bank is a facility which stores umbilical

cord blood for future use.1

Cord blood collection happens after the umbilical cord has been cut and is extracted

from the fetal end of the cord, diverting up to 75+/-23ml from the neonate. It is usually done

within 10minutes of giving birth. After the health care provider draws the cord blood from the

placental end of the umbilical cord, the placenta is couriered to the stem cell laboratory,

where it is processed for additional stem cells. An adequate cord blood collection requires

atleast 75ml in order to ensure that there will be enough stem cells to be used for a

transplantation .Before the cord blood is stored for later use, it undergoes viral testing

including tests for HIV and Hepatitis B and C and tissue typing. It will also be examined for

nucleated cell count, cell viability, blood group antigen (ABO &Rh), molecule cluster

(CD34), and bacterial and fungal growth.1

After the collection, the cord blood unit is shipped to the lab and processed and

then cryopreserved. There are many ways to process a cord blood unit, some processing

methods separate out the red blood cells and remove them, while others keep the red blood

cells. The unit is processed, a cryopreservant is added to the cord blood to allow the cells to

survive the cryogenic process.After the unit is slowly cooled to -90degree C,it can then be

added to a liquid nitrogen tank which will keep the cord blood unit frozen at -196degree

3

C.The slow freezing process is important to keep the cells alive during the freezing process.

Although many cryopreservation strategies suggest using dimethylsulfoxide(DMSO),slow or

controlled rate cooling and rapid thawing.1

A study to conduct the methods of cord blood collection and separation for

haematopoietic progenitor cells among health personnels. This study aimed to investigate the

level of knowledge on methods of umbilical cord blood collection and separation methods. A

structured questionnaire method was adopted for this study. Health personnels were surveyed

(n=150) with the response rate of 40%.The results of this study shows that majority of health

personnels are faced difficulties during collection and separation methods.2

Cord blood stem cells are used in the treatment of several life-threatening

diseases. It plays an important role in the treatment of blood and immune system related

genetic diseases, cancers and blood disorders like leukemia, Hodgkin’s lymphoma and sickle

cell anaemia. The use of cord blood stem cells are in the application of regenerative medicine.

It is used in children with type1 diabetes mellitus, cardiomyopathy and cerebral palsy etc.3

An International Cord Blood Transplant Registry conducted a study on cord

blood banking for hematopoietic stem cell transplantation. This study indicated that human

umbilical cord blood contains hematopoietic stem cells for transplantation to cure children

and adults with leukemia and other fatal marrow disorders.4

The FDA (Food and Drug Administration)governs the collection, processing,

storage, labeling, packaging and distribution of cord blood stem cells. There are two different

standards which can apply: cGTP(Current Good Tissue Practices)and cGMP(Current Good

Manufacturing Practices). cGTP standards apply to the collection, processing and storage of

human cells, tissues and cellular/tissue-based products and are regulated by the centre for

Biologics Evaluation and research .All us cord blood banks must be complaint with cGTP

standards. cGMP standards apply to the manufacture of a product that is considered a drug.

How one determines whether a bank must be complaint with cGMP standards is based upon

the product that they manufacture. If a cord blood bank manufactures cord blood stem cells

that are overly manipulated or the cells are used in a different basic biologic function that

product is regulated as a drug and both cGTP and cGMP standards would apply.5

4

India’s first public cord blood bank is Jeevan Blood Bank and Research

Centre(Chennai).The various private cord blood bank found across India are Life cell

India(Chennai,Mumbai,Hyderabad,Bangalore,Ludhiana,Ahmedabad,Delhi,Cochin),Asia cryo

cell private limited (Chennai& Bangalore),Reliance Life Sciences Pvt.Ltd(Mumbai),

Cryobanks international (Patna)&Rotary Narayana Tissue Bank and Stem cell research

centre(Bangalore).6The average charge to preserve cord blood for a period of 21 years is

Rs.70,000 to Rs.84,000 which can also be paid in divided rents of Rs.3500 per month and

further storage demands Rs.2000 per year.7

6.1 NEED FOR STUDY:“Believe that life is worth living and your belief will help create the fact’’

William James

Placenta is an organ within the uterus which connects embryo to the wall of

the uterus and provide nourishment, eliminates waste and exchange respiratory gases of the

embryo.8

Since this placenta was considered as medical waste and was discarded. Then

came a period when researchers found that it can be used for preparation of cosmetics and

now found that this is a source of precious primitive hematopoietic stem cells and progenitor

cells that can reconstitute the hematopoietic system in patients with malignant and non

malignant disorders treated with myeloablative therapy. 9Bone marrow Transplantation was

the major source for such conditions since 1960’s.The major issues concerned with bone

marrow transplantation are average length of time for searching the donor, low availability of

HLA matched donor and higher incidence of viral infection (90%) etc .10

The cord stem cells have many significant advantages over other sources.

Umbilical stem cells is the freshest and youngest stem cells, more tolerant to tissue mismatch,

do not have DNA mutation that adult stem cells may develop overtime, avoids ethical debate

and it is a biological health insurance for donor future off springs. 14 Cord blood stem cells

may be useful for the siblings, parents or cousins if there is an adequate Human leukocyte

Antigen (HLA) match.11

5

Umbilical cord blood has been approved for use by the Food and Drug

Administration (FDA)and other authorities since the late 1980’s.The first umbilical cord

blood transfusion cured a blood cancer in 1988,when French researchers took umbilical cord

blood from a newborn and gave it to a five year old sibling who had Fanconi’s anaemia, a

severe type of anaemia that causes skeletal defects. Over 1000 cord blood transfusions have

been successlly performed in the United States. Every year nearly 9,000 Americans die who

are waiting for stem cell transplantation.12

Survey of European blood marrow transplantation activity (2006)states that

hematopoietic stem cell transplantation should focus on use of cord blood products and in

2006 there were 25,050 hematopoietic stem cells transplantation from 605centers in 43

participating countries.12In India about 30,000 individuals each year are diagnosed with

conditions that could be treated with a bone marrow transplantation. A study found that

children who received cord blood transplant from closely matched sibling were 59% less

likely to develop graft versus host disease. In Karnataka more then 3,000 patients have now

been treated with cord blood stem cells and 400-500 new patients receives

treatmentannually.13

A study to conduct the uses of cord blood among pregnant mothers. The

result of this study was 67% of women would agree to store cord blood for research

purposes,39%for gene therapy, and 33%for drug manufacturing investigations.13 Recent

research has shown that umbilical cord blood stem cells have similar powers and health

promoting benefits as do embryonic stem cells. Advances are being made each day in

providing greater safety to the patient. Keeping in view the findings seen in scientific

literature, the present study is intended to assess the knowledge of cord blood banking among

staff nurses.14

Some of the common misconceptions about cord blood banking are (1) doctors

would never treat the child with his or her own blood stem cells because it would contain the

disease; (2) no family history of cancer or disease, will ever need their banked cord blood are

so low that people shouldn’t bother doing it; (3) cord blood is not being used yet in medical

treatments; (4) cord blood collection takes important blood away from the baby; (5) the cord

6

stem cell may not remain useful after long-term storage.14

With stem cell therapy proving to be the emerging treatment for the future, cord

blood is one of the cheapest alternatives. Stem cell transplantation facilities are increasing in

India but for optimal utilisation of these facilities, it is important to create concept awareness.

At present, lack of awareness about the huge potential to be gained from the storage of cord

blood stem cells and highly technical nature of the process is the key reason for a small

customer base in the country.11

Even several misconceptions, ignorance and inadequate knowledge on cord

blood banking are prevalent among the healthcare providers. Increased awareness levels

among the healthcare providers, especially the staff nurses about the concept and strong

legalised and less commercialised environment can work positively towards making cord

blood banking an integral part of Indian healthcare. Hence, the researcher felt the need to

improve the knowledge of staff nurses on umbilical cord blood banking by administering a

planned teaching programme.

6.2 REVIEW OF LITERAURE:

“Review of literature is a critical summary of research on topic of interest

often prepared to put a research problem in a context or as the basis for an implementation

projects.’’

The review of literature is an integral component of any study or research

projects. It enhances the depth of knowledge and inspire a clear insight in to the crux of

problem. Literature review throws lights on studies and findings reported about the problems

under study.

A study conducted on transplantation of unrelated donar umbilical cord blood for

non malignant diseases in Taiwan among 45 patients. This study results shows that incidences

of neutrophil engraftment were 88%, platelet engraftment was 82%,GVHD 42%,five years

7

overall survival 88% and disease free survival 77.1% respectively.15

A study conducted on umbilical cord blood collection and separation for

haematopoietic progenitor cell banking.25 samples were assessed. Recoveries of nucleated

cell count, total progenitors and CD34-positive cells in the buff coat were 90%,88% and

100% respectively. The result of this study shows that cord blood can be effectively readily

available blood banking techniques.11

A study was conducted on assessment of feasibility of related cord blood

collecting, the appropriateness of storage and the final suitability for transplantation.

63families were enrolled n this study. A total of 72 cord blood units were collected and stored

for 64 patients. HLA-typing was carried out for 34 donor-recipient couples and most unit

(72%)mismatched with the related patients. About 60% of collections had acceptable for

transplantation. In that only 21% of units had suitable for transplantation. Appropriateness of

related cord blood banking for parents should be further investigated and cost-effective

guidelines policies should be provided. The result shows that banking of related cord blood

unit is an important resource then, this public service should be supported and enhanced. 16

A study was conducted on impact of donor and collection related variables on

product quality in ex-utero cord blood banking. This study aimed to evaluates the role of

selected donor and collection related variables. Retrospective review was performed of cord

blood units collected ex-utero. This study shows that donor selection and collection technique

modifications may improve product quality.17

A study was conducted on impact of intra partum factors on umbilical cord

blood stem cell banking. Cord blood samples were obtained from 102 normal full term

deliveries for the banking of stem cells. Fluorescence activated cell sorting was used to

measure CD34+cell numbers. Statistical analysis was undertaken using Pearson correlation

test and multiple regression analysis. The result shows that some intra partum factors have an

impact on the characteristics of collected cord blood cells. Stress during delivery may

influence the number of haematopoietic cells, through altered cytokine production. This

knowledge may facilitate the selection of optimal cord blood samples for unrelated banking

and the early discarding of suboptimal cord blood samples thus resulting in the saving of

8

costs related to expensive further processing.18

A study was conducted in Calcutta on placental umbilical cord whole blood

transfusions. The sample consisted of 62 patients from nine years of age, of whom 32 were

suffering from varying stages and grades of malignancy. The remaining 30 patients included

patients suffering from thalassemia major, aplastic anaemia, systemic lupus erythematous,

chronic renal failure, rheumatoid arthritis, ankylosing spondylitis, and a geriatric group of

patients with benign prostatic hypertrophy. One hundred and seventy-four units of umbilical

cord whole blood was collected aseptically from the umbilical vein after caesarean section in

standard paediatric blood transfusion bags, after the removal of the baby from the operative

field and after confirming the stable condition of the mother. It was concluded that it also has

the advantage of a higher oxygen carrying capacity of foetal haemoglobin in addition to many

growth factors and other cytokine filled cord blood plasma along with its hypoantigenicity.19

A study was conducted in USA to overcome the barriers to umbilical cord

blood transplantation. The study results showed that there has been marked increase in the

utilisation of umbilical cord blood transplantation (UCBT) in recent years, especially in the

paediatric population. However graft failure, delayed engraftment, and profound delay in

immune reconstitution led to significant morbidity and mortality in adults. It was concluded

that the ability to transplant across Human Leucocytic Antigen (HLA) disparities, rapid

procurement time and decreased graft versus host disease (GVHD) seen with unit cord blood

transplant made it a promising stem cell source and while barriers existed, consistent progress

was being made to overcome them.20

A study was conducted in Coimbatore to evaluate the effectiveness of planned

teaching programme on umbilical cord stem cell collection, preservation and utilization.

Thirty health professionals were involved in the study. The study results showed that post-test

score (mean: 39.62.57) was higher than that of pre-test score (mean: 13.233.88).It is

concluded that planned teaching programme was effective in enhancing the knowledge of

health professionals regarding umbilical cord stem cell collection, preservation and

9

utilisation.21

A study was conducted in Brazil to evaluate bio antioxidants in cryopreservation

of umbilical cord blood using cryo-protectants and low concentrations of dimethylsulphoxide.

Umbilical cord blood was processed and subjected to cryopreservation in solutions containing

different concentrations of dimethylsulphoxide, bioantioxidants and disaccharides. The study

results showed that antioxidants, principally catalase, performed greater preservation of

CD34+ cells, CD123+ cells, colony forming units, and cell viability all post- thawed,

compared with the standard solution of cryopreservation. The study was concluded that the

addition of catalase improved the cryopreservation outcome.22

A study was conducted in New Delhi to assess the knowledge and attitudes of

pregnant women with regard to collection, testing and banking of cord blood stem cells. Data

was collected from 650 pregnant women using questionnaire. The study results showed that

more than half (70%) reported poor or very poor knowledge about cord blood banking. Many

of respondents (68%) thought that physicians should talk to pregnant women about the

collection of cord blood, and they wanted to receive information about this topic from

healthcare professionals or prenatal classes. Most of women would elect to store cord blood

in a public bank and a much smaller portion (14%) would elect private banking. The study

has concluded that most women in this study supported the donation of cord blood to public

cord blood bank for potential transplantation and research.23

A study was conducted in Thailand to evaluate the collection system and

processing of umbilical cord blood donation. A comparison of three cord blood collection

methods, namely, hanging method after delivery of the placenta, aspiration from in-utero

placenta, and the third method is aspiration from in-utero placenta with the help of syringe

assisted aspiration were adopted. The study results showed that the third method was the best

collection method, but it require more trained personnel and involved a complicated

procedure.24

A study was conducted in USA to evaluate the state of the art of unrelated donor

10

umbilical cord blood transplantation for the treatment of haematologic malignancies and

discussed the current issues associated with the use of this haematopoetic stem cell source.

The study findings showed that in contrast to the very high transplant-related mortality

associated with early experience of umbilical cord blood transplantation (UCBT), recent

series have been associated with comparable survival to that of human leucocyte antigen-

matched unrelated donor transplantation in children with similarly promising results in adults

with the use of double-unit grafts. In addition, utilisation of reduced intensity conditioning

regimens has been successful extending access to patients unsuitable for myeloablation. It

was concluded that improved transplant outcomes are now making umbilical cord blood

transfusion a rival to unrelated donor transplantation for the treatment of haematologic

malignancies.25

6.3 STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE EFFECTIVENESS OF

PLANNED TEACHING PROGRAMME ON KNOWLEDGE

REGARDING CORD BLOOD BANKING AMONG STAFF

NURSES IN SELECTED HOSPITALS AT BANGALORE”.

6.4 OBJECTIVES OF THE STUDY:

To assess the knowledge of staff nurses regarding cord blood banking.

To determine the effectiveness of planned teaching programme by comparing pre test

and post test knowledge scores.

To find out the association between pre test and post test knowledge scores with

selected demographic variables.

6.5 HYPOTHESIS:

11

H1: The mean post test knowledge scores of staff nurses after administration of planned

teaching programme will be significantly higher than their pre test knowledge scores.

H2: There is a significant association between the pre test and post test knowledge

scores of staff nurses with selected demographic variables.

6.6 OPERATIONAL DEFINITIONS:

Assess: It refers to the way of finding the knowledge of the staff nurses regarding cord blood

banking.

Effectiveness: It refers to gain in knowledge scores achieved by staff nurses regarding cord

blood banking after administration of PTP.

Knowledge: Knowledge means the scores obtained through planned teaching programme

on cord blood banking.

Planned Teaching Programme (PTP):It is a formal and specific teaching developed

for staff nurses regarding cord blood banking in the duration of 45 minutes.

Cord Blood Banking: It consists of the collection, processing and cryopreservation of the

remaining blood within the umbilical and placental circulation following the birth of a child.

Staff Nurses: It refers to all registered G.N.M, B.Sc and P.B.B.Sc, qualified professionals

working in selected hospitals, Bangalore.

6.7 ASSUMPTIONS:1. The staff nurses may have some knowledge regarding cord blood bank.

2. Adequate knowledge on cord blood banking improves saving of cord blood.

6.8 DELIMITATIONS:1. A data collection period of 4-6 weeks.

2. A sample size of 50 staff nurses.

3. Staff nurses who are working in selected hospitals at Bangalore, Karnataka.

6.9 PROJECTED OUTCOME:

12

7

This study will promote the knowledge of staff nurses regarding cord blood banking.

MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

Data will be collected from staff nurses working in selected hospitals at

Bangalore, Karnataka.

7.1.1RESEARCH DESIGN:

Research design is a blue print for conducting the study that maximizes control

over factors that could interfere with the validity of the findings. A pre experimental one

group pre test and post test design is planned for the research study with manipulation.

7.1.2 RESEARCH APPROACH: The research approach is evaluative.

7.1.3 SETTING:

This study will be conducted in selected hospitals at Bangalore.

7.1.4 POPULATION:

The population for the present study comprises of all staff nurses working in

selected hospitals at Bangalore, Karnataka.

7.1.5 SAMPLE SIZE: The sample size of this study is 50 Staff nurses.

7.1.6 SAMPLING TECHNIQUE: Non probability convenience sampling technique will be used.

7.2 CRITERIA FOR SAMPLE SELECTION:

13

7.2.1 INCLUSION CRITERIA: 1. Nurses with professional qualification for G.N.M, B.Sc(N)and P.B.B.Sc.

2. Staff nurses who are willing to participate in the study.

7.2.2 EXCLUSION CRITERIA:

1. Nurses who are in administrative post.

2. Staff nurses who have attending seminar regarding cord blood banking.

7.2.3. INSTRUMENTS INTENDED TO BE USED:

SELECTION OF TOOL:

This consists of two parts

Part 1: consists of demographic variables.

Part 2: questionnaire will be used to assess and reassess the knowledge level.

QUESTIONNAIRE:

1.General information about cord blood banking.

2.Collection,cryopreservation,benefits and methods of cord blood banking.

SCORING PROCEDURE:

For knowledge assessment

If answer is correct-1

If answer is wrong-0

SCORING INTERPRETATION:

Good:- 75-100%

Average:- 50-75%

Poor:- below 50%

7.2.4. DATA COLLECTION METHOD:

14

Data will be collected from 50 staff nurses working in selected hospitals at Bangalore by

using structured self administered questionnaire.

7.2.5. DATA ANALYSIS PLAN :

It includes descriptive and inferential statistics.

Descriptive statistics: The descriptive statistics analysis includes percentage,

frequency ,mean, standard deviation.

Inferential statistics: It includes parametric test and non parametric test.

Parametric test: paired t-test

Non parametric test: chi-square test

7.3. HAS THE ETHICAL CLEARANCE BEEN OBTAINED

FROM YOUR INSTITUTION? Yes, ethical clearance will be obtained from the research committee of Nightingale

College of Nursing.

Consent will be taken from the selected hospitals and permission will be obtained

before the collection of data.

15

8

LIST OF REFERENCES :

1. Lalitha M.” Cord Blood Banking”. Nightingale Nursing Times 2008 Feb ;3(11):39-40.

2. .Brodie JC, Humes HD.” Cord blood biology and transplantation”.Isr Med Assoc J

2004 Jan;6(1):39-46.

3. Warwick, Arbitage. “Cord blood banking Best Practice & Research” .Clin Obstet

Gynecol 2004;18(6):995-1011.

4. Pasquini MC, Logan BR, Verter F, Horowitz MM, Nietfeld JJ. The Likelihood of

Hematopoietic Stem Cell Transplantation (HCT) in the United States: Implications for

Umbilical Cord Blood Storage. Blood 2005;106(11):1330-33.

5. Frassoni F, Pedestal M, Maccario R.” Cord blood transplantation provides better

reconstitution of hematopoietic reservoir compared with bone marrow

transplantation”. Blood 2003;102:113.

6. Express news service. India’s first Public cord blood bank set up.[online]. 2009 Feb

o6 [cited 2009 Feb 06]; Available from: URL:http://.expressbuzz.com.

7. Cord blood banks in India.[online]. 2004 Aug 16; [15 screens]. Available from:

URL:http://parentsguidecordblood.org/content/usa/medical/diseases.

8. Dutta DC.” Text book of Obstetrics including perinatalogy and contraception”.

6thed.kolkata: New central book agency (P)LTD; 2009. P.28-36.

9. Bojonic I, Cepulic B.” Umbilical cord blood as a source of stem cells”. Acta

Medicinal Croatica 2006 Jun;60(3):215-25.

10. Nietfeld JJ,Pasquini MC, Logan BR, Verter F, Horowitz MM. Lifetime probabilities

of hematopoietic stem cell transplantation in the U.S. Biol Blood Marrow Transplant

2008 Mar;14(3): 316-22.

16

11. Cairo MS, Wagner JE.” Placental and/or umbilical cord blood: an alternative source of

hematopoietic stem cells for transplantation”. Blood 1997;90 (12): 4665-78.

12. Gratwohl A et.al. “The EBMT Activity Survey 2006 on hematopoietic stem cell

transplantation”. Bone marrow transplant 2008 Apr;41(8):687-705.

13. Dinc H, Sahin NH. “ Pregnant women's knowledge and attitudes about stem cells and

cord blood banking”. Int Nurs Rev 2009 Jun;56(2):250-56.

14. Jennifer D, Paul R, Stephen K.” Umbilical Cord Blood Research: Current and Future

Perspectives”. Cell Transplant 2007; 16(2):151–58.

15. Kurtzberg J, Laughlin M, Graham ML.” Placental blood as a source of hematopoietic

stem cells for trans plantation into unrelated recipients”. N Engl J Med 1996;335:157–

66.

16. Harris D, Schumacher M, LoCascio J. Phenotypic and functional immaturity of

human umbilical cord blood T lymphocytes. Proceedings of the National Academy of

Sciences. 1992;89:10006-10.

17. Ballen KK, Barken JN, Stewart SK, Greene MF, Lane TA.” Collection and

preservation of cord blood for personal use”. Bio Blood Marrow Transplant 2008

Jun;14(6):724-25.

18. Hossall O, Ngna L, Konga W, Othigo J, Mandailia K. “The acceptability to women in

Mombassa, Kenya, of the donation and transfusion of umbilical cord blood for severe

anemia in young children”. Haematologica 2009 Apr;94(4):451–54.

19. Jaing TH, Chen SH.” Transplantation of Unrelated Donor Umbilical Cord Blood for

Nonmalignant Diseases: A Single Institution's Experience with 45 Patients”. Biol

Blood Marrow Transplant 2009 Sep 16;100(5)1611-18.

20. Staba Kelly S, Parmar S, Delima M, Robinson S.Overcoming the barriers to umbilical

cord blood transplantation. Cytotherapy 2010 Feb;12(2):121-30(10).

21. Motta JPR, Gomes BE, Bouzas LF, Paragaussu-Braga FH, Porto LC. Evaluations of

bioantioxidants in cryopreservation of umbilical cord blood using natural

cryoprotectants and low concentrations of dimethylsulphoxide. Journal of Paediatric

Nursing 2010 Feb;8-10.

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22. .Kumaraswamy S, Muthulakshmi P. Umbilical cord stem cell collection, preservation,

and utilisation. Nightingale Nursing Times 2010 Apr;6:16-17.

23. Conrad V, Fernandez, Kevin Gordon, Michael, Taweel.” Knowledge and attitudes of

pregnant women with regard to collection, testing and banking of cord blood stem

cells”. Can Med Assoc J 2003 March 18;168(6): 695–98.

24. Sauter C,Barker JN.“Unrelated donor umbilical cord transplantation for the treatment

of haematological malignancies”. Schweiz Medicine 1998 May 2;128(18):689-96.

25. Wacharaprechanont T, Vanichsetakal P, Kupatawint U, Seksarn P, Samritpradit P,

Charoenvidhya D. Cord blood collection for National Cord Blood Bank in Thailand.

PMID: 12930018.

9.SIGNATURE OF THE CANDIDATE

10.REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)

18

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

1212.1 REMARKSOF THE

PRINCIPAL

12.2 SIGNATURE

19