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Regulatory agencies (eg, FDA, Federal Trade Commission, and state equivalents of these federal agencies) are encouraged to have an active role in providing oversight of the cord blood program. All cord blood–banking programs should comply with FACT or equivalent accreditation standards.
When you’re pregnant, especially for the first time, you have to make a lot of decisions. Will coffee remain a part of your life? Where are you going to give birth? What are you going to name the baby? What values will you teach him? Do you really need a baby spa bathtub?
Donating your baby’s cord blood to a public bank is always free. The limitations of the public banking network in the United States are: they only collect donations at large birthing hospitals in ethnically diverse communities, the mother must pass a health screening, they prefer registration by 34 weeks of pregnancy, and they only save the largest cord blood collections. The potential reward of public donation is that your baby could Be The Match to save a life!
There are around 20 companies in the United States offering public cord blood banking and 34 companies offering private (or family) cord blood banking. Public cord blood banking is completely free (collecting, testing, processing, and storing), but private cord blood banking costs between $1,400 and $2,300 for collecting, testing, and registering, plus between $95 and $125 per year for storing. Both public and private cord blood banks require moms to be tested for various infections (like hepatitis and HIV).
According to the statement, “Families may be vulnerable to emotional marketing at the time of birth of a child and may look to their physicians for advice. No accurate estimates exist of the likelihood of children to need their own stored cells. The range of available estimates is from 1 in 1,000 to 1 in 200,000.” For this and other reasons, it is difficult to recommend that parents store their children’s cord blood for future use. The AAP policy states:
6. Lou Gehrig’s disease. There’s hope that stem cells could help those with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, or ALS. The crippling disease comes with a grim prognosis: Many die within three to five years of diagnosis, as their bodies progressively damage muscle-controlling motor neurons in the brain and spinal cord. Scientists are exploring ways to coax stem cells into becoming motor neurons that could be transplanted into ALS patients, restoring their ability to move.
These are diagnoses for which stem cell treatments are being studied either in the laboratory with cell cultures or in animals that mimic the human disease. The experimental therapies are not yet in human clinical trials. In experimental research, it is often not clear whether an eventual therapy, if developed, would be Autologous or Allogeneic.
The stem cells obtained from umbilical cord blood are also less likely than bone marrow stem cells to be rejected in transplants. Considered to be immunologically immature, umbilical cord blood stem cells produce significantly fewer natural killer cells, creating a substantial decrease in rejection. Consequently, cord blood stem cells require less rigorous antigen tissue matching for transplants than bone marrow stem cells (Sullivan, 2008). Research indicates that a mismatch of up to two antigen sites still provides successful clinical outcomes (Ballen, 2006; Fox et al., 2007). In fact, researchers report that the rate of rejection for cord blood stem cell transplants is half the rate of rejection for bone marrow transplants (Ballen et al., 2001). When compared directly in cases of mismatched antigens, there was clearly less rejection in transplants involving cord blood stem cells than bone marrow stem cells (Moise, 2005).
Cord blood can be used in the treatment of nearly 80 life-threatening diseases – from cancers to blood disorders. It’s also being used in regenerative medicine research to help kids with conditions like Autism and Cerebral Palsy.
Despite the benefits of using umbilical cord blood stem cells for transplant, the process also has some disadvantages (see Table 3). For stem cell transplants to be successful, measurable signs of engraftment must occur. Engraftment is the opposite of rejection and indicates that the stem cell transplant is “working.” Two measurable signs of engraftment are the recovery of both neutrophil (a type of white blood cell) and platelet (a clotting factor) production. These two clinical signs of recovery take longer to occur in umbilical cord blood stem cell transplants than in bone marrow stem cell transplants. In other words, the lab values for white blood cell production and platelet production take longer to increase after umbilical cord blood stem cell transplants than after bone marrow stem cell transplants (Hess, 1997; Moise, 2005).
A well-established history. Public banks are affiliated with nonprofit research institutions or hospitals, so they have a better chance of being managed more soundly. For families without a history of diseases treated by cord blood, such as leukemia and sickle cell anemia, the American Academy of Pediatrics (AAP) recommends that cord blood be donated to public banks. Although the AAP states cord blood has been used to treat certain diseases successfully, there isn’t strong evidence to support cord blood banking. If a family does choose to bank cord blood, the AAP recommends public cord blood banking (instead of private) to cut down on expenditures. Private cord blood banks are affiliated with business corporations, so, like any business, they may go under, says William T. Shearer, M.D., Ph.D., professor of Pediatrics and Immunology at Baylor College of Medicine in Houston.
Korthof ET, Snijder PP, de Graaff AA, et al. Allogeneic bone marrow transplantation for juvenile myelomonocytic leukemia: a single center experience of 23 patients. Bone Marrow Transplant.2005;35 :455– 461
Another important disadvantage that is not well understood by the general public is the limited use of an infant’s own umbilical cord blood stem cells later in life, called an autologous transplant. Commercial cord blood banks often advertise the banking of the infant’s cord blood as “biologic insurance.” However, the chance that a child would be able to use his or her own cord blood is extremely small: from a 1:400 to a 1:200,000 chance over the child’s lifetime (Sullivan, 2008). In fact, there are certain instances in which the use of one’s own umbilical cord blood is contraindicated, as in cases when the defect is of a genetic origin. For example, autologous cord blood stem cells cannot be used to treat malignant cancers such as leukemia because the genetic mutations for the cancer already exist on the DNA of the cord blood. Using one’s own stem cells would be, in effect, “contaminating” oneself with the same disease process (Percer, 2009).
Umbilical cord blood was once thought of as a waste product. Now, years after the first successful umbilical cord blood transplant, more families seek information about whether or not to save their newborn’s cord blood. Childbirth educators may be one of the main sources that an expectant family depends on to gain more knowledge about cord blood banking in order to make an informed decision. Preserving umbilical cord blood in public banks is advisable for any family; however, it is recommended that expectant families only consider private cord blood banking when they have a relative with a known disorder that is treatable by stem cell transplants. The childbirth educator is encouraged to be well versed on the topic of cord blood banking, so that as questions from class participants arise, the topic can be explored and addressed appropriately.
The use of cord blood is determined by the treating physician and is influenced by many factors, including the patient’s medical condition, the characteristics of the sample, and whether the cord blood should come from the patient or an appropriately matched donor. Cord blood has established uses in transplant medicine; however, its use in regenerative medicine is still being researched. There is no guarantee that treatments being studied in the laboratory, clinical trials, or other experimental treatments will be available in the future.
Chandy M, Balasubramanian P, Ramachandran SV, et al. Randomized trial of two different conditioning regimens for bone marrow transplantation in thalassemia: the role of busulfan pharmacokinetics in determining outcome. Bone Marrow Transplant.2005;36 :839– 845
There are three types of umbilical cord blood banks: private, public, and direct-donation banks. The private bank is a commercial, for-profit entity that often advertises directly to expectant parents. These banks are designed for the sole use of the families who have saved the cord blood. Private banks charge an initial fee for collection and processing and, then, a yearly fee to maintain the specimen. Another fee is often charged when a sample is removed for testing or treatment (Moise, 2005).
Parents often complain about cord blood banking costs. This is not an industry where costs can be cut by running a turn-key operation. Each cord blood unit must be individually tested and processed by trained technicians working in a medical laboratory.
Recently, it was shown that umbilical cord blood contains a sufficient number of hematopoietic stem cells to be used for transplantation. More than 5500 unrelated-donor cord blood stem cell transplants for a variety of pediatric genetic,22,24–31 hematologic,22,24,25,29,32 immunologic,28 metabolic,26,27,30 and oncologic19,20,33–36 disorders have been performed to date (Table 1). The 1-year survival may be as high as 75% to 90% after sibling HLA-matched cord blood donor stem cell transplantation21,24,29 and 40% to 80% after unrelated cord blood stem cell transplantation.19,20,26,27,33,35,36 Advantages of the use of cord blood include the fact that it is readily available, carries less risk of transmission of blood-borne infectious diseases, and is transplantable across HLA barriers with diminished risk of graft-versus-host disease compared with similarly mismatched stem cells from the peripheral blood or bone marrow of related or unrelated donors.21,34,35,37 Autologous stem cells38,39 have been used for gene therapy in infants with severe combined immunodeficiency, but the appearance of T-lymphocyte leukemia in some patients has indicated the need for more basic research before additional clinical trials of gene therapy can be undertaken.
*Fee schedule subject to change without notice. If a client has received a kit and discontinues services prior to collection, there is no cancelation fee if the kit is returned unused within two weeks from cancelation notice; otherwise, a $150 kit replacement fee will be assessed. †Additional courier service fee applies for Alaska, Hawai’i and Puerto Rico. ††Applies to one-year plan and promotional plan only. After the first year, an annual storage fee will apply. Cryo-Cell guarantees to match any written offer for product determined to be similar at Cryo-Cell’s sole discretion. ** Promotional Plan cannot be combined with any other promotional offers, coupons or financing.
Wagner JE, Rosenthal J, Sweetman R, et al. Successful transplantation of HLA-matched and HLA-mismatched umbilical cord blood from unrelated donors: analysis of engraftment and acute graft-versus-host disease. Blood.1996;88 :795– 802
There are so many things to think about when you have a child. One of them is the blood from your baby’s umbilical cord (which connects the baby to the mother while in the womb). It used to be thrown away at birth, but now, many parents store the blood for the future health of their child. Should you do it?
Cord blood–banking recruitment practices should be developed with an awareness of the possible emotional vulnerability of pregnant women and their families and friends. Efforts should be made to minimize the effect of this vulnerability on cord blood–banking decisions.
Medical shipping: Some cord blood companies use medical shipping companies to deliver cord blood; these companies guarantee that cord blood is kept a certain temperature and delivered to the facility by a certain time, typically within 24 hours of collection.
Priority shipping: Cord blood companies that use priority shipping services have families ship them cord blood in a heavily insulated box, which arrives at the cord bank at a certain time, but does not guarantee that the blood remains at a certain temperature.
Back in the 1980s, umbilical cord blood caught the attention of researchers who suspected that the often-discarded tissue could be a valuable source of shape-shifting stem cells. These cells, which can become several different types of blood cells, are similar to the specialized stem cells found in bone marrow that can churn out new blood cells. Such stem cells are found in adult blood, too, but not as abundantly.
Families should seriously pursue public banking, donation for research, or private banking instead of discarding their baby’s umbilical cord blood. We aim to be nonpartisan in our dissemination of information, but we believe that discarding your baby’s cord blood is a waste of a once-in-a-lifetime valuable resource.
Anyway, the excitement over the embryonic cells comes from their remarkable ability, as biological blank slates, to become virtually any of the body’s cell types. Many observers believe the president’s move will accelerate the hunt for cures for some of our most vexing diseases. However, the benefits are largely hypothetical, given the infancy of the field, and are offset by some real obstacles: The risks of embryonic stem cells, as well as cells programmed to become like them, including the possibility they will actually cause cancers in people who receive them. Nonetheless, here’s a look at 10 health problems that stem cells might someday cure or at least help treat.
Not all moms can donate their cord blood. Moms who are not eligible are those who: are younger than 18 years old (in most states), have been treated for cancer or have received chemotherapy for another illness, have had malaria in the last three years, or have been treated for a blood disease such as HIV or hepatitis. It’s also not possible to donate cord blood if a mom has delivered her baby prematurely (there may not be enough blood to collect) or delivered multiples (but it’s possible to bank your cord blood of multiples privately).
For transplants, the primary advantage of cord blood stem cells over stem cells from adults is that they cause much less graft versus host disease (GvHD). In order to safely transplant adult stem cells, the patient and donor must match over at least 10 of 12 tissue types called Human Leukocyte Antigens (HLA), or 83% HLA match. By comparison, medical outcomes are just as good with cord blood that has a 4 out of 6 or 67% HLA match.
4. If your family, especially your children, are of mixed ethnic background, it may be impossible to find an adult bone marrow donor who is a perfect match. In that event, cord blood from even a partially matched sibling would be invaluable if a stem cell transplant is necessary.
The most obvious argument against is that the odds of needing cord blood for medical treatment is very, very slim. Below is a news release on a policy published in the July,1999 issue of Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP):
This is only the beginning. Newborn stem cell research is advancing, and may yield discoveries that could have important benefits for families. CBR’s mission is to support the advancement of newborn stem cell research, with the hope that the investment you are making now will be valuable to your family in the future. CBR offers a high quality newborn stem cell preservation system to protect these precious resources for future possible benefits for your family.
There are several cord blood banks that are accredited by the American Association of Blood Banks. Most offer information on cord blood banking and provide private cord blood banking services. With a little research, you should be able to locate a credible cord blood bank online.
Migliaccio AR, Adamson JW, Stevens CE, Dobrila NL, Carrier CM, Rubinstein P. Cell dose and speed of engraftment in placental/umbilical cord blood transplantation: graft progenitor cell content is a better predictor than nucleated cell quantity. Blood.2000;96 :2717– 2722
When it comes to raising kids, good advice and strong evidence can be hard to come by. The Growth Curve blog brings an accessible and metered approach to new studies and popular parenting topics. Growth Curve is a blog of Science News, which gives readers a concise overview of the most important science news from all fields and applications of science and technology.