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The second couple listened intently to the conversation, interjecting that they hadn’t considered cord blood banking, and they looked toward me. They started asking the other couple, and me, many questions about cord blood banking. What is the cost? How is it done? What are the uses of cord blood? Is it only used to treat the baby later in life? Will cord blood treat myasthenia gravis? And finally, is it worth the time, effort, and money to invest in cord blood banking?
Umbilical cord blood can save lives. Cord blood is rich in stem cells that can morph into all sorts of blood cells, which can be used to treat diseases that harm the blood and immune system, such as leukemia and certain cancers, sickle-cell anemia, and some metabolic disorders. There are a few ways for transplant patients to get blood cells (umbilical and placenta, bone marrow, peripheral/circulation), but cord blood is easier to match with patients, and because it is gathered during birth from the umbilical cord, it’s a painless procedure.
Some researchers suspect that umbilical cord blood contains other cells that may have therapeutic effects beyond the blood. Specialized immune cells may be able to tweak brain function, for instance. Trials around the world are studying umbilical cord blood’s capabilities in a wide range of diseases (see Table 2 here): Cerebral palsy, autism, diabetes and lupus are currently under investigation. The cells are even being tested for an ameliorating role in Alzheimer’s disease and other neurodegenerative conditions.
The process for umbilical cord blood harvesting is straightforward: An obstetrician or doctor harvests the umbilical cord blood at the time of the baby’s birth. Timing is very important, as the umbilical cord blood must be harvested quickly so that the cells remain fresh. The harvested umbilical cord blood should preferably be at least 75 mL to make sure that there is enough cord blood and stem cells to be transplanted at a later stage.
Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells). Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood. Although not standard of care, directed cord blood banking should be encouraged when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation.
Public cord blood banking is free, but you give up your rights to the cord blood stem cells at the time of donation. Just like donating to a blood bank, this means your donation would be owned by the public cord blood bank and not by you. Your donated cord blood stem cells can be used for medical research or could possibly save a life through a transplant. Public cord blood banks release your child’s stem cells when a good match from a registry is identified.1
Of particular interest are the flexible hematopoietic stem cells important in that initial transplant. In certain cases, transplanting these cells might be able to reboot a person’s body and get rid of a disease-related defect. Cord blood transplants are similar to bone marrow transplants. A person with leukemia, for instance, might have his own cancerous blood cells wiped out with chemotherapy and radiation. Healthy, non-cancerous stem cells from a donor can then repopulate the blood.
Blood naturally starts to clot when its outside the body. An anticoagulant is used to help prevent the cord blood from clotting while it is in transit to the laboratory for processing. CBR deliberately chose to use lyophilized (dry) heparin as the anticoagulant because of some potential advantages, including:
Proponents of cord blood banking are convinced that instead of being medical waste, the fetal cells within are biological gold. In this post, and the two that follow, I’ll take a look at the evidence for those claims, and sort through some of the questions that arise as parents consider whether to bank their baby’s cord blood.
5. Alzheimer’s disease. Likewise, embryonic stem cells may come in handy against Alzheimer’s disease, a progressive and deadly disorder that degrades and kills brain cells, leading to memory loss, cognitive decline, and behavioral problems. Stem cells may give rise to new treatments or even, some say, a cure; other experts have expressed skepticism.
Family Cord, located in Los Angeles, has a high-quality lab, a top rating from the Better Business Bureau, and accreditation from AABB; it’s also been in business since 1997. Family Cord is one of the few banks that will also cover the cost of cord blood banking for the first year (there’s an annual fee after the first year) in cases where a baby has a sick sibling or another family member who could benefit from the cord blood.
One of the factors that influence engraftment time is cell dose (Gunning, 2007). Cell dose is directly related to the volume of umbilical cord blood collected. Cell dose refers to the amount of useful stem cells in the sample of blood. Because of the limited volume of cells collected from cord blood, the amount of stem cells in cord blood is approximately 10% less than the amount obtained from bone marrow (Moise, 2005). A single unit of umbilical cord blood usually contains 50 to 200 ml of blood (Gonzalez-Ryan et al., 2000). If an amount of cord blood is less than this minimum volume, the unit is discarded as being unsatisfactory because the cell dose of the sample would not be high enough. Collecting an insufficient volume of cord blood occurs in about 50% or more cases of cord blood collection (Drew, 2005). In general, fewer stem cells are needed for cord blood transplantation, and usually a volume of 50 to 100 ml of cord blood will provide enough of a cell dose for a child or small adult. However, should the recipient need additional stem cells, it is impossible to obtain more stem cells from the infant because the cord blood volume is a limited amount (Percer, 2009).
Hard numbers are tricky to pin down, but between that first transplant in 1988 and 2015, an estimated 35,000 umbilical cord blood transplants had been performed globally. That number includes people treated for leukemia and other types of cancer, blood disorders and immune diseases. And the utility of umbilical cord cells may stretch well beyond the disorders that the cells are currently being used for. “If you read the literature, it’s pretty exciting,” says pediatrician and immunologist William Shearer of Baylor College of Medicine and Texas Children’s Hospital.
Anthony’s doctors found a match for him through the New York Blood Center’s National Cord Blood Program, a public cord blood bank. Unlike private banks, public banks do not charge to collect cord blood, they charge a patients insurance company when cells are used. And once it is entered in the public system, the blood is available to anyone who needs it.
* Disclaimer: Banking cord blood does not guarantee that treatment will work and only a doctor can determine when it can be used. Cord tissue stem cells are not approved for use in treatment, but research is ongoing.
Umbilical cord blood stem cells are different from embryonic stem cells. Umbilical cord blood stem cells are collected by your ob-gyn or a nurse from the umbilical cord after you give birth (but before your placenta is delivered). Embryonic stem cells are collected when a human embryo is destroyed.
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.
Publicly banking your baby’s cord blood is a wonderful gift. Unfortunately, however, your chance of donating your baby’s cord blood is very low due to the regional and financial constraints of public cord blood banks. It is estimated that cord blood from less than 3% of all U.S. births can be collected and stored by the public banks. We support any efforts to increase the resources available for public banking.
Private (commercial) cord banks will store the donated blood for use by the donor and family members only. They can be expensive. These banks charge a fee for processing and an annual fee for storage.
Jaing TH, Hung IJ, Yang CP, Chen SH, Sun CF, Chow R. Rapid and complete donor chimerism after unrelated mismatched cord blood transplantation in 5 children with beta-thalassemia major. Biol Blood Marrow Transplant.2005;11 :349– 353
Specializing in health and medicine, Sandra Gordon has written extensively about cord blood banking for national and regional parenting magazines. She also has written about baby products, including breast pumps, for national and regional parenting magazines, blogs and books. Her work has appeared in hundreds of publications, including Parents, Prevention, Woman’s Day and Self. Gordon also appears on TV as a baby safety and money-saving expert. She is also the author of 10 books and the founder of babyproductsmom.com, a site dedicated to helping new parents gear up safely and within their budget.
Families with a history of diseases can greatly benefit from cord blood banking, as an insurance policy against possible future diseases. However, cord blood banking is expensive, can’t be used to treat everything, and your child may not even need it—at private cord blood banks, most is eventually discarded. Lastly, you should be aware that if the child develops certain genetic diseases, the cord blood will have the same genetic flaws.
Harvesting and banking cord blood is a fairly simple procedure that can be performed during vaginal or cesarian deliveries without interrupting the birth process. The doctor or nurse will collect the cord blood after the umbilical cord has been clamped. The collection of cord blood is not painful, intrusive or risky to the mother or baby.
“Processing” refers to separating the important components of the whole cord blood before cryopreservation. There are many methods used to process cord blood that can achieve the same goal: storing the important cells for potential future use. However, it’s important to point out some differences between methods:
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Umbilical cord blood stem cells are different from other kinds of cells in a couple of different ways. The first is that umbilical cord blood stem cells are unspecialized cells, which have the ability to renew themselves by cell division, even after significant time has elapsed since they were frozen. The second reason is that in certain situations, and under exacting conditions, the umbilical cord stem cells can become tissue- or organ-specific cells, allowing regeneration of those tissues.
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).
Osteopetrosis is a genetic disease, so this means that doctors could use a sibling’s cord blood cells to treat Anthony, but they cannot use his own cells because the disease is in every cell in his body. In fact, a majority of the diseases listed in private banking firms’ marketing material as treatable with stem cells are genetic diseases.
CorCell has almost 20 years of experience banking cord blood, cord tissue and DNA. The company is one of the first licensed private cord blood programs in the United States and has its own AABB-accredited laboratory.