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Initially, cord blood stem cell transplantation using allogeneic umbilical cord blood was performed in relatively small children, because the cell dose per weight of recipient was shown to be important.19,20 However, older children, adolescents, and adults have benefited from unrelated allogeneic umbilical cord blood transplantation.34,55–61 Because of the relationship between cell dose per recipient weight and transplant outcome, the number of cord blood cells needed for marrow reconstitution in older children or young adults is much larger than that needed when cord blood is used for transplantation in small children. Cord blood transplants using multiple cryopreserved units from separate donors have been performed successfully in adults, and the approach is currently under investigation as a strategy to increase the dose of cells for transplantation in a single recipient.62 Cord blood is collected in observance of good obstetric and pediatric practice.45
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.
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.
RENECE WALLER-WISE is a licensed clinical nurse specialist and childbirth educator at Southeast Alabama Medical Center in Dothan, Alabama. She is also an adjunct faculty member at Troy University in Troy, Alabama.
Cord tissue is rich in another type of stem cell. Although there are no current uses, researchers are excited about the benefits cord tissue stem cells may offer in potential future users, such as regenerative medicine. By storing both, you’ll have potential access to more possibilities
Accurate information about the potential benefits and limitations of allogeneic and autologous cord blood banking and transplantation should be provided. Parents should be informed that autologous cord blood would not be used as a stem cell source if the donor developed leukemia later in life. Parents should recognize that there are no scientific data to support the claim that autologous cord blood is a tissue source proven to be of value for regenerative medical purposes. The current standard uses of cord blood transplantation are listed in Table 1.
Because there are no scientific data at the present time to support autologous cord blood banking and given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as “biological insurance” should be discouraged. Cord blood banks should comply with national accreditation standards developed by the Foundation for the Accreditation of Cellular Therapy (FACT), the US Food and Drug Administration (FDA), the Federal Trade Commission, and similar state agencies. At a minimum, physicians involved in procurement of cord blood should be aware of cord blood collection, processing, and storage procedures as shown in Table 2.
Parents have the option to privately store their newborn’s cord blood stem cells. There are now over a dozen private cord blood banks, and more open every year. Some have their own labs, while others contract with a lab. Cord blood stem cell banking is not a regulated industry; there are no certifications or licensing requirements to open a cord blood bank. Several banks are accredited by the American Association of Blood Banks. Please keep in mind there is a big difference between being accredited by the AABB and being a member of the AABB. To be accredited, the lab must follow strict standards and be inspected by the association.
The blood within your newborn baby’s umbilical cord contains young stem cells that can renew themselves and become specialized. These cord blood stem cells have been proven in treatment to help children replace damaged blood cells with healthy ones and strengthen their immune systems. Cord blood banking is the process of collecting and storing these stem cells for potential medical use.
Myers LA, Hershfield MS, Neale WT, Escolar M, Kurtzberg J. Purine nucleoside phosphorylase deficiency (PNP-def) presenting with lymphopenia and developmental delay: successful correction with umbilical cord blood transplantation. J Pediatr.2004;145 :710– 712
Cord tissue use is still in early research stages, and there is no guarantee that treatments using cord tissue will be available in the future. Cord tissue is stored whole. Additional processing prior to use will be required to extract and prepare any of the multiple cell types from cryopreserved cord tissue. Cbr Systems, Inc.’s activities for New York State residents are limited to collection of umbilical cord tissue and long-term storage of umbilical cord–derived stem cells. Cbr Systems, Inc.’s possession of a New York State license for such collection and long-term storage does not indicate approval or endorsement of possible future uses or future suitability of these cells.
Four main types of physical conditions are treated with stem cell transplants: cancers, blood disorders, congenital metabolic disorders, and immunodeficiencies (see Table 1). Examples of cancers that are treated with stem cells are both lymphoma and leukemia. Nonmalignant hemologic disorders also account for a fair share of the recipients of stem cells. Examples of these blood disorders are various types of anemias, such as sickle-cell anemia and Fanconi’s anemia (the first disorder treated with umbilical cord blood stem cells). Stem cells have also been used to treat various metabolic disorders, such as adrenoleukodystrophy. The fourth major category of uses for stem cells is in treating immunodeficiencies, such as Duncan’s disease or adenosine deaminase deficiency (Drew, 2005; Moise, 2005).
If the doubts of the AAP, weren’t enough to turn you off cord banking, the cost is enormous. At Viacord, (see ad on left) the price begins at $1550 at birth, plus $150 for a courier to deliver the blood, plus $95 dollars for storage a year. At these prices, that will cost you $2840 by the time your baby is 21.
Banking a baby’s blood and stem cells in a cord blood bank is a type of insurance. Ideally, you would not need to access your baby’s stem cells in order to address a medical concern. However, using a cord blood bank can provide peace of mind in knowing that you have a valuable resource if you need it.
Prior to freezing the cells, samples are taken for quality testing. Banks measure the number of cells that are positive for the CD34 marker, a protein that is used to estimate the number of blood-forming stem cells present. Typical cost, $150 to $200 per unit. They also measure the number of nucleated cells, another measure of stem cells, both before and after processing to determine the cell recovery rate. Typical expense, $35 per unit. A portion of the sample is submitted to check that there is no bacterial or fungal contamination. Typical expense, $75 per unit. Public banks will also check the ability of the sample to grow new cells by taking a culture called the CFU assay. Typical expense, $200 to $250 per unit.
Choosing a bank (specifically a private bank) for her daughter’s cord blood made perfect sense to Julie Lehrman, a mom based in Chicago. “We wanted the extra assurance that we were doing everything we could to keep Lexi healthy,” Lehrman says. “I was older when Lexi was born, and there’s a lot we didn’t know about my mom’s health history, so we felt that we were making a smart decision.” Fortunately, Lexi was born healthy, and neither she nor anyone else in the family has needed the cord blood since it was stored seven years ago. But Lehrman has no regrets; she still feels the family made a wise investment. “Lexi or her brother or even one of us could still need that blood in the future, so I’m thankful that we have it.” But banking your child’s cord blood may not be the right decision for you. Read on to see if you should opt for private cord blood banking.
When parents donate cord blood to a public bank, they are supporting patients around the world who are searching for an unrelated Allogeneic donor. When parents save cord blood in a family bank, they are reserving the options that the baby can use its own stem cells for an Autologous treatment, or an immediate relative (sibling or parents) can use the stem cells for an Allogeneic treatment.
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.
Karanes C, Confer D, Walker T, Askren A, Keller C. Unrelated donor stem cell transplantation: the role of the National Marrow Donor Program. Oncology (Williston Park).2003;17 :1036– 1068, 1043–104, 1164–1167
Properly preserved cord blood is long-lasting. Cord blood is stored in a nitrogen freezer (the same technology used to freeze donated sperm), so it can last for a long time. “The scientist who first developed cord blood preservation methods in 1990 has confirmed that some of the first specimens he stored 23 plus years ago are just as potent as fresh cord blood,” says Mary Halet, Director, Central Region at Be The Match, which is operated by the National Bone Marrow Foundation.
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.
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?
Kasamon YL, Jones RJ, Piantadosi S, et al. High-dose therapy and blood or marrow transplantation for non-Hodgkin lymphoma with central nervous system involvement. Biol Blood Marrow Transplant.2005;11 :93– 100
Well, this is how the entire procedure of cord blood banking. Right after the blood is extracted, it is sent for to the bank. In the bank, the cord blood is checked, tested, processed and finally preserved. This preservation is ensured by controlled freezing under high end freezing conditions. Certain private banks collect a certain segment of the umbilical cord along with the cord blood. The umbilical cord tissue contains various stem cells that are quite different from the general cord blood cells. Research experts are studying in order to understand the possible use of the stem cells in medicine.
The next step at either a public or family bank is to process the cord blood to separate the blood component holding stem cells. The final product has a volume of 25 milliliters and includes a cryoprotectant which prevents the cells from bursting when frozen. Typical cost, $250 to $300 per unit.
Let’s look back at the expectant couple in my childbirth class who asked about banking their infant’s umbilical cord blood. They should not base their decision to bank the umbilical cord blood on the type of anticoagulant used to preserve the sample; likewise, they should not obtain all of their information on cord blood banking from the private cord blood bank, whose major agenda is to gain another client. Instead, they must be encouraged to research various resources for reliable information (see Table 4). If they have evidence that stem cells are used currently to treat a specific disease process that is affecting a family member, and is not simply a proposed idea, then it might be in their best interest to privately bank the umbilical cord blood. However, they should be aware that simply banking the cord blood does not ensure a cure, and they would most likely be banking the blood not for the current baby, but for some other family member. They must also be aware of the cost involved in the banking process. Finally, if they do not have a relative with a disease process treated with stem cells or there is no evidence that stem cells are used to treat the diseases that are known to be in their family, then they should consider public banking of the umbilical cord blood (if they have access to a public cord blood bank).
Please tell us a little about yourself. A Newborn Stem Cell Educator may call to discuss your options and answer any questions you may have. You may also receive additional information about saving or donating newborn stem cells.
FACT accredited: Cord blood companies that are FACT accredited have been evaluated by the Foundation for the Accreditation of Cellular Therapy, and they’re found to have met the foundation’s standards of operation.
Lamaze International has created a continuing education home study based on this article. Visit the Lamaze Web site (www.lamaze.org) for detailed instructions regarding completion and submission of this home study module for Lamaze contact hours.
Check if the cord blood bank you’re considering is accredited with the American Association of Blood Banks (AABB). AABB is an international, not-for-profit organization that has been setting standards for both public and private cord blood banking companies for over 20 years. LifebankUSA is registered with the FDA and accredited by AABB. Click here for a list of AABB-accredited cord blood banking companies in the U.S. and around the world.
8. Arthritis. Also called degenerative joint disease, osteoarthritis—the most common form of arthritis—results when protective cartilage in joints wastes away. Once it’s gone, it’s gone for good. Stem cells could change that. Scientists are examining how best to use them to rebuild lost cartilage and repair shot joints.
Cord blood banking can be complex & difficult to research. To help consumers get started, our editors have spent over 200 hours reviewing the best cord blood registries & making this year’s selections of best all-around providers.
Cord blood banking is not always cheap. It’s completely free to donate blood to a public cord blood bank, but private banks charge $1,400 to $2,300 for collecting, testing, and registering, plus an annual $95 to $125 storing fee.
Additional ethical concerns about umbilical cord blood banking involve the timing of clamping the umbilical cord after birth. Overall, the issue of when to clamp and cut the umbilical cord is controversial. There is no consensus on how early or how late in the birthing process the umbilical cord ought to be clamped and cut, although the cord obviously still provides nourishment and removes waste until it is clamped or spontaneously stops pulsing (Lothian & DeVries, 2010). However, some practitioners might clamp the umbilical cord early in an effort to maximize the amount of cord blood obtained for banking, and thus “short change” the child and allow the infant to become anemic (Drew, 2005).
Nagatoshi Y, Kawano Y, Okamura J. Comparison of the outcomes of allogeneic bone marrow transplantation from partially mismatched related donors, matched sibling donors, and matched unrelated donors in Japanese pediatric patients: a single center result. Pediatr Transplant.2004;8 :260– 266
The primary benefit to cord blood banking is that it provides a type of medical insurance. This insurance is not from a financial perspective, but rather takes the form of having the necessary medical building blocks available should they be needed in the event of certain illnesses and diseases. Those medical building blocks are the stem cells found in umbilical cord blood.