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Cord blood contains stem cells that can save lives. Patients requiring a stem cell transplant will receive cells from one of three sources: bone marrow, circulating blood, or umbilical cord blood. The first two exist in all healthy adults, but cord blood can only be harvested and stored at birth
* 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.
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.
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.
Bielorai B, Trakhtenbrot L, Amariglio N, et al. Multilineage hematopoietic engraftment after allogeneic peripheral blood stem cell transplantation without conditioning in SCID patients. Bone Marrow Transplant.2004;34 :317– 320
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Most stored cord blood is discarded. At public cord blood banks, a unit of stored cord blood has a greater chance of being used to help a sick child or used toward stem cell research. Private cord blood banks, on the other hand, eventually throw away blood that a family no longer wants to store or use.
The cord blood of your baby is an abundant source of stem cells that are genetically related to your baby and your family. Stem cells are dominant cells in the way they contribute to the development of all tissues, organs, and systems in the body.
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.
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.
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 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):
Description: ViaCord, a PerkinElmer company, is an industry leading Cord Blood Collection and Storage company that was established in 1993. Over the years ViaCord has added services such as Cord Tissue collection & storage, and newborn genetic screening.
7. Lung diseases. From human embryonic stem cells, researchers in Texas have created transplantable sources of lung cells in the lab. Those lung cells could potentially be used to repair damage brought on by a variety of pulmonary conditions or by lung trauma resulting from a car accident, bullet wound, or sports injury. Unpublished studies using such cells have shown promise for tissue repair in mice with acute lung injury, the group reports.
In order to preserve more types and quantity of umbilical cord stem cells and to maximize possible future health options, Cryo-Cell’s umbilical cord tissue service provides expectant families with the opportunity to cryogenically store their newborn’s umbilical cord tissue cells contained within substantially intact cord tissue. Should umbilical cord tissue cells be considered for potential utilization in a future therapeutic application, further laboratory processing may be necessary. Regarding umbilical cord tissue, all private blood banks’ activities for New York State residents are limited to collection, processing, and long-term storage of umbilical cord tissue stem cells. The possession of a New York State license for such collection, processing and long-term storage does not indicate approval or endorsement of possible future uses or future suitability of these cells.
Refer-a-friend program: The New England Cord Blood Bank gives families $100 for each friend they refer to the company, so customers have further incentive to choose the company for storage and processing.
Frances Verter, PhD, founded the Parent’s Guide to Cord Blood in 1998 and has been a Scientific Advisor to Community Blood Services since 2007. In 2011 the NMDP presented her with their Lifeline Award in recognition of her efforts to improve public education about cord blood donation.
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?
It depends on who you ask. Although commercial cord blood banks often bill their services as “biological insurance” against future diseases, the blood doesn’t often get used. One study says the chance that a child will use their cord blood over their lifetime is between 1 in 400 and 1 in 200,000.
You’ve just visited the doctor and the good news is that you’re going to have a baby and everything looks good. Thirty years ago, your doctor may have given you a baby book and information about products that sponsors want you to buy for your new addition. Today, along with pretty much the same materials, you’ll be asked to consider saving the blood of your newborn that’s left over in the umbilical cord and placenta after the delivery. Another big decision, and possibly a costly one.
When you consider that public banks can only expect to ship 1-2% of their inventory for transplant, you can quickly understand why most public banks are struggling to make ends meet. That struggle means that fewer collection programs are staffed, and there are fewer opportunities for parents to donate to the public good. We said earlier that public banks only keep cord blood donations over a minimum of 900 million cells, but today most public banks have raised that threshold to 1.5 billion cells. The reason is that the largest units are the ones most likely to be used for transplants that bring income to the bank. Family cord blood banks do not need to impose volume thresholds because they have a profit margin on every unit banked.
Tracey said she felt lucky since she banked Anthony’s cord blood with a private company. And Osteopetrosis is one of 80 diseases listed by many cord blood companies in their marketing material as treatable with stem cells.
Umbilical cord blood transplants are now used to treat numerous types of immune- and blood-related disorders and genetic diseases. Cord blood (CB) banks play an important role in these transplants by processing and storing CB units. In addition to their therapeutic potential, these banks raise ethical and regulatory questions, especially in emerging markets in the Arab world. In this article, the authors review CB banking in five countries in the region, Jordan, Saudi Arabia, Egypt, Qatar, and the United Arab Emirates, selected for their different CB banking policies and initiatives. In assessing these case studies, the authors present regional trends and issues, including religious perspectives, policies, and demographic risk factors. This research suggests strong incentives for increasing the number of CB units that are collected from and available to Arab populations. In addition, the deficit in knowledge concerning public opinion and awareness in the region should be addressed to ensure educated decision-making.
There are two main types of cord blood banks: public and private. Public cord blood banks are usually nonprofit companies that store your donated cord blood for free, to be used for any sick child in another family or for research purposes, so accessing and using your own cord blood is not guaranteed. Private cord blood banks are companies that require a registration fee (plus annual storage fees) for your cord blood, but it is saved specifically for your own family, so you’ll have ready access to it.
The American Academy of Pediatrics (AAP, 2007) states that the use of banked umbilical cord blood as “biologic insurance” is unwarranted. The AAP also notes that many of the claims of private cord blood banks are unfounded. Unlike ACOG, the AAP recommends cord blood collection and banking for all families; however, their distinction is that all cord blood should be banked in public banks for use by the general population. In one study, the researchers reported that when pediatric transplant specialists were surveyed, overall, they did not recommend private cord blood banking (Thornley et al., 2009). The AAP recommends private cord blood banking only if a full sibling has a medical diagnosis for which stem cells are currently being used for treatment.
Cord blood transplantation has been shown to be curative in patients with a variety of serious diseases. Physicians should be familiar with the rationale for cord blood banking and with the types of cord blood–banking programs available. Physicians consulted by prospective parents about cord blood banking can provide the following information: