Blood & Bone Marrow Transplant

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Cord-Blood Banking

When you're expecting, you have many decisions to make. So if you've heard about banking umbilical cord blood, you might be wondering what it involves — and whether it's right for you and your family.

About Cord-Blood Banking

Cord-blood banking basically means collecting and storing the blood from within the umbilical cord (the part of the placenta that delivers nutrients to a fetus) after a baby is born.

Cord blood contains blood-forming stem cells, which are potentially useful for treating diseases that require stem cell transplants (also called bone marrow transplants), such as certain kinds of leukemia or lymphoma, aplastic anemia, severe sickle cell disease, and severe combined immunodeficiency.

 

There are two types of banks that store cord blood:

  1. Public banks collect donated cord blood for research or for use by anyone who may need it. There is usually no charge associated with this service. After birth, blood is collected, anonymously marked, and sent to a public bank to potentially save the life of another child one day.

    If you choose this option and your child or a family member later develops a disease that requires a stem cell transplant for treatment, you won't be able to obtain the donation you made to the bank.
  2. Private banks store cord blood for personal use by the family. There is a fee associated with this service. People who have a family history of disease that can be treated with stem cell transplants sometimes consider this option.

    Less commonly, people choose to privately bank their newborn's cord blood on the off chance that someday their child or a sick family member could be treated with it. This practice isn't recommended, however, since the costs associated with it are high and the chances of a family member ever using the cord blood are slim.

Like community or hospital blood banks, cord-blood banks are regulated by the U.S. Food and Drug Administration (FDA), which has developed standards regulating future cord-blood collection and storage.

Why Cord Blood Is Important

Up until the 1970s, the placenta and umbilical cord were discarded after birth without a second thought. But around this time, researchers discovered that umbilical cord blood could supply the same kinds of blood-forming (hematopoietic) stem cells as a bone marrow donor. They started collecting and storing umbilical cord blood.

What are blood-forming stem cells? These are primitive (early) cells found primarily in the bone marrow that are capable of developing into the three types of mature blood cells present in our blood — red blood cells, white blood cells, and platelets. cord-blood stem cells may also have the potential to give rise to other cell types in the body.

Some serious illnesses (such as certain childhood cancers, blood diseases, and immune system disorders) require radiation and chemotherapy treatments to kill diseased cells in the body. Unfortunately, these treatments also kill many "good" cells along with the bad, including healthy stem cells that live in the bone marrow.

When this happens, some kids can benefit from a stem cell transplant, from a donor whose cells closely match their own. Blood-forming stem cells from the donor are transplanted into the child who is ill, and those cells go on to manufacture new, healthy blood cells and enhance the child's blood-producing and immune system capability.

How Banking Works

Collection

Cord-blood banking isn't routine in hospital or home deliveries. It's a procedure you have to choose and plan for beforehand.

Collection of the cord blood takes place shortly after birth in both vaginal and cesarean (C-section) deliveries. It's done using a specific kit that parents usually order ahead of time from their chosen cord-blood bank.

Blood is collected immediately after delivery by an obstetrician, nurse, or technician. After birth, the umbilical cord is cut and clamped on one side. To collect blood, a small needle is passed into the umbilical vein and a syringe is used to draw blood. 

Blood also can be collected by hanging a bag below the mother and letting gravity draw the blood down through a tube and into the bag. Blood collection can occur either before or after the placenta is delivered.

Storing

After collection, the cord blood is taken by courier to the cord-blood bank. Once there, the sample is given an identifying number. Then the stem cells are separated from the rest of the blood and are stored cryogenically (frozen in liquid nitrogen).

How long can blood-forming stem cells last when properly stored? In theory, stem cells should last forever, but cord-blood research only began in the 1970s, so the maximum time for storage and potential usage are still being determined. Blood-forming stem cells that have been stored for more than a decade have been used successfully in transplants.

There is no cost involved when donating cord blood to a public bank, though some doctors or midwives may charge a small fee to collect the blood. The cost for storing cord blood privately is approximately $1,000-$2,000, in addition to a yearly maintenance fee (usually around $100). You also might pay an additional fee of several hundred dollars for the cord-blood collection kit, courier service to the cord-blood bank, and initial processing.

Transplantation

Cryogenic blood-forming stem cells can be thawed and used in either autologous procedures (when someone receives his or her own umbilical cord blood in a transplant) or allogeneic procedures (when a person receives umbilical cord blood donated from someone else — a sibling, close relative, or anonymous donor).

In most cases, these transplants are done only with children or young adults. That's because the volume of a cord-blood donation usually isn't enough for an adult's transplant. The larger a person is, the more blood-forming stem cells he or she needs for a successful transplant.

Private Banking Not Widely Recommended

Most medical organizations, including the American Academy of Pediatrics (AAP), recommend public donation of cord blood whenever possible.

Currently, they do not recommend privately banking your newborn's cord blood unless you have a child or family member with a current or potential need for a stem cell transplant. The reason? The likelihood of a healthy person ever needing stem cells is rare, and research has never confirmed that self-donated cells (rather than cells from a relative or stranger) make transplantations safer or more effective. 

Stem cells from cord blood from both related and unrelated donors have been successful in many transplants. That's because blood-forming stem cells taken from cord blood are naive (a medical term for early cells that are still highly adaptable and are less likely to be rejected by the recipient's immune system). Therefore, donor cord-blood stem cells do not need to be a perfect match to create a successful stem cell transplant.

There has been little experience with transplanting self-donated cells. Some experts are concerned that an ill baby who receives his or her own stem cells during a transplant would be prone to a repeat of the same disease. Most of the stem cell transplants that use blood-forming stem cells have been performed on relatives of the donating child, not on the donating child.

Finally, there are a few cautions to keep in mind when it comes to private banking. Some doctors and organizations express concern that private cord-blood banks may capitalize on the fears of vulnerable new parents by providing misleading information about the statistics of stem cell transplants. Parents of children of ethnic or racial minorities, adopted children, or children conceived through in vitro fertilization may be especially encouraged to bank cord blood because it's statistically harder to find a match in these cases.

Is Banking Right for You?

If you are considering banking your newborn's cord blood, be sure to discuss your options with your obstetrician.

Here are a few questions to consider before choosing a cord-blood bank:

  1. What are the pros and cons of public versus private banking?
  2. If you consider public:
    • Does the hospital where I will deliver work with a public cord-blood bank? If not, how can I get information about public banks that have a mail-in donation program?
  3. If you consider private:
    • How financially stable is the cord-blood bank? (Financial stability means a reduced chance that you will have to transfer your sample if the facility closes.)
    • How many samples are processed in the facility? (A larger number of samples usually means that there are more collection and handling procedures in place.)
    • Do I have the option of switching to another facility if I choose?
    • What happens to my sample if the facility goes out of business?
    • What are the yearly fees and maintenance costs involved? Will these fees increase, or are they fixed?

Answers to all of your questions might not be readily available. Cord-blood banking is still a relatively new medical practice. Many hospitals do not yet offer this service (or are not affiliated with a public or private bank that offers it), and some medical professionals are still not fully aware of how cord-blood banking works.

But other resources are available to help you make an informed decision, including:

  • The Parent's Guide to Cord Blood Foundation (www.parentsguidecordblood.org), which lists both public and private blood banks by geographic location
  • The National Marrow Donor Program (www.bethematch.org), with information on registered cord-blood facilities that accept donations

You also can contact your local chapter of the American Red Cross (www.redcross.org/find-your-local-chapter) or a local university hospital.

Deciding to Donate

Many doctors and researchers support saving umbilical cord blood mainly because of the promise that stem cell research holds for the future. Most of us would have little use for stem cells now, but research into using them to treat diseases is ongoing — and the future looks promising.

If you'd like to donate your child's umbilical cord blood, talk to your obstetrician or midwife or contact the hospital or birthing center where your baby will be born. It's best to start this process early in your second trimester to give yourself plenty of time to register for this service.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: November 2012