Umbilical Cord Blood Banking

Umbilical Cord Blood Banking

 

Definition

Umbilical cord blood banking is the practice of preserving for future use fetal blood that remains in the umbilical cord at the time of birth.

Purpose

During pregnancy, a developing fetus is attached to its mother's placenta by the umbilical cord. At birth, this cord is cut, and the placenta is expelled from the mother. Some fetal blood remains in the umbilical cord. Normally, this blood, along with the cord and the placenta, are simply disposed of. However, now there are ways to freeze the cord blood for future use.
Umbilical cord blood is special because it contains a lot of cells called hematopoietic stem cells. A stem cell is an unspecialized master cell that can develop into several different kinds of specialized cells. Hematopoietic stem cells normally develop into red blood cells that carry oxygen, white blood cells that fight infection, and platelets that help make blood clot. These hematopoietic stem cells are not the same as embryonic stem cells that are at the center political and ethical debate about their use in research. Their collection does not harm either the mother or the baby.
There are two other sources of hematopoietic stem cells—bone marrow and peripheral blood. Bone marrow is the spongy material inside bones that is the source for new blood cells produced throughout an individual's life. Peripheral blood is the blood that circulates through the body.
All cells have a protein profile that identifies them. When a foreign cell enters the body, immune system cells recognize the protein profile as foreign and attack the cell. The advantage of umbilical cord stem cells that they are more immature and have a less well developed protein profile than bone marrow or peripheral stem cells. As a result, they draw a weaker response from the body's immune system.
The protein profile of human cells is called the human leukocyte antigen (HLA) profile. Normally for transplanted cells such as bone marrow cells to be accepted, there must be a close to perfect match between the HLA profile of the donor and the recipient. Since there are over 10,000 HLA types, finding an exact match can be difficult. Because umbilical cord blood cells have a less well developed HLA profile, they do not have to match the recipient's HLA as closely to be accepted by the immune system of the transplant recipient.

Types of cord blood banks

There are two types of umbilical cord blood banks—private and public. Private blood cord banks can be for-profit or not-for-profit. They sell kits that can be used at any delivery to collect cord blood. They also charge a yearly fee to store the blood. The cord blood is available only to the child or members of the child's family from which it came. It is a perfect HLA match to child's blood. When a transplant is done using cells that came from the individual who needs the transplant, it is called an autologous transplant. Autologous transplants have a high rate of success.
Public cord banks do not charge a fee to collect or store cord blood. Parents of newborns donate the cord blood, and it is then available to anyone who needs it and is an appropriate match. This type of transplant where the recipient is not the same as the donor is called an allogeneic transplant. Much of the success of allogeneic transplants depends on finding a good HLA match. Because of funding considerations, there are a limited number of public cord blood banks. To donate to a public blood cord bank, the mother must give birth in a facility associated with a public blood cord bank.

How cord blood is used

The first successful umbilical cord stem cell transplantation occurred in 1988, when a newborn girl donated cord blood to cure her brother of Fanconi's anemia, a genetic defect. Many other blood diseases can now be treated successfully with cord stem cell transplants. These same diseases can be treated with bone marrow transplant if an appropriately matched donor can be found. In addition, research is ongoing in the hope that cord blood stem cells can be induced into differentiating into other types of cells, such as nerve cells that can be used to treat other diseases.
Some diseases treated with blood stem cell transplant include:
  • acute lymphatic leukemia
  • acute myelogenous leukemia
  • chronic myelogenous leukemia
  • Hodgkin disease
  • Non-Hodgkin lymphoma
  • neuroblastoma
  • severe combined immune deficiency
  • anapalstic anemia
  • thalassemia
  • sickle cell anemia
  • Fanconi's anemia
In addition to being more readily accepted by the donor's body, cord blood offers other advantages over bone marrow transplantation. It is relatively quick and easy to thaw the cord blood and infuse it, while bone marrow harvesting is an invasive procedure with risks to the donor. In addition, cord blood is less likely to be contaminated with viruses that may create complications for the recipient.

Considerations in deciding to bank cord blood

Although the list of diseases treated with umbilical cord stem cells is impressive and growing, controversy exists about whether parents should pay private cord cell banks to preserve their newborn's blood. Private cord cell banks sell their services as a type of "insurance." In case the child develops a treatable disease, the child's own stem cells will be a perfect match. However, if the disease is caused by a genetic defect, (e.g., sickle cell and other anemias) the child's own stem cells will be useless, because they will contain the same genetic defect. In addition, the quantity of cord blood that can be collected is only enough to treat a child. Although research is being done to try to multiply cord cells in the laboratory in quantities great enough to treat an adult, results have not been successful. Therefore, if an adult develops a treatable disease, even if his own cord blood was banked, the quantity will be insufficient to produce a cure. Also, cord blood storage is a new enough technology, that it is not clear how long the blood can remain frozen and still be effective.
In the most recent statement on cord blood banking released by the American Academy of Pediatrics in 1999, they concluded:
  • There are no good estimates of how often a child will need a transplant of his own cells. Estimates range from 1 in 1,000 to 1 in 200,000
  • Certain genetic disorders are not cured by autologous transplants
  • Parents should be encouraged to donate their child's cord blood to free public cord blood banks for the widest possible use rather than paying private companies to store cord blood
The American College of Obstetricians and Gynecologists supports the position that parents should not be sold private blood cord banking without a realistic assessment of their need, nor should parents feel guilty if they are not eager or able to meet the annual expense associated with private storage. Although cord blood collection is safe, unless there is a family history of diseases for which hematopoietic stem cells are helpful, most pediatricians and obstetricians feel private cord blood storage is an unnecessary expense.

Precautions

Umbilical cord blood collection is usually not done in the case of multiple births.

Description

Cord blood collection is a simple procedure that takes between three and seven minutes. It is done immediately after the baby is delivered. Cord blood is drained into a standard blood bag, and then processed and frozen at very low temperatures.

Preparation

Parents who wish to bank their child's cord blood must plan ahead. Private storage requires ordering a kit in advance and coordinating with the health care providers doing the delivery to make sure the cord blood is collected properly. Mothers must test negative for infectious diseases such as HIV and hepatitis before delivery. Donation to a public cord blood bank is not always possible because of their limited number and location.

Aftercare

No special aftercare is required for mother or child, but the cord blood must remain frozen at low temperatures.

Risks

The main risk associated with umbilical cord blood collection is the possibility that it will become contaminated with bacteria during collection.

Key terms

Allogeneic — A transplant where the donated material comes from different (although often related) individual than the recipient
Autologous — A transplant where the material for the transplant comes from the individual who is also the recipient; thus, the transplant material is genetically identical to the donor's body.
Hematopoietic stem cell — A cell that can develop into any type of specialized blood cell.
Parents who are interested in private cord blood storage should research the company with which they contract, just as they would in making any business decision. They need to know the costs, whether the annual fee can increase, and what will happen to the blood if the company goes out of business.

Resources

Periodicals

Chao, Nelson J, Stephen G. Emerson, and Kenneth I. Weinberg "Stem Cell Transplantation (Cord Blood Transplantation)" Hematology 2004 no. 1 pp. 354-371. [cited 1 March 2005].
Oh, Weltham et at. "Cord Blood Banking for Potential Future Transplantation: Subject Review" Pediatrics 104 no. 1 (July 1999) pp. 116-118 [cited 16 February 2005].

Organization

Leukemia and Lymphoma Society. 1311 Mamaroneck Avenue, White Plains, New York 10605. 914-949-6691. http://www.LLS.org.

Other

Coale, Kristi. "Can the Umbilical Cord Save Lives?" WebMD, 26 June 2000 [cited 16 February 2005]. 〈http://www.leukemia-lymphoma.org/all_mat_toc.adp?item_id=9622gt;.
Eflom-Ekaha, Daniel and Arunbhai G. Patel. Hematopoietic Stem Cell Transplantation, 13 October 2004 [cited 5 March 2005]. http://www.emedicine.com/med/topic3387.htm.
"Cord Blood Stem Cell Transplantation" Leukemia and Lymphoma Society, [cited 1 March 2005]. http://my.webmd.com/content/Article/13/1691_50298.htm>.
Moran, Mark. "Banking on Umbilical Cord Blood," WebMD, 2001 [cited 16 February 2005]. kidshealth.org/parent/pregnancy_newborn/pregnancy/cord_blood.html.
Nemours Foundation. "Banking Your Newborn's Cord Blood," KidsHealth, June 2004 [cited 16 February 2005]. http://my.webmd.com/content/Article/14/3606_537.htm.
"Patient Fact Sheet on Umbilical Cord Blood Transplantation" National Marrow Donor Program, 17 February 2005 [cited 1 March 2005]. 〈http://www.marrow.org/PATIENT/patient_fact_sheet_umbilical_cord_blood_transplantation.htm〉.
References in periodicals archive ?
Kurtzberg is considered the world's leading expert in pediatric hematology/oncology, pediatric blood and marrow transplantation, umbilical cord blood banking and transplantation, and novel applications of cord blood.
If a patient requests information on umbilical cord blood banking, physicians should provide "balanced and accurate" information that explains the pros and cons of public versus private banking, according to the American College of Obstetricians and Gynecologists.
Also, with the addition of umbilical cord blood banking to the services available through the agency, the program said it has to position itself as offering more than stem cells collected from bone marrow only.
Lorraine Sheremeta & Suzanne DeBow, "Public Meets Private: Challenges for Informed Consent and Umbilical Cord Blood Banking in Canada" DNA Sampling Conference, Montreal PQ, June 4-7, 2006 (poster presentation).
Of the 245 responses analysed, 95% were in support of umbilical cord blood banking for future transplantation.
From an historical perspective, PharmaStem initiated patent litigation against CRYO-CELL and other umbilical cord blood banking firms in February 2002.
With umbilical cord blood banking, families can store the blood--for a price--for their own use, donate it, or choose neither.
In accordance with the Umbilical Cord Blood Banking Education and Donation Act (Pennsylvania) and the Umbilical Cord Blood Donation Act (Illinois), there is no charge to the donor from the Bank, Hospital or Physician, nor is there payment.
LifeSource Cryobank is the first private company in the United States to offer both umbilical cord blood banking and adult bone marrow stem cell storage for therapeutic uses in either reparative or regenerative medicine.
About China Cord Blood Corporation China Cord Blood Corporation is the first and largest umbilical cord blood banking operator in China in terms of geographical coverage and the only cord blood banking operator with multiple licenses.
Cord Blood Registry (CBR), the global leader in umbilical cord blood banking, announced today that the company achieved a record number of client enrollments for the quarter ended September 30, 2008, achieving a 33 percent increase year-over-year.
and Rahal Letterman Lanigan Racing (RLL) will work to support awareness of umbilical cord blood banking and its educational initiative 'Stars for Stem Cells'.