Cord Blood Banking: What You Need To Know

Article By Dr. Pranita Nirgudkar

Cord blood banking is the collection and cryopreservation of stem cells obtained from the umbilical cord at the time of childbirth. Stem cells are building blocks of our blood and immune system and have the ability to replace or repair any kind of damaged cell in the body.

Two main types of cord blood banks exist for the purpose of storing cord blood for potential future transplantation: public cord blood banks and private cord blood banks.

Let us talk about each of these types:

Public cord blood banks – Public cord blood banks collect and store cord blood units for use by any individual who has a medical indication for hematopoietic stem cell transplantation and for whom a suitably matched unit is available. These banks perform collections at a limited number of hospitals throughout the world. A mother can choose to donate her infant’s umbilical cord blood to a public cord blood bank, only if the infant is delivered at a hospital with access to such a bank. Following collection, each cord blood unit is characterized, and the parameters (e.g., HLA profile, total nucleated cell count) are placed in a public database accessible to health care providers. For a list of hospitals that participate in the public donation program, visit http://www.marrow.org/Get_Involved/Donate_Cord_Blood/How_to_Donate/Participating_Hospitals.aspx#FL

Private cord blood banks – Private cord blood banks are for-profit enterprises that facilitate the collection of cord blood for families who are willing and able to pay for such a service. Typically, families decide to bank their infant’s cord blood so that it might serve as a source of hematopoietic stem cells for the child or another member of the family, should the need arise. Private cord blood banks supply the family with a collection kit and generally depend on the mother’s obstetrician or midwife to collect the umbilical cord blood upon delivery.  The collected blood is then transported to the company’s stem cell  laboratory, where it is processed , stored and  reserved for future use by the family.  The family pays a  one-time  fee for the collection and processing of the blood and an annual fee thereafter for its storage. Cord blood units that are privately banked for potential use by the donor  have only a remote chance of being used for that  purpose. An estimated 1 in 2700 umbilical cord blood units that are collected and stored privately are eventually used by the child or a family member.  There is a 1-in 4 chance that cord blood will be a perfect match for a sibling, but cord blood is always a perfect match for the donor.

The Woman’s Group works with three private cord blood banking companies.  These are: 

• CBR              (visit http://www.cordblood.com for additional information)
• Cryo-Cell       (visit http://www.Cryo-Cell.com for additional information)
• ViaCord         (visit http://www.ViaCord.com for additional information)

For a comprehensive list of private banks please visit http://www.savethecordfoundation.org/banking-choices/private-cord-blood-banking-and-donation/

Directed cord blood banking –  Private, as well as public cord blood banks, also provide a service called directed cord blood banking for families who currently have a child or other family member with a potential  stem cell transplant-treatable disease and who are expecting another child. The programs providing such a service either facilitate or perform the cord blood collection and then process, characterize and cryopreserve the unit, which is reserved for exclusive use by the donor’s family. These collection and banking services for medically indicated families, either private or public, are most often performed free of charge.

Cord blood collection

Cord blood collection may be performed either prior to delivery of the placenta (“in utero”) or following delivery of the placenta (“ex utero”).  Regardless of the technique employed, the earlier the blood is collected, the less likely it will clot and the greater the probability of obtaining the maximum volume or blood.

Ideally, at least 40 to 60 mL of blood (in addition to the anticoagulant) should be collected. A volume below 40 mL is unlikely to contain a sufficient number of cells to be usable in transplants. Once collected, the cord blood is stored at room temperature until it is transported to the processing laboratory to preserve cell viability.  A maternal blood sample is also collected at the same time to check for the mother’s  HLA type, HIV, hepatitis B and C, HTLV I/II, RPR, West Nile virus, CMV IgG and sometimes, for Malaria and Chaga’s Disease.

Processing and preservation

After collection, cord blood units are tested, processed, and stored for future use, typically within 48 hours of collection.

Complete characterization of a cord blood unit should include the following assays:

• Unit volume and weight, total nucleated cell count with differential, as well as an assessment of the unit’s hematopoietic potential (e.g. CD34+ cell count or colony forming unit count) after processing.
• ABO/Rh blood type and human leukocyte antigen (HLA) class I (-A, -B) and class II (-DRB1) haplotypes.
• Testing for hepatitis B, hepatitis C, HIV-1 and -2, HIV p24, syphilis, cytomegalovirus, and bacterial culture.
• Hemoglobin electrophoresis to screen for the presence of a hemoglobinopathy.
• At public banks, mononuclear cells, plasma, and DNA from the cord blood unit may be stored in an aliquot separate from the main unit for future infectious and/or genetic disease testing.

Shelf-life of units

It is not known how long umbilical cord blood cells remain viable when stored. However, other stem cell sources have been stored for many years and retained viability and engraftment potential.

What expectant parents need to know:

• Given the current uncertainties of this technology, the American Academy of Pediatrics does not recommend that parents routinely store their infant’s umbilical cord blood for future use, unless there is an immediate medically indicated use for a sibling.
• The American College of Obstetricians and Gynecologists states that patients who request information on umbilical cord blood banking should be provided with “balanced and accurate information regarding the advantages and disadvantages of public versus private banking and be informed of the approximately 1 in 2700 chance that an autologous unit of umbilical cord blood will be used for a child or family member.
• Parents should be aware that autologous cord blood cannot be selected if the donor child develops leukemia, as the cord blood will have genetic markers of leukemia.
• The indications for cord blood transplant are limited to certain genetic, hematologic, and malignant disorders. (A complete list is provided in http://www.nmdp.org
• Routine storage of umbilical cord blood as “biologic insurance” against future disease is not recommended.
• Cord blood banked by families is much more likely to be used by the donors’ siblings than by the donors.
•  Private storage of umbilical cord blood should be considered if there is a family member with a current or probable future need for transplantation.

If, despite the above information,  parents decide to proceed with cord blood banking through a private agency, it is wise for them to thoroughly investigate available companies.  At a minimum, parents should do the following:

•  Read all contracts thoroughly and know all costs associated with banking through a given company.
• Understand whether the stored cord blood will be available for donor use only, or whether another member of the family, such as a sibling, could utilize the unit, should the need arise (so-called “family use”).
•  Confirm that the company is financially and otherwise stable, since the cord blood may be stored for years to decades before being used.
•  Inquire whether the company is accredited by a reputable regulatory agency (e.g., AABB, FACT).
•  Know how long the company has been involved in cord blood storage, how many samples they currently have in storage, whether any units banked through the company have been used for transplantation, and their outcomes.

What is the future?

There are several clinical trials evaluating the use of cord blood stem cell infusions for conditions such as cerebral palsy and diabetes.  In addition, there are studies underway using cord tissue stem cells.  Cord tissue contains mesenchymal stem cells which can form bone, cartilage and tendons. Mesenchymal stem cells are thought to have better regenerative properties than cord blood cells. In clinical trials, they are being studied as possible treatment for spinal cord injuries, brain trauma from stroke, and cartilage damage. The research using cord tissue is at an early stage and medical treatments are not currently available.

Summary

At The Womans’ Group, we keep up with the latest developments in the collection and use of cord blood.  We also provide our patients with the latest information available to make an educated decision regarding a financial commitment to collect and preserve their newly born baby’s cord blood as a means to potentially treat a family member’s disease that may be treatable through implantation of stem cells.  The collection and storage of cord blood should be looked at as one would look at a conditional insurance policy.  One bets on never having to need it, but should the need arise, there is comfort in knowing that coverage may be available.