Cord Blood

The Babble Staff

Cord blood banking may sound vaguely creepy, even vampiric, but it's a simple medical procedure: the extraction of blood from the umbilical cord and placenta (after the umbilical cord has been severed) and storing it for possible future use. The immature stem cells in cord blood are more valuable than adult stem cells. Some also consider cord blood a more ethical alternative to embryonic stem cells. But before you shell out for storage of your baby's cord blood, know that private cord blood banks are expensive and some experts say they lack adequate record-keeping. Skeptics also say it's extremely rare your baby or anyone in your family will ever need his cord blood. And the baby's stem cells are not always a miraculous cure-all; some genetic diseases might be present in the cord blood itself. If you have the money to bank cord blood there's no harm in it, but several doctors advocate an expansion of the more closely monitored public cord blood holdings rather than leaving individuals to fend for themselves.

Umbilical cord blood banks have been established in some areas of the United States, Canada, and many countries in Europe to supply stem cells for related and unrelated people. Using blood from these banks decreases the time it takes to search for a match, because the samples are already typed for genetic information (HLA) and blood group and treated for infection. The match does not need to be as specific as it does with bone marrow or peripheral stem cells. Umbilical cord blood transplants also cause fewer problems with graft-versus-host disease.

Research is showing promising results using stem cells to treat heart disease and neurological diseases . . . Cord blood stem cells are not just for your baby. It's really an investment for the whole family. Virtually all mothers and about half of siblings will be a suitable match for baby's stem cells. And while the chance that any family member will use the cord blood for cancer treatment is very low, the likelihood that it could be used to treat a variety of other diseases is considerable. The list of such diseases is growing every year as researchers study this fascinating field.

Stem cells can either be taken from the patient's or a matching family member's bone marrow, or from stored cord blood. Here are some benefits when cord blood is used instead of bone marrow:
? Research has shown that survival rates double when a person's own cord blood or a family member's cord blood is used, compared to using an unrelated donor sample from a public stem cell bank.
? Having your own private sample ensures immediate availability of a perfectly matched sample.
? While bone marrow can also be a source of stem cells if needed, cord blood stem cells are easier to match for family members, thus increasing the chance that a family member can receive a related stem cell transplant.
? Research has shown that patients who receive cord blood stem cell transplants have a smaller chance of rejecting the cells, compared to bone marrow stem cell transplants.

Months before your due date, the cord blood bank sends you a collection kit that contains everything that is needed for the process. The bank also sends your OB or Midwife instructions to make sure he or she knows how to collect the blood. When baby is born, and the umbilical cord is cut, the OB or Midwife collects the blood from the remaining umbilical cord and placenta (not from baby) into a syringe or blood bag.

There are several private cord blood companies to choose from. [. . .] Some companies aren't even certified as a blood bank. And I was shocked to find out that some banks have never even had a single stored sample used for transplant.

The newly discovered human cells, named "cord-blood-derived embryonic-like stem cells" or CBEs, are not quite as primitive as embryonic stem cells, which can give rise to any tissue type of the body. But they appear to be much more versatile than "adult stem cells" such as those found in bone marrow which repair damaged tissue during life.

"We have found a unique group of cells that bring together the essential qualities of both types of stem cells for the first time," says Colin McGuckin of Kingston University in Surrey , UK , who co-led the team with colleague Nico Forraz.

The factor that may make the discovery very significant is that umbilical cord blood can be saved, stored and multiplied without any of the ethical dilemmas facing embryonic stem cell use, which are derived from human fetuses.

And with more and more "banks" around the world for saving cord blood, the potential for finding tissue matches for every patient becomes more and more realistic. "There are now eight banks in the UK alone," says McGuckin.

Stephen Minger, director of the Stem Cell Biology Laboratory at King's College London, UK, says he is "intrigued" by the claims but would like to see more proof of the cells' embryonic character.

No accurate estimates exist of the likelihood of children to need their own stored cells. The range of available estimates is from 1 in 1,000 to 1 in 200,000. For this and other reasons, it is difficult to recommend that parents store their children's cord blood for future use.

Given the difficulty in estimating the need for using one's own cord blood cells for transplantation, private storage of cord blood as "biological insurance" is unwise. However, banking should be considered if there is a family member with a current or potential need to undergo a stem cell transplantation. For example, conditions such as leukemia or severe hemoglobinopathy may indicate the need for directed-donor cord blood banking for sibling cord blood transplantation.

In March 2004, The Medical Letter concluded: "At the present time, private storage of umbilical cord blood is unlikely to be worthwhile. Parents should be encouraged to contribute, when they can, to public cord banks instead."

Cord blood banking has some legitimate uses but appears to be a poor investment except for people who (a) have a relative with a disease for which cord blood effectiveness has been demonstrated or (b) are wealthy enough to afford betting more than $3,000 on a long shot.

When she was pregnant with her first son, Tracey Dones and her husband, like many couples today, faced a tough decision: Was it worth the $500 to $1,800 fee and then annual payments up to $100 to have a private company bank blood from her child's umbilical cord?

"In the end, I said to myself, how could we not do it?" Dones said about their decision to bank Anthony's cord blood. "It could save my child's life."

But when Anthony was diagnosed with a rare genetic bone disorder at four months and needed a transplant, she learned his banked blood would not help. Those cells, her son's doctor explained, contained the same genetic defect that was causing his condition.

Dones says her story emphasizes the need to bolster cord blood supplies within the public cord blood network. Currently, only a handful of hospitals across the country are equipped to handle public cord blood donations. The option to pay to have your own child's cord blood stored for personal use, meanwhile, is not only widely available, but competitive.

For the most part, [cord blood units in private banks] are held exclusively for the use of the families who paid to have them stored.
    "There's no question it's an elective and not a necessity," said Grant, who reports that 36 of his company's 270,000 clients have tapped their stored cord blood units for transfer therapy. "But there is a strong case for attaining this unique genetic resource for its known and emerging uses. It's an investment."
    Public cord blood banks, meanwhile, are struggling to increase their holdings above the current level of 60,000. A couple of proposals now under consideration could help or hinder that effort.

Rich Miller-Murphy of the New York Blood Center , a public cord blood organization, explains having 150,000 cord blood units on hand could ensure that 80 percent to 90 percent of those seeking a match for transplant therapy would find it. With its current holdings, about a quarter of patients seeking a match can't find them among bone marrow and cord blood holdings.

"The level of matching is less critical with cord blood," said Boo. "The cells are thought to be more primitive and therefore they're better tolerated than adult bone marrow cells."

Until recently, cord blood was considered suitable only for children due to the small amount of blood per donated unit. But a new study led by Mary Horowitz of the Medical College of Wisconsin showed that cord blood can also save adults.
    Currently anyone can try and sign up to donate their child's umbilical cord blood, but there are only some 23 public cord banks in the United States and fewer than 65 hospitals throughout the country are equipped to accept donations. Cord banks are also limited in the number of donations they can accept so they usually screen potential donors to make sure they're getting donations that meet their needs for a diverse gene pool. Most banks plan to hold donated units for up to 10 years, but that may be extended if studies demonstrate that the cells remain viable for longer periods.

With the public bank system still lacking, a match can't always be guaranteed. That's why many families continue to bank their child's cord blood in private banks - just in case their child or another family member needs the blood for treatment.

The American Academy of Pediatricians issued a statement in 1999 saying there is "no strong evidence to recommend routine cord blood banking for an infant's future use." Many pediatricians issue similar advice to their patients, although some may suggest that parents consider paying for the storage if their family has a history of illnesses that can be treated by the cells. The National Heart, Lung and Blood Institute estimates the likelihood that a child will use his or her own stored cord blood cells is 1 in 200,000. Other groups have set the chances higher, at 4 in 10,000.

"If the choice were to instead use that money and start a college fund, I would advise parents to put the money in a college fund," said Curt Civen, a professor of oncology and pediatrics at Johns Hopkins University School of Medicine.

Dones, whose son is now 2 years old, has traveled to Washington , D.C. , to testify to members of Congress about how public cord blood banks saved her son's life.

"You can't pick up a pregnancy magazine today without seeing ads from private cord blood companies," she said. "It's about time public cord banks got more attention."