Cord blood (short for umbilical cord blood) is the blood that remains in the umbilical cord and placenta post-delivery. At or near term, there is a maternal–fetal transfer of cells to boost the immune systems of both the mother and baby in preparation for labor. This makes cord blood at the time of delivery a rich source of stem cells and other cells of the immune system. Cord blood banking is the process of collecting the cord blood and extracting and cryogenically freezing its stem cells and other cells of the immune system for potential future medical use.
Banked cord blood is most abundant in white blood cells and stem cells. While a lot of attention is paid to the stem cells, there are approximately 10 times more total nucleated cells (TNCs) than stem cells in any cord blood collection. TNCs are basically white blood cells, or leukocytes; they are the cells of the immune system that protect the body. Despite stem cells comprising one-tenth of most collections, cord blood is still considered a rich source of hematopoietic (he-mah-toe-po-ee-tic) stem cells (HSCs). HSCs are often designated by the marker CD34+. Hematopoietic stem cells can become two categories of cells: myeloid and lymphoid cells. Myeloid cells go on to form your red blood cells, platelets, and other cells of the blood. Lymphoid cells go on to become the B cells and T cells and are the basis for the immune system. Cord blood also contains mesenchymal (meh-sen-ki-mal) stem cells (MSCs), but they are much more abundant in cord tissue, which we will discuss in a minute.
Like any insurance, cord-blood banking isn’t cheap. Banks initially charge from $1,000 to $2,000 to collect and process the stem-cell units, which are stored for a family’s exclusive use. When you factor in additional costs for shipping (about $150 for a medical courier), the doctor’s collection fee (prices can range from $150 to $500), and annual storage fees averaging $100 per year for 18 years, parents can expect to pay up to $4,000 in expenses not covered by insurance.
Cord blood can’t be used to treat everything. If your child is born with a genetic condition such as muscular dystrophy or spina bifida, then the stem cells would have that condition, says Dr. Kurtzberg. But if the cord blood donor is healthy and there is a sibling or another immediate family member who has a genetic condition, the cord blood could be a good match for them.
Because the body’s immune system is designed to find and get rid of what it believes to be outside contaminants, stem cells and other cells of the immune system cannot be transfused into just anyone. For stem cell transfusions of any type, the body’s immune system can mistakenly start attacking the patient’s own body. This is known as graft-versus-host disease (GvHD) and is a big problem post-transplant. GvHD can be isolated and minimal, but it can also be acute, chronic and even deadly.
* 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.
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Public cord blood banks do not pay the fees associated with transporting the stored cord blood to the necessary medical facility if they are needed for a transplant, so if this is not covered by your insurance, it could be very costly to use stem cells from a public cord blood bank
Editor’s Note: This article originally appeared in the Volume 16, Number 1, Spring 2009 issue of Dignitas, the Center’s quarterly publication. Subscriptions to Dignitas are available to CBHD Members. To learn more about the benefits of becoming a member click here.
If someone doesn’t have cord blood stored, they will have to rely on stem cells from another source. For that, we can go back to the history of cord blood, which really begins with bone marrow. Bone marrow contains similar although less effective and possibly tainted versions of the same stem cells abundant in cord blood. Scientists performed the first bone marrow stem cell transplant in 1956 between identical twins. It resulted in the complete remission of the one twin’s leukemia.
Gift of Life is a non-profit charity that seeks to help Jewish patients find a transplant match. They recruit both bone marrow donors and cord blood donations from the Jewish community. Gift of Life operates their own accredited cord blood laboratory that participates in the national NMDP network.
In fact, the AAP does encourage parents to keep their child’s cord blood if a family member has already been diagnosed with a stem-cell-treatable disease. But a family won’t have to foot the bill: The Children’s Hospital Oakland Research Institute, in California, will bank a baby’s cord blood for free if a family member needs it at the time of the baby’s birth. Some private banks, such as Cord Blood Registry, Cryo-Cell, and ViaCord, have similar programs.
The American Pediatric Association in 2008 recommended that physicians recommend that cord blood be donated instead of saved privately for family families. One of the major proponents for this was Joanne Kurtzberg, who profited from this by getting funding for her public cord blood bank at Duke University. She has since started her own private cord blood bank after doing more research on Cerebral Palsy. Interesting.
While many diseases can be treated with a cord blood transplant, most require stem cells from another donor (allogeneic). Cord blood cells taken from the patient (autologous) typically contain the same defect or precancerous cells that caused the patient to need the transplant in the first place. Most medical professionals believe the chance that cord blood banking will be utilized by the patient or a close relative is relatively low. Estimates range from 1 out of 1,000 to 1 out of 200,000. From these estimates, privately stored cord blood is not likely to be utilized by the average family. The American Academy of Pediatrics has discouraged cord blood banking for self-use, since most diseases requiring stem cell transplants are already present in the cord blood stem cells. Additionally, a recent study published in Pediatrics indicates that few transplants have been performed using privately stored cord blood. From the responses of 93 transplant physicians, in only 50 cases was privately banked blood used. In 9 of these cases the cord blood was transplanted back into the donor patient (autologous transplant). One of the main selling points of private cord blood banks is the possibility of a future autologous transplant.
Another way scientists are working with stem cells is through expansion technologies that spur replication of the cord blood stem cells. If proven effective and approved by the U.S. Food and Drug Administration, these expansion technologies will allow scientists to culture many stem cells from a small sample. This could provide doctors and researchers with enough stem cells to treat multiple family members with one cord blood collection or provide the baby with multiple treatments over time. To better prepare for the day when these expansion technologies are more easily accessible, some cord blood banks have begun to separate their cord blood collections into separate compartments, which can easily be detached from the rest of the collection and used independently. You can learn more about Cryo-Cell’s five-chambered storage bag here.
Private (commercial) cord banks will store the donated blood for use by the donor and family members only. They can be expensive. These banks charge a fee for processing and an annual fee for storage.
LifebankUSA seeks mothers in NEW YORK & NEW JERSEY ONLY who will donate both their cord blood and their placenta. The donations support an international registry, clinical trials and research. Donations can be taken from any hospital, but mothers must register at least 8 weeks prior to delivery and pass a health screening.
In Europe and other parts of the world, cord blood banking is more often referred to as stem cell banking. As banking cord blood is designed more to collect the blood-forming stem cells and not the actual blood cells themselves, this term may be more appropriate.
Your baby’s cord blood could be a valuable resource for another family. From foundations to non-profit blood banks and medical facilities, there are numerous locations that will collect, process, and use the stem cells from your baby’s cord blood to treat other people.
Banking cord blood is a new type of medical protection, and there are a lot of questions that parents may want to ask. The Parent’s Guide to Cord Blood organization even has questions it believes all parents should ask their cord blood banks. We have answers to these and other frequently asked cord blood questions in our FAQs. If you can’t find the answer for which you are looking, please feel free to engage one of our cord blood educators through the website’s chat interface.
Sutter Neuroscience Institute has conducted a landmark FDA-regulated phase II clinical trial to assess the use of autologous stem cells derived from cord blood to improve language and behavior in certain children with autism.
There is no cost associated with public cord blood banking, but you do give up your rights to your baby’s stem cells at the time of donation. The public cord blood bank owns the donation. If your child or another family member needs a transplant in the future, there is no guarantee you would have access to your baby’s cord blood.
Public cord blood banking supports the health of the community. Public banks collect qualifying cord blood donations from healthy pregnancies and save them in case one of them will be the match to save the life of a patient who needs a stem cell transplant. In the United States our registry of donors is called Be The Match. Patients who have a rare genetic type are more likely to receive cord blood transplants. In order for parents to donate cord blood to a public bank, their baby must be born at a hospital that accepts donations. Public cord blood banking is highly recommended by both the American Academy of Pediatrics (AAP) and American Medical Association (AMA).
If you want the blood stored, after the birth, the doctor clamps the umbilical cord in two places, about 10 inches apart, and cuts the cord, separating mother from baby. Then she inserts a needle and collects at least 40 milliliters of blood from the cord. The blood is sealed in a bag and sent to a lab or cord blood bank for testing and storage. The process only takes a few minutes and is painless for mother and baby.
Cord blood cannot be used if the donor (baby) contains the same genetic illness as the recipient. Most cord blood banks glaze over this, but it is important to understand that the odds of using cord blood for the same child are much lower than the odds of using them for a sibling.
Sign a consent form to donate. This consent form says that the donated cord blood may be used by any patient needing a transplant. If the cord blood cannot be used for transplantation, it may be used in research studies or thrown away. These studies help future patients have a more successful transplant.
You certainly should, especially if you have a family history of any diseases or conditions that could be treated with cord blood stem cells. Since there is only a 25% chance of a match, you should bank the cord blood of each individual child if you have the means.
Georgia Regents University is conducting an FDA-regulated phase I/II clinical trial to assess whether an infusion of autologous stem cells derived from their own cord blood can improve the quality of life for children with cerebral palsy.
* Annual storage fees will be charged automatically to the credit/debit card on file, on or around your baby’s birthday, unless you’ve chosen a prepay option and are subject to change until they are paid.
Are public banks and family banks the same, except for who may use the cord blood and the cost to the parents? No. Public banks are subject to much higher regulatory requirements, and compliance with regulations carries costs. At a family bank you pay the bank enough to cover the cost of storing your baby’s cord blood, plus they make a profit. When you donate to a public bank, it costs you nothing, but the bank pays more on processing each blood collection than at a family bank. Let’s look at the steps that take place in the laboratory.
The umbilical cord blood contains haematopoietic stem cells – similar to those found in the bone marrow – and which can be used to generate red blood cells and cells of the immune system. Cord blood stem cells are currently used to treat a range of blood disorders and immune system conditions such as leukaemia, anaemia and autoimmune diseases. These stem cells are used largely in the treatment of children but have also started being used in adults following chemotherapy treatment.
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.
Families have the additional option of storing a section of the umbilical cord, which is rich in unique and powerful stem cells that may help repair and heal the body in different ways than stem cells derived from cord blood.
Your child may never need it. Stem cell-rich cord blood can be used to treat a range of diseases, but Frances Verter, Ph.D., founder and director of Parent’s Guide to Cord Blood Foundation, estimates that there’s only a 1 in 217 chance that your child will ever need a stem cell transplant with cord blood (or bone marrow). This is particularly true if the child doesn’t have a family history of diseases such as leukemia, lymphoma, or sickle cell anemia. Although the American Academy of Pediatrics (AAP) states cord blood has been used to treat certain diseases successfully, there isn’t strong evidence to support cord blood banking. If a family does choose to bank cord blood, the AAP recommends public cord blood banking (instead of private) to cut down on expenditures.
The American Academy of Pediatrics supports efforts to provide information about the potential benefits and limitations of cord blood banking and transplantation so that parents can make an informed decision. In addition, the American College of Obstetricians and Gynecologists recommends that if a patient requests information on umbilical cord blood banking, balanced information should be given. Cord blood education is also supported by legislators at the federal and state levels. In 2005, the National Academy of Sciences published an Institute of Medicine (IoM) report titled “Establishing a National Cord Blood Stem Cell Bank Program”.
Umbilical cords have traditionally been viewed as disposable biological by-product. Cord blood, however, is rich in multi-potent hematopoietic stem cells (HSCs). Recent medical advances have indicated that these stem cells found in cord blood can be used to treat the same disorders as the hematopoietic stem cells found in bone marrow and in the bloodstream but without some of the disadvantages of these types of transplants. Cord blood is currently used to treat approximately 70 diseases including leukemias, lymphomas, anemias, and Severe Combined Immunodeficiency (SCID). Six thousand patients worldwide have been treated with cord blood stem cell transplants, although the FDA considers the procedure to be experimental. These multipotent stem cells also show promise for the treatment of a variety of diseases and disorders other than those affecting the blood.
One oft cited argument against cord blood banking is that it is not known how long these cells can remain viable in storage. While it is not known if cells taken from an individual as an infant will be beneficial to them as an adult, units stored for up to 10 years have been transplanted successfully. This indicates that there is no reason to suggest serious deterioration in the quality of cord blood units stored for longer periods of time.
Stem Cell Storage is not included in their price. Viacord and Cord Blood Registry both charge for annual storage. This means that when you pay for your initial cord blood and/or cord tissue storage you will also have to pay annually for storage.