Cord blood

Umbilical cord blood is up to 180mL of blood^[1] from a newborn baby that is returned to the neonatal circulation if the umbilical cord is not prematurely clamped.^[2] In some obstetric and midwifery practices, physiological extended-delayed cord clamping protocol, as well as water birth, allows for the cord blood to pulse into the neonate for 2–20 minutes after delivery.^[3] If the umbilical cord is not clamped, a physiological clamping occurs upon interaction with cold air, when the internal gelatinous substance, called Wharton's jelly, swells around the umbilical artery and veins.

Cord blood harvesting

A cord blood bank may be a private commercial enterprise, or public medical resource, used to store umbilical cord blood for future use.

While public cord blood banking is widely supported, private cord banking is controversial in both the medical and parenting community. Up to 180mL may be collected from the umbilical cord after cord has been clamped. The blood is what is left over in the placenta and the umbilical cord after the birth of the baby. The cord blood is from the baby and contains stem cells, including hematopoietic cells. Removing the umbilical cord blood is not harmful to the baby and the blood would normally be thrown away as medical waste. Although umbilical cord blood is well-recognized to be useful for treating hematopoeitic and genetic disorders, some controversy surrounds the collection and storage of umbilical cord blood by private banks for the baby's use. Only a small percentage of babies (estimated at between 1 in 1,000 to 1 in 200,000^[4]) ever use the umbilical cord blood that is stored. The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking states that:

"Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood;"^[4]

Cord blood is stored by both public and private cord blood banks. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the National Marrow Donor Program (NMDP). Private cord blood banks are for-profit organizations that store cord blood for the exclusive use of the donor or donor's relatives.

Public cord blood banking is supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases.

New parents have the option of storing their newborn's cord blood at a private cord blood bank or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage, as of 2007. Donation to a public cord blood bank is not possible everywhere, but availability is increasing. Several local cord blood banks across the United States are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation; the OB/GYN may still charge a collection fee, although many OB/GYNs choose to donate their time.

After the first sibling-donor cord blood transplant was performed in 1988, the National Institute of Health (NIH) awarded a grant to Dr. Pablo Rubinstein to develop the world's first cord blood program at the New York Blood Center (NYBC),^[5] in order to establish the inventory of non embryonal stem cell units necessary to provide unrelated, matched grafts for patients.

In 2005, University of Toronto researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.^[6]

Controversy

While there is general support in the medical community for public banking of cord blood, the question of private banking has raised objections from many governments and nonprofit organizations. The controversy centers on varying assessments of the current and future likelihood of successful uses of the stored blood. In March 2008, a paper was published by Nietfeld et al.^[7] in the journal Biology of Blood and Marrow Transplantation which computed the lifetime probability (up to age 70) that an individual in the US would undergo a stem cell transplant. The likelihood of an autologous transplant using your own stem cells is 1 in 435, the likelihood of an allogeneic transplant from a matched donor (such as a sibling) is 1 in 400, and the net likelihood of any type of stem cell transplant is 1 in 217.

The National Marrow Donor Program estimates that by the year 2015, there will be 10,000 cord blood transplants world-wide per year using publicly banked cord blood. It is therefore vitally important to build public repositories of cord blood donations throughout the world. In the United States, the Health Resources and Services Administration (HRSA) of the US Dept. of Health and Human Services is responsible for funding national programs to register marrow donors and bank cord blood donations.^[8]

The European Union Group on Ethics (EGE) has issued Opinion No.19 ^[9] titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that "[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."^[9] However, in the final section 1.27 of their Opinion, the EGE admits that: "if in the future regenerative medicine developed in such a way that using autologous stem cells became possible, then the fact to have one's own cord blood being stored at birth could increase the chance of having access to new therapies."^[9]

In May 2006, The World Marrow Donor Association (WMDA) Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage^[10] stated that:

1. The use of autologous cord blood cells for the treatment of childhood leukemia is contra-indicated because pre-leukemic cells are present at birth. Autologous cord blood carries the same genetic defects as the donor and should not be used to treat genetic diseases.
2. There is at present no known protocol where autologous cord blood stem cells are used in therapy.
3. If autologous stem cell therapies should become reality in the future, these protocols will probably rely on easily accessible stem cells.

As of spring 2008, there are several known instances where autologous use of cord blood is indicated:

1. Whereas the WMDA cautioned against autologous transplant for diseases with a genetic signature, there are pediatric cancers (ex: neuroblastoma) and acquired conditions (ex: aplastic anemia) which can be treated by autologous transplant. There has even been one autologous transplant for leukemia^[11]
2. Type 1 Diabetes, also known as Juvenile Diabetes, has been shown to improve if treated shortly after onset with an infusion of autologous cord blood.^[12] The American Diabetes Association reports that 1 in 7000 children is diagnosed each year with Type 1 diabetes, and 1 in 600 children are living with it.
3. A Phase I clinical trial is underway at Duke University to investigate whether cerebral palsy and other forms of pediatric brain injury may responded to infusions of autologous cord blood.^[13] The Brain Injury Association of America^[14] estimates that the prevalence of Cerebral Palsy is about 1 in 300 among children up to age 10.

See also

• Cord blood bank
• Stem cell
• Doula
• Umbilical cord
• Placenta cord banking
• Gift of Life Bone Marrow Foundation

References

External links

General information

• Cord Blood Banking info, news and articles on Cord Blood, Umbilical Cord blood Banking
• National Marrow Donor Program
• Save the Cord Foundation, a non-profit educational foundation established to create unbiased awareness about the life saving benefits of cord blood.
• Cord Blood Donation
• Cord Blood Rights
• Cord Blood Association of Canada — A non-profit organization about cord blood banking.
• The New Jersey Cord Blood Bank (NJCBB)
• Northern California Umbilical Cord Blood Bank (NCUBB) — A non-profit public organization
• Jesse Farquharson - The first autologous transplant in North America
• The March of Dimes - Umbilical Cord Blood
• GentleBirth.org - Umbilical cord issues
• Parent's Guide to Cord Blood Foundation, a non-profit educational foundation
• Cord Blood Information
• Cord Blood Legislation by State (United States)
• Gift of Life Cord Blood Program
• Information on therapies using Umbilical Cord Blood Stem Cells

Free, public donation information

• Cryobanks International — Accepts free collections throughout the USA
• Babies for Life Foundation^{[dead link]} — Accepts free collections throughout the USA
• Stemcyte — Accepts free collections at 5 hospitals in the USA
• Alberta Cord Blood Bank — Accepts free collections throughout Canada
• NHS Cord Blood Bank — Accepts free collections throughout England and Wales
• National Marrow Donor Program — Details on umbilical cord blood donation

Diseases treated with cord blood

• Diseases treatable with hematopoietic cells — i.e., marrow, cord blood and peripheral blood stem cells
• National Cord Blood Program — Frequency of patients transplanted with cord blood by disease
• Cord Blood Center — The list of diseases treated with haematopoietic cells transplantation, including autologous cord blood, cord blood from a sibling, autologous bone marrow, and bone marrow from a donor
• Treatable conditions using umbilical cord blood-derived stem cells