Published: Mar. 14, 2012
Updated: Mar. 14, 2012
Today, patients frequently ask me whether they should store blood from their baby for possible future use. Thirty years ago I was never asked this question.
Jessica M. Sun, MD, a pediatric blood and marrow transplant specialist at Duke Children's, explains why you might want to save your child's umbilical cord blood.
-- Dennis Clements MD, PhD, MPH
Umbilical cord blood is a baby’s blood left in the placenta after the baby is born and the umbilical cord is cut.
Historically, umbilical cord blood was discarded with the placenta as medical waste. Over the past few decades, cord blood has been shown to contain stem cells and early precursor cells that can be used for life-saving stem cell transplantation for children and adults in need of a stem cell transplant.
Cord blood is more tolerant of a new host and can be used without full matching, providing increased access to transplantation for patients who cannot find a matched donor.
Hematopoietic stem cell transplantation can be an effective therapy for pediatric and adult patients with certain cancers, immune deficiencies, bone marrow failure syndromes, and some genetic diseases including inborn errors of metabolism and hemoglobinopathies.
Traditionally, stem cells used for transplantation were obtained from bone marrow or blood. More recently, cord blood has become an alternative source of stem cells for transplantation.
A major limitation to stem cell transplantation therapy is the ability to find a suitable donor. Only 20 to 25 percent of patients in need of a transplant have relative who is a “match” and can serve as their donor. Of those without a related donor, only 10 to 50 percent of patients (depending on their race and ethnicity) will find a matched unrelated bone marrow donor through the National Marrow Donor Program and other donor registries.
Cord blood transplantation does not require as strict matching as bone marrow, so many patients who cannot find a matched bone marrow donor can find a suitable cord blood donor. It is estimated that more than 4,000 cord blood transplants are being performed each year around the world.
Cord blood is also being studied as a source of stem cells for other purposes, including regenerative therapies for tissues damaged by injury or disease. However, these applications remain unproven and are currently the subject of ongoing research.
Umbilical cord blood can be collected without risk to the mother or infant donor. Cord blood can be collected from the placenta, either during the third stage of labor or within 10 to 15 minutes after delivery of the placenta, by sterilely puncturing one of the umbilical veins with a needle and allowing the cord blood to drain into a sterile bag containing an anticoagulant to prevent clotting.
After collection from the placenta, some of the red blood cells are usually removed and the volume of the cord blood collection is reduced.
For long-term storage, cells undergo specialized freezing procedures and are stored in special freezers under liquid nitrogen. Maximal storage time, or expiration date, is unknown, but cells are likely to remain usable for decades. Cord blood units from public banks have been successfully transplanted after 18 years in storage.
There are two main types of cord blood banks, public and private.
In general, public banks are nonprofit entities supported by federal or private funding. After the mother consents, public banks collect cord blood from healthy full-term pregnancies at no cost to the donor’s family.
In giving consent, the infant’s mother acknowledges that the donation is voluntary and gives up all rights to the cord blood for the public good. The mother also agrees to allow her medical records and the baby’s newborn records to be reviewed, gives a detailed family medical history, and allows a sample of her own blood to be taken for infectious disease testing.
Units passing screening tests designed to eliminate risks of transmitting genetic or infectious diseases are typed, placed in the search registry, and are available to any suitable patient in need of transplantation. Units that do not meet criteria for public banking may be discarded or used for research purposes.
Private cord blood banks are generally for-profit companies that store “directed donations” intended for future use by the child or a family member. Using a kit provided by the bank, the cord blood is collected by the physician, midwife, or nurse delivering the baby and shipped back to the company’s banking facility. The parents of the infant are charged an initial fee for collection and processing of the cord blood and then an annual fee for storage.
Varying degrees of testing is performed on the units, and minimal standards are used to determine whether a unit is eligible for processing and banking. The majority of private collections are undertaken as an investment in the unknown potential for cord blood to be used to treat serious illnesses in the future.
Most obstetricians and pediatricians feel that routine cord blood storage in healthy babies is unnecessary. In this regard, it is important to note that a child’s own cord blood would not be used for transplantation of a child with leukemia or other cancers, in part due to concern for contamination with cancerous cells, and it would not be used to treat a genetic condition because the cord blood would contain the same genetic problem.
Currently, directed donation of umbilical cord blood for another family member is recommended when a first-degree relative has a high risk pediatric cancer that can be treated with transplantation therapy, a hemoglobinopathy or other transfusion-dependent blood disorder, a congenital immune deficiency, or an inborn error of metabolism.
It is always a good idea to discuss options for cord blood banking with your obstetric provider or pediatrician.
To privately store your baby’s cord blood for possible future use by the child or a family member, you may contact one of the many private cord blood banks to arrange collection, shipment, and payment. Additional information about cord blood banking, including a list of private banks, can be found through the Parent’s Guide to Cord Blood Foundation.
To donate your baby’s cord blood for public use, first check whether the hospital at which you plan to deliver works with a cord blood bank to collect cord blood for public donation.
In North Carolina, public collections are available at Duke, UNC, Duke Regional, Womack Army Medical Center, Women’s Hospital of Greensboro, and Rex Hospitals.
If your hospital does not participate in public cord blood banking, there are a few public cord blood banks, including the Carolinas Cord Blood Bank at Duke, that offer a free kit program so that public donations may be collected at other hospitals. Interested parents should contact the bank (919-668-2071) at least six weeks before the baby’s due date to learn more about the program.
Currently, public donations are limited to mothers who have a healthy pregnancy, are 18 years or older, and are pregnant with a single baby. More information about public cord blood donation is available through the National Marrow Donor Program.
-- Jessica M. Sun, MD, is a pediatric hematology / oncology specialist in the Duke Department of Pediatrics.
-- Dennis Clements, MD, PhD, is the chief of primary care pediatrics at Duke Children's Hospital.