Cord blood banking is definitely a confusing topic. This article summarizes the information you need to understand cord blood banking and make an informed decision. Learn how cord blood stem cells are used, what conditions can be treated with cord blood stem cells, and how it is stored at a cord blood bank. When considering all of the pros and cons of cord blood banking, perhaps the biggest consideration is how it fits in with delayed cord clamping. This episode breaks down the evidence on cord blood banking so you can decide if it is right for you and your baby.
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What is the big deal about cord blood?
Cord blood contains hematopoietic stem cells. What the heck is that? Hematopoietic stem cells are different than embryonic stem cells. These types of stem cells can differentiate only into blood cells, whereas embryonic stem cells can differentiate into any cell in the body. Cord blood stem cells can form red blood cells, white blood cells, and platelets. The ability to differentiate into these different types of blood cells can make cord blood helpful in treating blood and immune system related genetic diseases, cancers, and blood disorders. Right after your baby is born cord blood is collected and then it is stored in a cord blood bank to potentially be used at a later date.
The History of Cord Blood Transplants
The first clinically documented use of cord blood stem cells was in the successful treatment of a six-year-old boy afflicted by Fanconi anemia in 1988. Since then, cord blood has become increasingly recognized as a source of stem cells that could be used in stem cell therapy. There is a fairly long list of things (nearly 80) that may be treated with cord blood. This includes many types of cancers, bone marrow failure syndromes, blood disorders, metabolic disorders, immunodeficiencies, and some other diseases like osteopetrosis. Take note that these are not common, and your little one has a very small chance of having any of these. If you have a family history of any disorders or diseases it may be worth talk to your care provider about whether cord blood banking could potentially help treat it, in the event your baby had it, or someone else in your family does.
Can You Actually Use Your Own Cord Blood
While cord blood banking is often marketed as biological insurance, you cannot assume that your baby would be able to use their own cord blood. Often, children who develop an immunological disorder often are unable to use their own cord blood for transplant because their blood also contains the same genetic defect. This is often true with leukemia, which is a cancer and the largest use of cord blood stem cells. Additional issues include the possible contamination of the cord blood unit with the same cancer, which may not be diagnosed until later in life. So your baby’s own cord blood may not be the ideal source of stem cells.
Cord Blood Banks
A cord blood bank is a facility which stores umbilical cord blood for future use. Private banks store cord blood solely for the potential use by the donor or their family. There are no accurate estimates of the likelihood of children to need their own stored cord blood stem cells in the future. Private banks do charge a fairly high fee, typically around $2,000 for the collection, and around $200 a year for storage. Of course this could vary from one company to the next, but this is a good ballpark figure of what you can expect to spend. There is some controversy in the medical community about private for-profit cord blood banks, and whether physicians, employees, and consultants of private banks have potential conflicts of interest in recruiting patients because of their own financial gain.
Public Cord Blood Banks
If you choose to store it at a public bank, it works very much like a blood bank, and you don’t own the cord blood donated. Public cord blood banks accept donations from anyone, they discard donations that don’t meet their quality control standards, and they use national registries to find recipients for their samples. Some public cord blood banks funded by the National Heart, Lung, and Blood Institute, the National Marrow Donor Program, the American Red Cross, or academic programs based in not-for-profit organizations.
Samples sent to a public bank are tested for chromosomal abnormalities and infectious diseases and that if abnormalities are identified, you will be notified. It is important to note that the cord blood banked in a public program may not be accessible for future private use. It is also a possibility your donation could be life saving for someone else. Public banks generally do not charge any fees.
Regulation of Cord Blood Banks
In the United States, the FDA regulates cord blood and cord blood banks. Several states also require accreditation, including New York, New Jersey, and California. Any company not accredited within those states are not legally permitted to collect cord blood from those states, even if the company is based out of state. Both public and private cord blood banks are also eligible for voluntary accreditation with either the American Association of Blood Banks (AABB) or the Foundation for the Accreditation of Cellular Therapy (FACT).
Other countries also have regulations pertaining to cord blood. If you are looking at some different companies it would be a good idea to make sure that they are legit, and have any required accreditations for the country or state that you live in. When in doubt, ask. Sometimes it can be tricky to navigate around the website to get the info you need. Often, the best way to get all your questions answered is to get on the phone.
Since patients who need cord blood frequently need more cells than a single collection would have provided, public banks frequently combined multiple samples together when preparing the treatment for a single patient. Many cord blood samples are too small for transplantats because they don’t contain enough stem cells. When this happens, a private bank will store a sample, even if it is too small, you are paying them to store it and they will, even if the sample is too small to be usable.
If someone needs a cord blood transplant as an adult, they will need an even larger sample because their body is larger than a child. It is unlikely that there will be enough cells in the cord blood collected from birth to treat any condition that a donor might be diagnosed with once they weigh over 90 pounds. Unlike private banks, public banks will discard any samples that do not collect enough usable cells. The percentage of public bank donations discarded as medical waste is often cited to be between 60 to 80%. This seems like a lot, right? Some of this is due to contamination that can occur during collection or complications arising from shipping, but this is mostly due to the collection not collecting enough usable cells.
The Medical Community’s View on Cord Blood Banking
Overall the attitude is that private banks have lower quality control and lower medical usefulness of using a patient’s own potentially diseased cord blood. Matches are almost always likely to be better in a public than a private bank. The American Academy of Pediatrics official opinion says that cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood. The cord blood stem cell–collection program should not alter routine practice for the timing of umbilical cord clamping.
Cord blood transplants require less stringent matching than something like a bone marrow transplant. Bone marrow transplants require a complete match on six key antigens, while cord blood transplants only need to match 4 of the 6. Siblings are particularly likely to be a match, and people from the same ethnic heritage are more likely to match. The odds that two siblings will have a match required for a cord blood transplant are 39%, and a 50% chance a baby’s cord blood would be a match for parents, and even grandparents. Obviously this tells us that there is at least a 50% chance that if someone needs a cord blood transplant they would not be a match for a related donor, in which case it would probably come from a public bank.
If you want to collect a cord blood sample, ultimately you need to decide whether a public bank, or a private bank is the best decision for your baby and your family. I do want to mention that private cord blood banks are a big business. Ads for cord blood banking are everywhere. There is a lot of money in this industry. Plus, it is an emotional decision when presented as potentially life saving for your baby. I also do not want to discredit that there have been babies who received a cord blood transplant and it was a life saving procedure.
How Cord Blood Banking Works
If you choose to use a private cord blood bank, the way most companies work is you sign up with them, complete some paperwork. They send you a collection kit, which you take with you to the delivery. After the umbilical cord has been cut, cord blood is extracted from the end of the cord that was attached to your baby. This is usually done immediately following birth. Following the collection, you call in and a medical courier picks up the cord blood and delivers it to the cord blood bank.
Each cord blood bank may do things a little bit differently, but overall, the process is very similar from one company to the next. At the laboratory it undergoes viral testing, to test for viruses including HIV and Hepatitis B and C. It is examined for cell count, cell viability, blood group antigen, whether it is ABO & the Rh blood group, whether it is positive or negative, bacterial and fungal growth, and some other really technical testing that we are not going to get too into the weeds on here. After testing it goes through processing to prepare it to be cryopreserved (frozen).
There are many ways to process cord blood, and there are differing opinions on what is the best way. Some processing methods separate out the red blood cells and remove them, while others keep the red blood cells. However the unit is processed, a cryopreservant is added to the cord blood to allow the cells to survive the cryogenic process or the freezing process. After the unit is slowly cooled to −90 °C, it can then be added to a liquid nitrogen tank which will keep the cord blood unit frozen at −196 °C. The slow freezing process is important to keep the cells alive during the freezing process. Once the cord blood is frozen it sits at the cord blood bank for possible future use.
Compatibility with Delayed Cord Clamping
So now that you understand what cord blood is, how it is collected and stored, and what your options are as far as cord blood banks let get to whether cord blood banking is compatible with delayed cord clamping. Adequate cord blood collection requires at least 50-75mL to ensure that there are enough cells for a transplant. About 80 mL of blood is transfers from the placenta to your baby within the first minute after birth. This amount increases to about 100 mL within three minutes. You can see that there could be a conflict if you want to both delay cord clamping and bank cord blood. However, the estimates I have seen are that the placenta contains approximately 200 mL of blood, although that doesn’t mean that exactly 200 mL of blood could be extracted from it. The short answer is that delaying clamping and cord blood banking are not mutually exclusive, you can potentially do both, but the delay should be brief.
I contacted five of the largest private cord blood banks to inquire about delaying clamping and cord blood banking. I wish I could say I got a consistent answer from all of them but unfortunately that was not the case. The answers I received were all over the place. The common theme is that yes, you can delay cord clamping, but the longer the delay, the less cord blood that will be collected to bank. There was no defined length of time.
American College of Obstetricians and Gynecologists
The American Congress of Obstetricians and Gynecologists does say it is possible to delay clamping and collect enough cord blood to bank it. ACOG says that only about 50 milliliters (mL) of blood is necessary for cord blood storage, which is just a portion of the approximately 200 mL of blood contained in the placenta and umbilical cord. If you choose to delay the cord clamping by 1 minute, around 80 mL of this blood is transferred into the infant, leaving more than enough to be stored in a cord blood bank. Even if you delay clamping by 3 minutes, only around 100 mL will have gone into the baby. They recommend that you probably don’t want to wait to clamp the umbilical cord for much longer than 3 minutes to ensure you’ll have enough for cord blood storage.
ACOG states that the routine collection and storage of umbilical cord blood with a private cord blood bank is not supported by the available evidence.
American Academy of Pediatrics
According to the American Academy of Pediatrics, if you are banking cord blood, you can delay cord clamping, as long as the delay is brief – no more than a minute or two. I was able to track down a study that looked at how delaying clamping impacts the size of a cord blood sample. In a study of 1,210 births they defined immediate clamping and cutting as being under 30 seconds and delayed cord clamping as 30 seconds or more. They found successful recovery of cord blood units decreased 10‐fold with delayed clamping of more than 60 seconds. This went down from 22% for the group whose cords were clamped within 30 seconds to only 2.6% after 60 seconds and 2.4% after 2 minutes. 38% to 46% of cord blood units after delayed clamping of more than 60 seconds had volume of less than 40 mL. Remember that the minimum requirement for collection is 50-75 mL, and these did not meet that.
American Medical Association
The view of the American Medical Association in the show notes, and their view is that collection procedures must not interfere with standard delivery practices and the safety of a newborn or the mother. In regards to public and private banks the AMA recommends that private banking should be considered in the unusual circumstance when there exists a family predisposition to a condition in which umbilical cord stem cells are therapeutically indicated. However, because of its cost, limited likelihood of use, and inaccessibility to others, private banking should not be recommended to low-risk families.
Talking to Your Doctor or Midwife
If you are considering cord blood banking, and want to delay cord clamping, I really suggest talking to your doctor or midwife, since they will be the ones actually taking the sample. Ask them for a specific time frame and for their opinion on delaying and whether they feel that you can still get an adequate sample size after a delay of one minute or three minutes, or whatever the length of time is that you want to delay clamping and cutting your baby’s cord.
After my conversations with cord blood banks I did not feel like the likelihood of obtaining a big enough sample of cord blood was very high if you were planning to delay cord clamping for longer than one minute. Honestly I didn’t feel like any of them really gave me a clear answer and it was confusing at best. This really is a good topic to discuss with your care provider, especially if you have a family history of any diseases or abnormalities that could potentially be treated with cord blood. Ask all the questions you need to so you can be really clear on it.
Collecting Placental Stem Cells
One last thing I want to mention is that additional stem cells may be collected from the placenta. This was mentioned by a couple of the private banks I reached out to and may be helpful if you are concerned about delaying clamping. If you are having stem cells collected from your placenta, it will be taken to a stem cell laboratory, where it is processed for additional stem cells. Of course this is not compatible with placenta encapsulation. If you already know that you want to encapsulate your placenta you would not be able to also have additional stem cells collected from the placenta.
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