What is cord blood? Cord blood is composed of the young stem cells that have the potential to run into any part of the body–from blood vessels to organs and tissues–and that is the subject of several FDA-regulated clinical trials to determine whether or not these specialized stem cells are suitable for the treatment of brain injury, autism or other conditions. Cord blood and other sources of stem cells like bone marrow are already used to treat dozens if not hundreds of diseases with varying levels of success.
How is cord blood collected?
In general, the cord blood collection process is painless and completely safe for both the baby as well as, the mother. Collection occurs directly after birth and is so fast and pain-free that new parents often aren’t aware that it has even happened! The umbilical cord is clamped and cut, no matter your delivery method, just as it normally would be by either your doctor or your partner. Some people believe there is a benefit in waiting up to a minute before clamping the cord, in the hopes that the baby will receive the extra benefit of additional blood moving through the cord. However, the cord must be clamped in the first 30 to 60 seconds or the blood becomes of no use to anyone as clotting has occurred and it cannot at that time be collected for storage. Once the cord has been clamped, your doctor or a nurse will extract the blood from the umbilical vein near the still-attached placenta, nowhere near your newborn baby. From there, typically 1 to 5 ounces of blood is collected as it drains into a collection bag, with the entire process taking ten minutes or less.
Once collection is complete, the cord blood is transported to a cord blood bank to be cryopreserved after testing and processing to ensure that the cord blood meets quality standards. There is also the possibility that you could have a portion of the umbilical cord retained, as it contains yet another type of stem cell that may turn out to be useful in the future, although no uses have yet been proven.
What does cord blood banking entail?
If you make a decision to store your baby’s cord blood in either a public or private bank, you’ve made a commitment to the future of your family–that cord blood and the stem cells contained within can help not just your baby with any future abnormalities, but potentially provide remedies for siblings or parents as well. Siblings are approximately 50% likely to be a partial match with the cord blood, while parents will be a partial match at least due to shared genetics. Once you have made the decision to store the cord blood, then you have another decision at hand; whether to choose public or private cord blood banking.
Cord blood banking is the process of collecting the small bit of blood that is left in your newborn’s placenta and umbilical cord. The blood will then be stored for future medical use along with the potentially life-saving stem cells contained within it. It is important to note that cord blood stem cells are different from embrionic stem cells, and both are different from the stem cells found in adult bone marrow, which can also be transplanted.
Cord blood can be banked in a private facility, which can be expensive, but offers a long-term guarantee that the cord blood will be available for your child and your family and the cord blood will be under your direct control at all times. The agreements generally last 20 years and can cost upwards of $3,000 over the life of the storage agreement. Alternatively, public cord blood banks offer nearly the same certainty of usage availability, but at a very small fraction of the cost. The downside to public cord blood banking is that, there is always the possibility that someone else may be a partial match to the cord blood that you stored, and that it wouldn’t be there for you when you needed it for your family. While that scenario sounds incredibly scary, it should be noted that the chances of this happening are incredibly small and remote.
What are some cord blood uses?
There are nearly 100 diseases that react well to treatment from cord blood stem cells, including genetic disorders, a broad range of cancers and several blood disorders as well. When cord blood is transplanted, it is introduced into the unhealthy body via an infusion directly into their blood, where the stem cells begin the work of repairing damaged cells and tissue. A successful immune system is the anticipated end result of a successful transplant.
Donated cord blood must meet certain quality standards before it will be accepted into a public or private bank. Some of those standards include assuring that there are enough blood-forming cells available for a transplant if one is needed in the future. If the number of cells is too low, there is still the potential that the cord blood could be used in research to help others be the recipients of successful cord blood transplants. The mother’s health is also studied extensively in order to be sure she meets basic guidelines, and the samples of blood must be free from medical concerns or infection of any kind. Any of the above reasons could cause a public or private cord blood facility to reject the addition of your newborn’s cord blood to the facility.
How do public cord blood registries work?
Cord blood and bone marrow donors are all entered into a “Be the Match Registry”, which is a national registry of umbilical cord blood units as well as those individuals who are ready and willing to donate bone marrow to others. This consolidated registry allows those who need the donation to be matched with donors, either from within their family or outside their family. Public cord blood facilities list their donated cord blood, and it can be incredibly useful when there are no adult donors who are a close match for the patient–patients are much more likely to have a successful transplant if they’re able to get a match that is as similar to their blood and body tissues as possible. The good news is that, cord blood does not require the near-perfect match that bone marrow does.
There are significant challenges for ethnic minorities who are sick and need to have stem cell treatment, as the number of minorities who are listed bone marrow donors is much smaller than the demand. This is yet another area where it is good to know how to donate cord blood–since the match required is less exact, racially or ethnically diverse patients are much more likely to be able to find a partial match that is “good enough” amongst a public cord blood bank. Also, when patients need a quick transplant, there often is not enough time to find a suitable bone marrow donor before the patient deteriorates. Patients are much more likely to find a match with someone of a similar racial and ethnic profile as they have.
Autologous use versus allogeneic use of cord blood
People often wonder what is cord blood used for? Two of the main uses for cord blood are: Use for the baby from who the stem cells were extracted and use by a sibling. Use by a sibling is allogeneic use of the cord blood, while use by the original donor is called autologous use. Both uses are equally valid, although, obviously, the original donor is a perfect match while the sibling is only a potential (thought highly likely) match for the cord blood stem cells. Several phase II clinical trials for diseases such as type 1 diabetes and cerebral palsy are currently underway, and require that individuals utilize their own stored blood in order to be eligible for participation in the study. In general, children receive treatment from their own blood (autologous use), especially in the case of cancers like neuroblastomas.
Allogeneic use of cord blood stem cells is on the rise though, as inherited genetic diseases often require a sibling donor transplant in order to be successful. Since inherited genetic disorders are inherited, siblings are actually prefered to first-person donors as there is a high likelihood that the cord blood already contains the abnormalities which caused the condition in the first place. In general, treatment from a close relative’s (like a sibling’s) cord blood can be up to two times as effective as cord blood that was collected outside the base family unit.
Use of the cord blood is better than using bone marrow because it is much easier to collect and can be stored frozen until it is needed. It is also much less likely to fall victim to graft versus host disease, where the immune system rejects the introduction of a foreign body into the host body. Adult treatment for disease with cord blood can be challenging, partially due to the very small volume of cord blood that is collected, and also because it can generally only be used to treat blood diseases–and isn’t a proven successful as of yet.
However, cord blood transplants also have limitations. Treatment of adults with cord blood has so far proved to be very challenging, despite some successes. Cord blood can also only be used to treat blood diseases. No therapies for non-blood-related diseases have yet been developed using HSCs from either cord blood or adult bone marrow.