Should You Bank on it?
The basics of cord blood banking.
by Mamie Lipari

PARENTGUIDE NEWS January 2008

Have you seen ads for cord blood banking in pregnancy and parenting magazines? If you are expecting children or you plan to have kids in the future, you may be wondering if this seems right for you.

Most infants and children grow up healthy without needing to use cord blood. “No estimates exist of the likelihood of children to need their own cells,” according to a position statement by the American Academy of Pediatrics. “The range of available estimates is from 1:1000 to 1:200,000... Private storage of cord blood as biological insurance is unwise. However, banking should be considered if there is a family member with a current or potential need to undergo stem cell transplantation.” Despite these recommendations, there is always a chance that a child might develop a serious illness for which a cord blood transplantation may be a useful and lifesaving treatment.

In 1998, I was pregnant with twin boys, and my husband and I decided to bank the umbilical cord blood. We felt that we were securing our family’s future health by making this decision. At the time, there were less than a handful of private cord blood storage facilities in the United States. Now, there are at least 28 private storage companies throughout the country.

A growing number of families are banking cord blood. According to Rita Kennen, the media relations manager of Cord Blood Registry (CBR), the number of expectant parents taking advantage of this lifesaving technology is steadily increasing. In 1995, when Cord Blood Registry started storing cord blood for families, about 1,000 families a year in the United States stored their newborns’ cord blood. Currently, about 150,000 families a year bank their newborns’ stem cells.

Umbilical cord blood can be stored for private use for a fee. First-year fees can range from $900 to $1,700. This usually includes collection, processing and first-year storage fees. There is then an annual storage fee of about $100. Umbilical cord blood can also be donated and stored at one of about 20 public cord blood banks in the country and then listed on a National Marrow Donor Program Registry. The list is then available to patients all over the world searching for a match. There is no cost for this type of storage.

What is umbilical cord blood? After a baby’s birth, when the umbilical cord is clamped, there is a small amount of blood remaining in the placenta and umbilical cord. This is approximately 3 to 5 ounces. It is rich in blood-forming primitive stem cells that have potential to become all components of blood. It can be used for transplants as an effective alternative to bone marrow in both children and adults. Because of the limited amount of blood, it is usually reserved for children or small adults. However, the cells can be expanded using growth factors and multiple cord units can be used in combination for transplant in larger patients.

Cord blood cells are hematopoietic stem cells. That means that they have the potential to grow a complete human immune system including white blood cells, red blood cells and platelets. This is useful in patients with a variety of disorders including, but not limited to, acute and chronic leukemia, aplastic anemia, sickle cell anemia, thalassemia or any other condition involving bone marrow failure. It is collected after delivery and clamping of the umbilical cord with no harm to the mother or fetus.

Cord blood stem cells should not be confused with pluripotent stem cells, which are presently the subject of much debate in this country. Pluripotent stem cells are derived from human embryos and have potential to grow all types of human tissues. There is ongoing research to determine if cord blood stem cells could also give rise to different tissues, such as nerve cells in the brain.

Cord blood is quickly available when needed for a transplant. Due to the immunologic immaturity of the cells, there is less incidence of graft versus host disease when compared to bone marrow transplants. This is a rejection and a potentially fatal complication of transplants that are non-autologous (not one’s own blood or marrow).

Potential setbacks of cord blood use are the small amounts of blood, the lack of backup donations from the same donor should the need arise, the lack of experience with the viability of the cells beyond ten years, the inability to use the blood for certain genetic diseases because of contamination of the cells with the disease, and longer time for engraftment. Engraftment is the time it takes for cells to grow and form a new immune system. Longer periods of engraftment are associated with increased risk of infection.

According to Kennan, Cord Blood Registry has provided samples for 45 medical therapies. The stem cells were 100 percent viable for use. In fact, CBR holds the world record for the longest a sample was stored and then thawed for use in medical treatment. That sample was processed and stored in 1997 and recently used by physicians at City of Hope Hospital in San Diego, California, to treat a child with aplastic anemia.
Anyone who has decided to store their child’s umbilical cord blood should take the following steps.

•Research the different cord blood storage facilities and find one that is right for you. Ask about fees, accreditation, storage facilities, transport and other important details. For public donation, contact the National Marrow Donor Program.

•Choose a facility and contact it. The facility will send an information packet that may include a family medical history questionnaire, a consent form and collection materials.

•Inform your obstetrician of your decision as soon as possible. Bring your kit with you to the next office visit so that he can familiarize himself with the collection process.

•Pack the kit in your “delivery bag” along with your other personal items. You must give this kit to your obstetrician at the hospital so the blood will be collected.

•As soon as possible during labor or after labor is completed, contact the cord blood storage facility and arrange for a courier to pick up the collected blood. Insist on a medical courier. This will ensure that the blood is handled with the utmost care to maintain viability. Most facilities arrange this for a fee. Public storage facilities pick up the collected blood for free.

•The blood will be delivered and tested before being stored for potential future use for a yearly fee.
•Breathe a sigh of relief. The blood is there if you need it, but hopefully and most likely you won’t. Now enjoy time with your new baby.

Private Cord Blood Banking
These are the oldest and most experienced private cord blood banking facilities nationwide.
All are accredited by the American Association of Blood Banks.
•Cor Cell, established 1996, www.corcell.com.
•Cord Blood Registry, established 1995, www.cordblood.com.
•Cryo-Cell International, Inc., established 1989, www.cryo-cell.com.
•ViaCord, established 1995, www.viacord.com.

Public Cord Blood Banking
Information regarding public donation of cord blood can be obtained through the National Marrow Program Registry at www.marrow-donor.org. To contact the registry, call (800)627-7692.

Dr. Mamie Lipari is a board-certified neurologist in Rockville Centre, New York, with three children.