Umbilical cord blood banking is the process of harvesting the blood from the umbilical cord and placenta after childbirth. The cord blood is obtained at childbirth, after the cord is severed from the newborn. The reason for collecting this blood is its supply of stem cells. Stem cells are characterized by their ability to renew themselves while differentiating into a number of specialized types of cells. Cord blood contains hematopoietic cells, which are stem cells that can be used to treat blood formation disorders and genetic disorders.
Removing umbilical cord blood causes no harm to the baby. Normally the umbilical cord would be simply thrown away and considered medical waste. There are a number of methods for collecting umbilical cord blood for an umbilical cord blood bank. Most commonly, the “closed technique” is used, which is very much like a standard technique for blood collection. A technician punctures the cord vein with a needle connected to a special bag. The blood flows into the bag from the needle. This technique typically yields around 75 ml of umbilical cord blood.
The blood collected from umbilical cords is cryopreserved. It is stored in an umbilical cord blood bank where it can be used later for transplantation. Umbilical cord blood banks may be private, in that the blood is specifically banked for donor families, who pay for the service, or public, where it is stored and becomes available to unrelated recipients. Private umbilical cord blood banking is a subject that raises differing opinions among doctors and parents, while public umbilical cord blood banking receives widespread support.
One reason for controversy over private cord blood storage is that the blood is reserved for the baby who donated it, just a ti ny percentage of babies – from 0.1% to 0.0005% – ever use their stored umbilical cord blood. The American Academy of Pediatrics made a policy statement in 2007 that physicians need to be aware of unsubstantiated claims made by private umbilical cord blood banks to expectant parents of insuring infants or their family members in the event of serious illness by use of the baby’s cord blood. The only time private umbilical cord blood banking is recommended is in the event of a family history of certain specific diseases that are genetic in origin. Private umbilical cord blood banks are generally for-profit agencies that store the blood for exclusive use by the donor or the donor’s relatives. It costs around $2,000 for collection of the blood and about $125 a year for storage.
Public banks store umbilical cord blood for the benefit of the public, and most coordinate matching through the National Marrow Donor Program . Donation to public umbilical cord banks is not available everywhere, though availability continues to expand. Public cord blood banks do not charge donors for the donation, though the OB/GYN may charge a collection fee if they so choose.
The first time a sibling-donor umbilical cord blood transplant took place was in 1988. After that, the U.S. National Institute of Health awarded a grant to start the first cord blood bank in New York. This was to establish an inventory of non-embryonic stem cells necessary to make unrelated, matched blood grafts for patients. A 2005 method developed at the University of Toronto resulted in an increase in the volume of stem cells from the umbilical cord to make them available for treating adults. http://en.wikipedia.org/wiki/National_Marrow_Donor_Program
The field of regenerative medicine represents research to develop treatments for repairing or even regrowing specific body tissues. A person’s own cord blood stem cells can be safely infused back into that person without immune system rejection, and because umbilical cord cells have characteristics that stem cells from other sources don’t have, they are attracting much attention in regenerative medicine research. The field is advancing quickly, so much so that medical societies and other sources of information for expectant parents have a hard time keeping up with the pace of change.
The use of umbilical cord stem cells for uses beyond blood diseases and cancers is showing promise, too. Blood from umbilical cord blood banks are being used in the treatment of certain brain injuries, Type 1 Diabetes, stroke, and hearing loss. It is estimated that as many as one in three Americans could benefit from the discoveries being made in rege nerative medicine. Children whose umbilical cord blood was stored privately could be the first to benefit from new therapies because there is no risk of rejection of the umbilical cord blood cells that came from their own umbilical cords.
There are already almost 80 diseases approved for autologous (donor and recipient are the same person) treatments with cord blood cells. They include several forms of leukemia, lymphoma, Hodgkin’s lymphoma, Waldenstrom’s macroglobulinemia, Ewing sarcoma, ovarian cancer, neuroblastoma, small cell lung cancer, renal cell carcinoma, testicular cancer, aplastic anemia, sickle cell disease, Langerhans’ cell histiocytosis, acute myelofibrosis, Hunter disease, Hurler syndrome, Maroteaux-Lamy syndrome, Batten disease, Nieman-Pick disease, Gunther disease, osteopetrosis, multiple sclerosis, rheumatoid, and lupus. This list is incomplete and is being expanded rapidly.
The most promising applications for autologous cord blood treatment are for type 1 diabetes, neuroblastoma, aplastic anemia, and cerebral palsy. With type 1 diabetes, infusion of autologous cord blood stem cells has been shown to be safe, and may slow the loss of insulin production in children with this di sease.
In animal studies of myocardial infarction (heart attack), autologous stem cells have shown that they can selectively seek out injured heart tissue and improve vascular function and blood flow, improving overall heart function. Animal studies of brain injury have even shown alleviating of mobility-related symptoms. Even administering human cord blood stem cells into animals who have had a stroke was seen to stimulate the creation of new blood vessels and neurons. At Duke university, autologous infusions in children with cerebral palsy and other brain injury are showing promise.
Private umbilical cord blood banks have generated controversy from government and nonprofit organizations, primarily based on varying beliefs about the current and future success of using stored blood. A study in a clinical journal on the topic of bone marrow transplantation calculated the lifetime probability (to age 70) of an individual in the U.S. u ndergoing a stem cell transplant at 1 in 435.
The National Marrow Donor Program has estimated that by 2015, cord blood transplants could reach 10,000 per year using blood from public umbilical cord blood banks. Therefore, the U.S. Health Resources and Services Administration and the Department of Health and Human Services is funding registry programs for bone marrow donors and donations of cord blood. In Europe, the European Union Group on Ethics issued an opinion that questioned the legitimacy of for-profit blood banks for autologous umbilical cord blood because of the lack of real therapeutic options. However, the group states that in the future if autologous therapies advanced sufficiently, then private cord blood storage could be reconsidered.
The World Marrow Donor Association issued a policy statement in 2006 on private umbilical cord blood banking stating that because autologous umbilic al blood carries genetic defects already, they should not be used against genetic diseases, and there is no contemporary protocol using autologous umbilical cord blood stem cells. But if autologous stem cell therapy should become a reliable form of treatment in the future, then the issue should be revisited.