Cord blood banking, is it beneficial?

14April 2023

What is cord blood and cord blood banking?

`Cord blood is the blood that is left in the umbilical cord and the placenta after birth. It can be used for research or preserved and later on used for stem cell transplant. Therefore cord blood banking is process of collecting the cord blood and freezing its stem cells for future use.

Cord blood banking is rapidly becoming popular. Over 780,000 cord blood units are stored in about 130 private blood banks. Similarly more than 400,000 units are stored in 100 public blood banks.

Why is cord blood necessary?

Cord blood is the main source of hematopoietic stem cells. Typically a cell from bone marrow can copy only itself; however, the hematopoietic stem cells can mature into other types of blood cells. The stem cells are also present in the bone marrow of adults and children.

Stem cells can help in the treatment of numerous diseases. In fact, for some conditions, stem cells are the primary treatment available.

Some of the disorders that can be treated using stem cells include:

Immune system disorders
Genetic disorders
Neurologic disorders
Some forms of cancer like leukemia and lymphoma

There are two types of stem cell transplant:

Autologous transplant	Allogenic transplant
The same child uses the cord blood collected at birth	The stem cells of somebody else are used to treat a disease
Rare	Common
It is not effective: · In the case of genetic diseases, since all the stem cells will have the same genes that caused the illness in the first place · For the treatment of a child’s leukemia,leukemia is a cancer of the blood.	It is not effective: · If the donor cells and the recipient’s cells are not compatible, since if the match is not right, the recipient’s immune system will reject the donor cells and the transplant would fail.

What are the risks and benefits of cord blood for the treatment of a disease?

The stem cells present in cord blood have a few advantages over the bone marrow cells present. Some of the advantages of using cord blood for the treatment of disease include:

It is much more challenging to collect bone marrow than it is to collect cord blood. The process of harvesting bone marrow can also be painful for the donor.
Cord blood can be saved for later use after freezing However, the bone marrow must be used as soon as it is extracted.
Bone marrow stem cells can’t be used for strengthening the immune system for cancer treatments. The cord blood stem cells can do this.
More people can get cord blood stem cells than bone marrow stem cells. This is because:
- Bone marrow stem cells have a higher chance of getting rejected.
- In cord blood transplant, more matches are possible.

The major disadvantage of cord blood is that it does not have enough stem cells. Therefore several donors would be needed to collect the requisite number of stem cells for a transplant in the case of an adult.

How is cord blood collected?

The collection of cord blood is a painless process takes about 10 minutes. There are two main ways to collect cord blood; these include:

In utero collection:
- Before delivery, the placenta (typically, after the baby is delivered), a small section of the umbilical cord is clamped. This is done to stop the blood flow.
- The clamped section of the umbilical cord is cleaned.
- With the help of a needle, which is connected to a blood bag, blood is removed from a vein in the umbilical cord.

The umbilical cord doesn't have nerves; therefore, the baby doesn’t feel anything when the blood is collected. It can be done in both vaginal delivery and Cesarean delivery.

Note: It is called in utero collection because when the blood is being collected the placenta is still in the uterus

Ex Utero collection:
- Cord blood can also be collected after the placenta is delivered.
- In the Ex Utero collection, after the delivery, the placenta is cleaned and placed on a high stand.
- When the cord is placed on the stand, the blood from the umbilical cord and the placenta drains out.

Note: It is called Ex Utero collection since, at the time of collection, the placenta is out of the uterus and disconnected.

What are the preparatory steps for cord blood collection?

The bank must be notified.
The collection kit must be obtained at least 6 weeks before the due date. Some hospitals have collection kits, whereas others do not.
You need to share your family’s medical history.
You will undergo some blood tests.
You must give your consent and sign a consent form before the labor begins.
In case you are opting for a private bank, you would need to sign a contract and pay a fee beforelabor.

What are the problems that you can encounter during cord blood collection?

Delivery-related emergencies: in this case, a priority is given to the baby's safety over the collection of cord blood
Insufficient amount of blood collected: Although this can happen for no reason, generally it occurs when:
- The baby is preterm
- The decision to clamp the umbilical cord is delayed.

Which method of cord blood collection is better?

Typically, cord blood is collected instantly after the delivery to save as much blood as possible. Generally,20 to 50 mlof blood is collected during cord blood collection.

Based on a study, it was found that regardless of the method of collection, the volume of blood that is collected remains the same.

However, in some cases,research shows that if the blood was collected by the in utero method, the chances are high that it will get rejected by the public banks. In comparison to the blood collected by Ex Utero method, the cord blood collected by In Utero method gets discarded more frequently because the following issues are common in the latter:

Contamination
Clotting
Processing delays

How is cord blood stored?

There are three types of cord blood banks for storing the blood collected:

Private cord blood banking:Also known as family banks, these store cord blood either for:
- Direct donation for a family member
- Autologous use

These parents store their babies' cord blood so that the baby or other family member may use it in the future. In return of their services the private banks charge a fee for:

Collecting the cord blood
Processing the cord blood
Annual storage fee

On an average private cord blood banking costs anywhere between $1350 to $2300 and an annual maintenance fee.However, some private banks may store the blood for free if you have a family member who may need treatment with stem cells in the future.

Advantages of private cord blood banking:

Reassurance:It is privately stored, therefore in case your child or anybody from your family needs this because of any disease like leukemia or lymphoma- you will have exclusive access to this valuable resource. Therefore reassurance of owning something so priceless and rare to find is a significant advantage.
Standards: the blood that is stored at a private bank must meet the same rules and standards as for the blood stored in a public bank

Disadvantages of private cord blood banking:

Store cord blood at private banks can be expensive: It may cost you around $1200 to $2500 in addition to the recurring annual storage charges. Moreover, you will have to pay for the blood collection kits and other services you take at the blood bank. There are private banks that offer short term and long term payment plans, however, over time this may become extremely expensive
Less government oversight: Due to the lenient regulations may negatively affect the quality of services like handling and storing. This may negate the chances of successfully using the stem cells if you ever need it.
No guarantee of viability:On some occasions, the cord blood stored privately may not be suitable or viable for treatment when your baby eventually needs it.

Public cord blood banks: These store cord blood for allogenic transplants. The services of public banks are free of cost. However, you will not have exclusive access to any donation of blood that you make. The blood will be made available to the public or can be used for research.You will have to sign a consent form that will give the public bank permission to collect and list your donation in its database to make it available to the needful.

You can store cord blood at a public bank for a direct donation if you have a family member suffering from a disease that may be treated with stem cells.

At the bank, the blood is given a type name. This is done so that when needed, it could be rapidly searched for from the database.

Advantages of public cord blood banking:

It is much cheaper for you than a private cord blood bank. The public banks don’t have storage charges however you may have to pay the hospital fees
It increases the diversity of cord blood available across the world.
People of different backgrounds have cheaper access to this valuable resource.
The blood stored at a public cord bank is tested for any kind of disorder before storing it. If the blood doesn’t pass the screening test for blood or immune system disorders, it is rejected.
It can be collected at any medical facility where the healthcare providers are trained to obtain and manage the cord blood.

Disadvantages of public cord blood banking:

You will lose all the rights to the blood at the time of the donation.
Unlike organ donation, you will not get priority treatment should you or your family members ever need a stem cell transplant.

Is it worth it to bank cord blood?

The decision to whether or not you should bank and store your cord blood is a very personal choice. However, the following factors may help you decide whether to save or not and what type of bank to choose:

In case you already have a child suffering from a medical condition that can be cured a cord blood transplant. In this situation, donating a sibling’s cord blood can prove to be really helpful.
When cord blood is donated to public banks, it adds to the supply and can prove helpful.
Cord blood bank donations can help someone who is from an ethnic minority group.
Public cord donations increase the chance of people from all groups in finding a match.

Since only a few hospitals collect cord blood for storage, therefore it is difficult to find. Cord blood is stored privately can prove to be helpful for your child and family members. It is better to have it and not need it than to need it and not have it.

Reference:

By -
Dr. Ruchika Singh

14-April-2023

Cord blood banking, is it beneficial?

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