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Cord blood bank

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Both private and public cord blood banks have developed since in the mid- to late 1990s in response to the success of umbilical cord blood transplants in treating diseases of the blood and immune systems, such as Fanconi's anemia and Leukemia. Cord blood, once seen as waste to be discarded after a birth, is now viewed as a precious resource. Since the first successful cord blood transplant was performed on a child with Fanconi’s anemia in 1988, over 6,000 patients have been treated with this procedure. In 2004, 600 of those transplants took place in the United States. Cord blood contains hematopoietic stem cells, progenitor cells that can form red blood cells, white blood cells and platelets and can be used to treat many diseases of the blood and immune systems.

Public banks accept donations to be used for anyone in need. However, there are very strict regulations that public banks need to follow in order to enable the donated units to be added to a registry. The National Marrow Donor Program has a list of public cord blood banks on their website. www.marrow.org. Once the blood is donated, it loses all identifying information after a short period of initial testing, so that families will not be able to retrieve their blood later. Private banking allows families to preserve their blood for their own use. For-profit private banks charge a fee of around $2000 to preserve a newborn’s cord blood for possible use by the family later.

Private cord blood banking is controversial within the medical community. This practice is opposed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the Royal College of Obstetricians and Gynaecologists, and the European Group on Ethics.

Contents

The collection process

Whether a mother chooses to donate cord blood or store it for private use, the initial collection process is the same and poses no danger to mother or baby. There are two methods to collection, in-utero and ex-utero. During in-utero collection, the cord blood is collected while the doctor or midwife is waiting for the placenta to deliver naturally. There is a period of 5-10 minutes after the baby is delivered and before the placenta is delivered where there is ample time to collect the cord blood. During an ex-utero collection, the placenta is delivered and then placed in a sterile supporting structure with the umbilical cord hanging through the support. For a picture of the ex-utero collection you can visit [www.cordblood.com]. An adequate cord blood collection requires at least 75 mL in order to ensure that there will be enough cells to be used for a transplantation. After the collection, the cord blood unit is shipped to the lab and processed and then cryopreserved. There are many ways to process a cord blood unit 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 cryoperservant is added to the cord blood to allow the cells to survive the cyrogenic process. After the unit is slowly cooled to -90 Celsius it can then be added to a liquid nitorgen tank that will keep the cord blood unit frozen at -196 Celsius. The slow freezing process is important to keep the cells alive during the freezing process. Before the blood is stored for later use, it undergoes viral testing, including tests for HIV and Hepatitis B and C and tissue typing (to determine HLA type).

Likelihood of use

"According to research in the Journal of Pediatric Hematology/Oncology (1997, 19:3, 183-187), the odds that a child will need to use his or her own stem cells by age twenty-one for current treatments are about 1:2,700, and the odds that a family member would need to use those cells are about 1:1,400." [source]

Benefits

Cord blood is currently used to treat approximately 75 genetic diseases, cancers, and blood disorders. For a list, see cord blood.

Problems

Public bank problems

Cord blood Banking is still in its developmental stages and there are issues in both private and public banking that need to be resolved before it will become a widely established practice. The main concern of cord blood banking, private or public, is that the long-term viability of cryogenically frozen cord blood has yet to be firmly established. The primary concern with public banking is how to ensure the safety of the cord blood. Because of privacy concerns, it is agreed by most ethical review boards that blood donated to a public bank cannot be permanently linked to the donor. Although cord blood that is donated goes through a series of tests for potentially harmful genetic disorders and viruses, some genetic disorders such as congenital anemias or immunodeficiencies might not become apparent in the donor for months or years, by which time all identifying information has long been removed. Because the recipient of the blood could also develop these disorders, this is an important concern. The larger obstacle facing public banks is that the costs required to maintain them has prevented more than a handful from opening. Because public banks do not charge storage fees, many medical centers do not have the funds required to establish and maintain them.

Private bank problems

Private cord blood banking also poses problems. Children who develop an immunological disorder often are unable to use their own cord blood for transplant because the blood also contains the same genetic defect. The cost of private banking also prevents it from being an option available to all families. Private cord blood banks have often been criticized for preying upon the insecurity of new parents, on the grounds that currently the chances of a child needing his or her own cord blood are exceedingly small, whereas storage fees at private banks are typically very high. Accordingly, whether cord blood banking is a worthwhile investment for the expectant parent depends in part upon the economic status of the parent.

Concerns about premature clamping

Concerns have been raised that the current interest in cord blood could cause a perception that cord blood is 'unused' by the birth process, thus decreasing the amount of blood that is infused into the child as part of the birth process. The pulsation of the cord pushes blood into the child, and it has been recommended that the cord cease pulsation prior to clamping. With the demand for cord blood increasing, there is a possibility that the cord could be clamped prematurely to preserve even more 'extra' cord blood. This action could have detrimental affects on the child's future development. See the websites: www.cordclamping.com [link] and www.gentlebirth.org [link]. It is important to note however, that it is considered standard practice by cord blood banks to request that the delivering physician not alter the regular course of the birthing process, and if delivering in a hospital under standard procedures, collection of cord blood will not have any effect on the normal birthing process.

Sources

See also

External links

General

Public cord blood banks

Private cord blood banks

 

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