On the day you
deliver
your baby, you'll probably be overcome with visions of your
future with your child - first smiles and steps, birthday parties
and sports events, and holidays and life milestones. Your little
one ever becoming seriously ill will probably be the last thing on
your mind.
But some parents do consider the possibility that a serious
illness might someday affect their child - and they make a choice
on the
day their baby is born
that might impact the future health of that child or even their
other children. They're deciding to bank their newborn's
cord blood.
So, what is cord-blood banking, and is it right for you?
Cord-Blood Banking
After a baby is delivered, the mother's body releases the
placenta, the temporary organ that transferred oxygen and nutrients
to the baby while in the mother's
uterus
. Until recently, in most cases the umbilical cord and placenta
were discarded after birth without a second thought. But during the
1970s, researchers discovered that umbilical cord blood could
supply the same kinds of blood-forming (hematopoietic) stem cells
as a bone marrow donor. And so, umbilical cord blood began to be
collected and stored.
What are blood-forming stem cells? These are primitive (early)
cells found primarily in the bone marrow that are capable of
developing into the three types of mature blood cells present in
our
blood
- red blood cells, white blood cells, and platelets. Cord-blood
stem cells may also have the potential to give rise to other cell
types in the body.
Some serious illnesses (such as certain
childhood cancers
, blood diseases, and immune system disorders) require
radiation
and
chemotherapy
treatments to kill diseased cells in the body. Unfortunately, these
treatments also kill many "good" cells along with the
bad, including healthy stem cells that live in the bone marrow.
Depending on the type of disease and treatment needed, some
children need a bone marrow transplant (from a donor whose marrow
cells closely match their own). Blood-forming stem cells from the
donor are transplanted into the child who is ill, and those cells
go on to manufacture new, healthy blood cells and enhance the
child's blood-producing and immune system capability.
How It Works
Collection of the cord blood takes place shortly after birth in
both vaginal and cesarean (c-section) deliveries. It's done
using a specific kit that parents must order ahead of time from
their chosen cord-blood bank.
After a vaginal delivery, the umbilical cord is clamped on both
sides and cut. In most cases, an experienced obstetrician or nurse
collects the cord blood before the placenta is delivered. One side
of the umbilical cord is unclamped, and a small tube is passed into
the umbilical vein to collect the blood. After blood has been
collected from the cord, needles are placed on the side of the
surface of the placenta that was connected to the fetus to collect
more blood and cells from the large blood vessels that fed the
fetus.
During cesarean births, cord-blood collection is more
complicated because the obstetrician's primary focus in the
operating room is tending to the surgical concerns of the mother.
After the baby has been safely delivered and the mother's
uterus has been sutured, the cord blood can be collected. However,
less cord blood is usually collected when delivery is by c-section.
The amount collected is critical because the more blood collected,
the more stem cells collected. If using the stem cells ever becomes
necessary, having more to implant increases the chances of
engraftment
(successful transplantation).
After cord-blood collection has taken place, the blood is placed
into bags or syringes and is usually taken by courier to the
cord-blood bank. Once there, the sample is given an identifying
number. Then the stem cells are separated from the rest of the
blood and are stored
cryogenically
(frozen in liquid nitrogen) in a collection facility, also known as
a cord-blood bank. Then, if needed, blood-forming stem cells can be
thawed and used in either
autologous
procedures (when a person receives his or her own umbilical cord
blood in a transplant) or
allogeneic
procedures (when a person receives umbilical cord blood donated
from someone else - a sibling, close relative, or anonymous
donor).
How long can blood-forming stem cells last when properly stored?
Theoretically, stem cells should last forever, but cord-blood
research has only been ongoing since the 1970s, so the maximum time
for storage and potential usage are still being determined.
Blood-forming stem cells that have been stored for more than a
decade have been used successfully in transplants.
Pros and Cons
Cord-blood banking isn't routine in hospital or home
deliveries - it's a procedure you have to choose and plan for
beforehand, so be sure to consider your decision carefully before
delivery day.
The primary reason that parents consider banking their
newborn's cord blood is because they have a child or close
relative with or a
family medical history
of diseases that can be treated with bone marrow transplants. Some
diseases that more commonly involve bone marrow transplants include
certain kinds of
leukemia
or
lymphoma
, aplastic
anemia
, severe
sickle cell anemia
, and
severe combined immune deficiency
.
The odds that the average baby without risk factors will ever
use his or her own banked cord blood is considered low; however, no
accurate estimates exist at this time.
The expense of collecting and storing the cord blood can be a
deciding factor for many families. At a commercial cord-blood bank,
you'll pay approximately $1,000-$2,000 to store a sample of
cord blood, in addition to an approximately $100 yearly
maintenance fee. You might also pay an additional fee of several
hundred dollars for the cord-blood collection kit, courier service
to the cord-blood bank, and initial processing.
In most cases, stem cell transplants are performed only on
children or young adults. The larger the size of the person, the
more blood-forming stem cells are needed for a successful
transplant. Umbilical cord blood stem cells aren't adequate in
quantity to complete an adult's transplant.
In addition, it's not known whether stem cells taken from a
relative offer more success than those taken from an unrelated
donor. Stem cells from cord blood from both related and unrelated
donors have been successful in many transplants. That's because
blood-forming stem cells taken from cord blood are
naive
(a medical term for early cells that are still highly adaptable and
are less likely to be rejected by the recipient's immune
system). Therefore, donor cord-blood stem cells do
not
need to be a perfect match to create a successful bone marrow
transplant.
There has been little experience with transplanting self-donated
cells. Some experts are concerned that an ill baby who receives his
or her own stem cells during a transplant would be prone to a
repeat of the same disease. Most of the bone marrow transplants
that use blood-forming stem cells have been performed on relatives
of the donating child, not on the donating child.
The risks to the health of the mother and baby at the time of
collection are low, but they do exist. Clamping the umbilical cord
too soon after birth may increase the amount of collected blood,
but it could cause the baby to have a lower blood volume and
possible anemia soon after birth.
Is It Right for You?
As parents evaluate their reasons for banking their
newborn's cord blood and begin to research cord-blood bank
facilities, there are many considerations and cautions to keep in
mind.
Some doctors and organizations, such as the American Academy of
Pediatrics (AAP), have expressed concern that cord-blood banks may
capitalize on the fears of vulnerable new parents by providing
misleading information about the statistics of bone marrow
transplants. Parents of children of ethnic or racial minorities,
adopted children
, or children conceived through in vitro fertilization may be
especially encouraged to bank cord blood because it's
statistically harder to find a match in these cases.
The AAP doesn't recommend cord-blood banking for families
who don't have a history of disease. That's because
research has not yet determined the likelihood that a child would
ever need his or her own stem cells, nor has it confirmed that
transplantation using self-donated cells rather than cells from a
relative or stranger is safer or more effective. According to the
AAP, "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 a stem cell transplantation."
Other doctors and researchers support saving umbilical cord
blood as a source of blood-forming stem cells in every delivery -
mainly because of the promise that stem-cell research holds for the
future. Most people would have little use for stem cells now, but
research into the use of stem cells for treatment of disease is
ongoing - and the future looks promising.
If you do decide to bank your newborn's cord blood, be sure
to discuss your options with your obstetrician. Here are a few
questions to consider before choosing a cord-blood bank:
- How financially stable is the cord-blood bank? (Financial
stability means a reduced chance that you will have to transfer
your sample if the facility closes.)
- How many samples are processed in the facility? (A larger
number of samples usually means that there are more collection
and handling procedures in place.)
- Do I have the option of switching to another facility if I
choose?
- What happens to my sample if the facility goes out of
business?
- What are the yearly fees and maintenance costs involved? Will
these fees increase, or are they fixed?
Like community or hospital blood banks, cord-blood banks are
regulated by the U.S. Food and Drug Administration (FDA), which has
developed standards regulating future cord-blood collection and
storage.
Donating Your Baby's Cord Blood
You may decide that instead of banking your newborn's cord
blood, you'd like to donate it to a nonprofit cord-blood bank
for research or to save the life of another child. By choosing this
option, the cord blood will still be collected after your
child's birth, but it will be anonymously marked and sent to a
public bank. However, if your child or a family member later
develops a disease that requires a bone marrow transplant for
treatment, you won't be able to obtain the donation you made to
the bank.
If you'd like to donate your child's umbilical cord
blood, contact your local chapter of the American Red Cross or a
local university hospital, or check the National Marrow Donor
Program's list of registered cord-blood facilities that accept
donations. You'll need to give proper written consent before
you donate your child's umbilical cord blood, but there's
no cost and the process is confidential.
Reviewed by:
Steven Dowshen, MD
Date reviewed: November 2007
Originally reviewed by:
Michael Trigg, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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