Mrs. Michelle was seven months pregnant. She and her husband came in the office for a “pregnancy consult,” whereby they could meet me to see how the office operated. It also afforded an opportunity to answer any questions they might have about breast feeding, immunizations, availability of the doctor on call during the weekend, etc.
Everything was going fine when Mrs. Michelle asked me a question that gave me pause. She said that her sister had just had a baby back East. She and her husband had arranged for the umbilical cord blood to be saved in a cord blood bank, just in case their new baby should develop some life-threatening disease in the future. She asked if they should do the same. It was an interesting question. I had to honestly say that I didn’t know the answer, but that I would research it and get back to them as soon as possible.
Umbilical cord blood is an excellent source of hematologic stem cells. It can be used to reconstitute the bone marrow in the treatment of many malignancies such as Hodgkin’s disease, lymphoma, leukemia, and other cancers that might require a bone marrow transplant. It can also be used in the treatment of certain hemoglobin abnormalities, particularly sickle cell disease, and in certain immune system disorders and genetic metabolic disorders (inborn errors of metabolism).
The umbilical blood is obtained shortly after the baby is born while the obstetrician is waiting for the placenta to be delivered. The OB will clean and prep the umbilical vein while the placenta is still inside the womb. Then a needle is inserted into the vein, letting the blood flow freely for approximately ten minutes, collecting as much as possible. In no way is this a painful procedure as the umbilical cord has no nerves. The umbilical blood is then ultimately transported to the cord blood bank where it is stored at minus 196 degrees Centigrade.
There are many benefits to cord blood. In certain situations it can work every bit as well as a bone marrow transplant, AND there is a much better chance of a match with the cord blood. Experience has shown that frozen cord blood can be used for up to ten years after it has been harvested without fear of it’s biological potency deteriorating. Everyone knows the wonderful life-saving benefits of a bone marrow transplant. However, the harvesting of the marrow can be an unpleasant and painful procedure. This is not an issue when using umbilical cord blood.
Currently there are about 25 accredited cord blood banks in the country. If one were interested in donating cord blood they should discuss this with their obstetrician or contact www.nationalcordbloodprogram.com.
There are two main types of cord blood bank programs: private and public. The private cord blood banks are not inexpensive to employ. The initial cost to harvest and transport the cord blood is approximately $1,800. In addition about $150 a year is needed to store it. Most people use the private banking system as a source of ”biological insurance” in the event that a newborn might acquire a life-threatening illness in the future. However, the odds of one needing a cord blood transplant are very small. It is estimated to be approximately 1:2700. What parents need to know is that a cancer specialist usually avoids autologous cord blood transplants (cord blood from the same person) in the treatment of leukemia. That is because of the likelihood that there may be pre-malignant cells in the cord blood itself.
The public cord blood banks operate differently in that there is no cost to the family to store it. However, the family has no say in where this cord blood is donated. If a family wishes to make the donation to a public bank the expectant mother must be enrolled by 35 weeks of gestation. She must fill out a very comprehensive family history and sign an informed consent thereby agreeing to have her blood tested for a number of illnesses. During the screening process the mother’s blood will be tested for a number of infections, metabolic disorders, congenital disorders, chromosomal abnormalities and hemoglobinopathies. She will be given the results of the testing at no cost to her.
It must be agreed that the cord blood will not be stored for personal use, and that it will be used for unrelated donations. Information must be provided to the center about the health and well-being of her baby as he/she grows up. The likelihood that this particular cord blood will be used in the future is around one-in-three. The benefits to donating the cord blood to a public bank is that it will increase the pool nationwide and may very well save the life of another child.
There are a number of conditions that would preclude one from donating their cord blood. These include a history of exposure to a live virus vaccine within three months of delivery, drug abuse, high-risk sexual activity, a tattoo within the last year, or if they are a medication dependent diabetic.
While umbilical cord blood transplant holds much promise for the future, it is not without controversy. The controversy lies between the private and public banks. The American Academy of Pediatrics addressed this in January of 2007 in a policy statement entitled “Cord Blood Banking for Potential Future Transplantation.” In this statement policy the AAP officially encourages families to donate their newborn’s cord blood to a public cord blood bank if they so choose. It discourages private cord blood banking except where the infant has an older sibling with a condition that will require a bone marrow transplant.
I shared this information with Mr. and Mrs. Michelle. There was a long pause. Looking at each other Mr. Michelle said, “Whew! I didn’t know it was this complicated.” His wife agreed. They left saying that they were going to give it a lot of thought and would get back to me in the near future. A wise choice, for such an important decision.