The umbilical cord connects a fetus to the placenta, supplying an unborn baby with nutrients and oxygen and removing waste products. After delivery of the baby, the cord is clamped and cut, leaving a small stump that will heal and become the baby’s belly button. (For an explanation of the structure and function of the umbilical cord, read this Pulse post.) The remainder of the cord, and all the blood that it contains, is usually discarded. Cord blood banking, however, is the process of storing and preserving the cord blood for future use.
The magic of stem cells
One of the most important things that umbilical cord blood contains is hematopoietic stem cells (HSCs). (HSCs are also found in the blood and bone marrow of adults and children.) These cells are able to develop into all types of blood cells, including white blood cells, red blood cells, and platelets, which are responsible for maintaining the body’s immune system and healing capabilities.
HSCs are particularly special because most cells are only able to make copies of themselves, but HSCs can mature and change into different types of cells. This feature means that HSCs can be used to treat some diseases (in a process called a “stem cell transplant”), including immune system, genetic, and neurological disorders, as well as some cancers.
Your own or someone else’s?
HSCs can be transplanted to a recipient in one of two ways. An autologous transplant means that a recipient uses his or her own cord blood that was collected at birth. This type of transplant cannot be used to treat genetic diseases, since all of the stem cells have the same genes as the cells that caused the disease. A person’s own HSCs also cannot be used to treat his or her own blood cancer. The more common type of transplant is an allogenic transplant, which means that a recipient receives HSCs obtained from another donor. The donor may be related or unrelated to the recipient, but the HSCs must be a good match—based on things like ethnicity, blood type, and other blood characteristics—between the donor and recipient.
The HSCs found in cord blood are advantageous over those obtained from bone marrow since they can be used to treat more people: HSCs from cord blood are less likely to be rejected by a transplant recipient than those from bone marrow. It’s also much easier to collect HSCs from cord blood than from bone marrow: bone marrow donation from a living donor can be difficult and painful. Cord blood can also be frozen and stored for later use by someone who needs it: bone marrow donations must be used soon after collection. And, HSCs from cord blood have not been exposed to illness or environmental factors like stem cells from living donors.
A significant disadvantage of HSCs from cord blood is the small number of HSCs contained in the blood. Several cord blood donations need to be combined to obtain enough HSCs to be used for an adult transplant.
Public or private?
Cord blood obtained shortly after birth can be stored in a public or a private bank. Private banks are often used to store blood for autologous transplants or transplants directly to a family member of the donor. There is usually a storage fee, but some banks waive the storage fee under certain circumstances. A public bank stores cord blood for allogenic transplants. There is no charge for the storage, but the blood and its HSCs can be used by anyone who is a match.
If you are interested in storing your baby’s cord blood, you need to contact a storage bank approximately 6 weeks before your due date. Some hospitals have collection kits on hand, but many do not. The process is simple and painless but does require plenty of notification and preparation and, in the case of private banks, the remittance of a fee prior to labor beginning. Cord blood collection can be completed after a vaginal or cesarean delivery, and there are no health risks to the donor mother or baby.
Read this Pulse post for more information on how to decide if you are a suitable cord blood donor and understand the steps you need to take before donating.
Store or donate?
Cord blood banking may be the right choice for you:
- If you already have a child with a medical condition that may benefit from an HSC transplant
- If you want to donate to the public supply of cord blood so that others can be potentially helped
Storing cord blood as “insurance” against future illnesses is not recommended by the American College of Obstetricians and Gynecologists. In part, this is because of the very low possibility that your child will need and be able to use the cord blood. One study estimated that the lifetime chance of using your own cord blood is between 1 in 400 to 1 in 200,000. The blood may not be able to be stored indefinitely, also limiting its usefulness in the future.
The American Academy of Pediatrics also acknowledges the limited role of private cord blood banking for your child’s own future use but does advocate for the public donation of cord blood.
If you choose to bank your baby’s cord blood (either publicly or privately), make sure you find a facility that is accredited by the American Association of Blood Banks or the Foundation for the Accreditation of Cellular Therapy (FACT) to handle HSCs.
Cord blood stem cells have plenty of medical value and, if you decide not to store it for your own family’s future use, donating it to advance medical research or potentially save the life of a stranger may be the right choice for you. So far, more than 40,000 people have received stem cell transplants from cord blood donations, and research is giving hope to thousands more people with conditions for which there are currently no effective treatments, including autism and cerebral palsy.