Cord Blood Banking

The process of a baby developing and growing inside of Mommy is an amazing thing. From a medical standpoint, a baby starts as two cells, an egg and a sperm. They meet and 9 months later, you have a beautiful baby in your arms who is made of millions of cells — cells of all kinds (epithelial, myocardial, neural and more). The more you think about it, the more you realize the true miracle of life and the existence of God. As a friend who recently had a baby said, there are no atheists in the delivery room. He said that even if they don’t believe in God, they believe in some kind of higher power. Even just knowing and being witness to all of the things that have to take place for that baby to take its first breath, it is impossible to say God does not exist. This kind of thing doesn’t happen from the course of a “big bang” or as a result of evolution from a single cell millions of years ago. But this is not what I wanted to talk about.

In addition to seeing Baby develop over 9 months from two cells to something that actually looks like a person, there are plenty of other amazing things that happen. And a few of those things are what I want to talk about.

Placenta

If you took a biology course that touched on any anatomy and physiology, or have any basic knowledge of the reproductive system, you are probably familiar with the fact that during the early stages of development inside of Mommy, a placenta develops against the uterine wall. This is complete by the end of the first trimester (the first 3 month period of pregnancy). The placenta is the barrier between Baby and Mommy so that Baby can get nutrients from Mommy, expel his or her waste products as well as exchange oxygen and carbon dioxide. This placenta also prohibits blood exchange (or mixing, if you prefer) between Mommy and Baby, which is important for many reasons. But how do we connect the placenta to Baby so he or she can get the nutrients she needs?

A cord of three strands is not quickly torn apart

The umbilical cord solves that issue for us. Unlike the placenta which is relatively fragile (you could put a finger through it with minimal effort), the umbilical cord is relatively strong. This doesn’t mean that you can’t break them, because you can, but you can tug and pull with some force behind it and not see many problems. It’s pretty amazing how strong it is, but when you think about it, this is is the lifeline for Baby. You don’t want it to tear easily. It is made up of one large vein (what you see as the thick blue part in the picture to the right) and two much smaller arteries (in the white area, one which you can see, it is less prominent than the thick vein and rests just below it). My mind often goes to this phrase: “A cord of three strands is not quickly torn apart.” Through the cord, Mommy sends oxygen and nutrients that help Baby to grow; and Baby sends its waste back to Mommy for her to get rid of.

So, all of these parts are wonderful, but I have left one important part out. The blood. This is what helps create the magic of helping Baby develop by allowing nutrients and waste to be transported within it. But, did you know that once Baby is born, the blood that remains in the cord and placenta is no longer needed for him or her? Both the placenta and umbilical cord, and with that the cord blood, are thrown away in medical waste following the birth of your beautiful miracle. Did you know, though, that cord blood can be harvested and used in transplants before the physical structure that houses it during Baby’s development is thrown away?

It’s true! Cord blood is an amazing thing! Physicians and researchers still don’t understand all of the ways that the cord blood works — but we know it does, and it’s doing some phenomenal things. The cells within this blood are stem cells, hematopoietic (blood-forming) stem cells to be more exact. This is what makes them a fantastic source for transplant for lethal blood diseases, like leukemia, and as a substitute or supplement for bone marrow transplant (bone marrow helps produce blood). (Some of the benefits of cord blood over bone marrow is that cord blood is already harvested and the match doesn’t have to be as exact as with bone marrow.) During the transplant process, the hematopoietic stem cells are infused into the patient and they find their way (all on their own, amazingly!) to the area they are needed and start their work. However, to get to the point we are at now, we had to start with the first transplant more than 20 years ago.

It was almost 25 years ago, in 1988, that the first cord blood transplant took place. The idea has been researched long before a transplant occurred, but performing transplants using cord blood is still a very new field in the grand scheme of medicine. However, we have made great strides in this field in a short amount of time. It’s phenomenal to see how far it has come.

So, the first transplant: it was an international undertaking, to say the least. Physicians from across the US and the world collaborated on this case to help ensure a positive outcome for the patient, Matthew Farrow. Matthew was a patient at Duke University, where some of the pioneers in this field have spent their career. He suffered from a disease called Fanconi’s Anemia, which is a disease that damages cells and prevents them from repairing damaged DNA.

Phenotype = the observable characteristics, vs. genotype = the genetic makeup

(Although I’m not sure exactly how all these events fell into place…) He became a big brother and the cord blood from his sister was banked and stored in the Mid-West and then he received the transplant in France at the age of 5, because the procedure was not approved here in the States. This transplant cured him of his life-threatening disease, Fanconi’s Anemia, and is the first successful related cord blood transplant (“related” meaning coming from a blood relative). Today, Matthew is alive and well; he is a husband and father. Within 5 years of Matthew’s successful transplant (1993), the first successful unrelated cord blood transplant occurred (“unrelated” meaning coming from someone with no blood relation to the patient). It occurred in the States, and was done at Duke University. Since then, the number of cord blood transplants, both related and unrelated, have grown significantly. There have been thousands of transplants and thousands of lives saved or impacted because of these transplants.

Giving transplants is only one part. Cord blood banks are an essential part of the process. The banks that provide the cord blood for transplants are public banks (versus the private banks that many expecting parents have heard about through the literature they are inundated with). Public banks, as a rule, should be a voluntary donation from the mother to the bank of the placenta and umbilical cord, to include the blood inside. There should not be any money charged to the mom or her insurance. With public banks, the cord blood goes into a database and can be searched for through the Be the Match Registry in the National Marrow Donor Program to find the best match for a patient. This means that the cord blood you donated is not saved for your family. This is in contrast to the private banks where it is saved for your family; however, there is an initial fee to start the process and a yearly maintenance fee in order to keep the storage active (there are many reasons that saving it for your family is generally an unwise way to spend your money, the least of which is that the chances of needing to use it without any family history of *specific* problems is small; however, you would want to talk with your doctor and see if they have any specific reasons they would suggest it for you).

The first public cord blood bank in the US was started in New York in 1992. The hospital that performed the first cord blood transplant state-side, Duke University, opened their public cord blood bank in 1996. Both are going strong and have a large number of banked units ready to be shipped across the country and across the world to transplant centers. Today, there are more than two dozen public banks with about 100 collection sites across the United States.

As far as the donation process, I can speak to the center I work for since I know that system but I imagine others are relatively similar. Our labor patients are pre-screened, both by the cord blood collectors and to some extent by the labor nurses, as they have a good idea of some of the major criteria that would exclude patients from becoming donors (like mother’s age, gestational age, history of cancer, etc). Once we have given them a check on the pre-screening, the collector approaches the patient, as long as she is comfortable (we don’t talk to them if they are uncomfortable — we speak with the patient’s nurse before approaching the patient to ensure she is approachable) and explains the cord blood program. Some of the highlights that she will receive are:

  • We are a public bank
  • This is a voluntary donation and it is completely free of charge to you and your insurance
  • We don’t want this to change your delivery process at all
  • This cord blood could be life saving for the person receiving it
  • In order to start the collection, you need to sign a consent (which we are carrying with us)
  • If we get enough cord blood to start the banking process, there will be a medical questionnaire for you to fill out and a blood draw that will be tacked onto your normal blood draw that the hospital does the day after delivery (as we say to them, we don’t want to cause additional pain: the hospital is already sticking you to get blood, so we get them to draw our tubes at the same time)
  • Confidentiality is of the highest priority — throughout the transplant process, you can only be identified through a barcode system — your identifying information (name, address, etc) is kept in a confidential database at our bank
Once we get a confirmation of the patient saying they would like to donate, we also gather information about the ethnicity and race of the mother and father. We have found that the cord blood transplant recipients do better if they are matched up by ethnicity and race to the donor. One of the goals of my bank, and many banks across the country, is to increase the number of quality minority cord blood units available transplant. While we are “color-blind” in medicine, sometimes “color” makes a difference, and this is one of those cases. There are fewer minorities who choose to donate than Caucasians, on an overall basis, and therefore we are less picky on those units in order to have a greater selection, in terms of numbers, for our patients to be matched to. Of course, we would prefer to have excellent units for all ethnicities and races available. However, in an effort not to put pressure on our potential donors, we do not share this information until after they have stated they want to donate.

We are treating more and more diseases with this stem-cell rich cord blood. The list continues to grow, and the success rate continues to climb since the first transplant nearly a quarter century ago (now that makes it seem like a long time ago, eh?). The New York Blood Center, the first public cord blood bank, complied a list of all of the diseases that their cord blood units have been used to treat. The list includes the number of units that have been used to treat each of the diseases. For example, 2,030 units were used as transplants for leukemia patients and of those, 851 were used to for patients with Acute Lymphoblastic Leukemia. These numbers are a little out of date, probably from around 2008 or 2009, but you get the idea of the spread of what kinds of diseases are treated with transplants using cord blood. Click here for the link to the page.

For me, it’s an easy decision. When we have a baby, I will have no problem donating our cord blood to the public bank to be used for transplant (or, at our bank, there is the possibility for using it for research if the unit does not meet the requirements for transplant — this research is to help us learn how to use it even better for transplants; no cloning or anything like that). Donating the cord blood will take a few minutes out of my time to sign the consent and to fill out the medical questionnaire (something that, in conjunction with the blood tests, will help ensure the safety of the blood for the person receiving the transplant); however, this small contribution of my time will potentially save someone’s life or improve the quality of his or her life by stopping the disease process which is robbing them of their childhood (while adults can receive transplants, children are generally the primary beneficiaries).

Think about that. You can save a life by donating something that would otherwise be thrown away. Why wouldn’t you want to do it?

I want to leave you with this story done by Fox News. They recently visited the cord blood bank at Duke University and shared about public banking. I hope this will continue to increase interest in public banking, especially among the populations that we are really hoping to the availability for.

 

Where I got some of my information: 

Cord Blood Awareness 

Fox News :: Story & Just the Video

Hematology.org

National Cord Blood Program (NY Blood Center)

  • Mom

    Excellent explanation of the process and why it can be beneficial to others!  Hope folks will consider donating….it’s  just like at the Red Cross…. almost….
    Mom