A slew of thoughts ran through my mind when I found out I was expecting my first little bundle. Is it a boy or a girl? What color should I paint the nursery? Will he or she look like me? Act like my husband? Which stroller should I add to my registry? But as my pregnancy progressed, the trivial thoughts took a backseat to the truly important decisions that would affect the future health of my son. (It’s a boy!) When first asked how I felt about banking my little guy’s cord blood, I wasn’t even able to give an answer. I hadn’t done any research and didn’t know all the facts. Since then, I’ve learned everything I could about the process from medical professionals, cord blood banks and families who saved their children’s cord blood, so I could make an informed and deliberate decision.
To be honest, initially I wasn’t quite sure what cord blood was. Sure, it sounded obvious—blood that comes from the baby’s umbilical cord—but as it turns out, there’s a little more to it. Banking facility Cord Blood Registry (CBR) clarifies the facts on its website: “Cord blood is the blood that remains in your baby’s umbilical cord after the cord has been cut. It is a rich source of unique stem cells that can be used in medical treatments.” In other words, the umbilical cord, which is responsible for carrying nutrients and oxygen to the baby while in utero, is also home to a high number of stem cells.
To delve further into my stem cell education, I turned to Cryocell, a cord blood bank that prides itself on innovative approaches and applications of newly developed stem cells. According to its site, stem cells are “special cells normally found in bone marrow. They are responsible for producing all of the mature cells in our blood and immune system.” And they don’t stop there. They also form the white cells that fight infection, the red cells that carry oxygen, and the platelets that promote clotting. Pretty impressive, huh? These little fellas also continuously make copies of themselves. If you were to transplant these cells into a compatible person’s body, they would transform into whatever type of cell that body needs—they’re completely adaptable.
Once researchers realized the potential benefits of the stem cells in cord blood, cord blood banks were created. These storage centers allow families to harness the power of life-saving blood and stem cells in case they need to call on it in the future.
Now that I understood the basics of cord blood, I wanted to investigate the reasons for storing it. In doing so, I came across Quentin Murray’s story. When Quentin was 4 years old, he was diagnosed with a form of lympho- blastic leukemia that left him with less than a 30 percent chance of survival. With the help of Quentin’s mother, who was pregnant with Quentin’s sister, and the guidance of his doctor, Lolie Yu, MD, MPH, a pediatric oncologist, transplant specialist and professor of pediatrics at Lousiana State University’s Health Center, the family was able to store the new baby’s placental and cord blood with LifebankUSA. The cord blood was a match for Quentin, and he was able to undergo a transplant using stem cells from both the placenta and umbilical cord. Murray’s leukemia has been in continuous and complete remission since his transplant, and he was deemed fully cured on March 28, 2010, the two-year anniversary of his transplant.
Quentin’s story isn’t unique. While talking with blood bank ViaCord, I learned the story of Andy Treviño. Eleven years ago, Andrés and Paulina Treviño embarked on a desperate quest to save their 2-year-old son Andy, who was dying from a rare genetic disorder called primary immune deficiency. He needed a transplant of healthy stem cells to replace defective cells in order to survive. After exhausting their options searching for a compatible donor in the public registry for more than two years, the family decided to have another child (they had always planned on doing so) whose umbilical cord blood stem cells could save Andy. After three years and five IVF cycles, Sofia was born. Her cord blood stem cells were transplanted into her brother via blood transfusion, replacing his faulty immune system and eventually saving his life. Today, Andy, 13, and Sofia, 8, are both healthy, active children.
With all the medical advancements, it was clear to me that cord blood banking is a valuable investment, but I still didn’t know the details of how it was collected and stored. Would it hurt? Was it a lengthy process? Upon looking into it, I was pleased to find it was painless and wouldn’t bother my son or me at all. First, the umbilical cord is clamped; then blood from it and the placenta are drawn and transferred via needle into a sterile bag. The whole process takes only about five minutes. Once the cord blood is collected, it’s picked up by a courier and transported to the storage facility (either public or private) where it is processed and frozen.
The advancements in regenerative medicine were promising and the collection process seemed easy enough, but now I needed to make some inquiries regarding public versus private facilities, so that if I decided to bank my baby’s cord blood, I would know which storage option was best for us.
Private. The decision to store at a private bank comes with the benefit that the blood “belongs to the family,” explains Morey Kraus, chief scientific officer at ViaCord, and therefore can be used at the family’s discretion. “If a valid medical professional requests it for the family,” Kraus says, “we have it shipped.”
An important part of the success of private blood banking has to do with human leukocyte antigens (HLA) found in the cord blood. “HLA antigens are found on most cells of the body and play an integral role in the body’s recognition of self and non-self,” says Nancy L. Sapanara, MD, JD, FCAP, medical director of Lifebank USA. “Because HLA antigens can recognize non-self, or foreign, cells in the body, they are an important part of the immune system.” Sapanara says that the unfortunate part comes when the antigens can’t tell the difference between a bad foreign cell, such as an infectious bacteria, and a good foreign cell, such as those used in stem cell transplants. “Doctors try to find donor stem cells with the same HLA antigens as the recipient so that the cells are not rejected by the recipient,” she explains. “Oftentimes, the closer the HLA match between donor and recipient, the better the outcome.”
Everybody has two copies of the chromosome that codes for HLA—one from each parent—so there are a total of four possible HLA combinations in the child. This means there is a 25 percent chance that a child’s banked cord blood will be an exact match for his sibling and at least a 50 percent chance for his parent. Should you decide to bank privately, you will have access to the cord blood that is most likely to be a good match for a close blood relative.
Public. “Mothers delivering full-term, healthy, single babies can elect to donate their baby’s cord blood to a public bank,” explains Joanne Kurtzberg, MD, director of Carolinas Cord Blood Bank at Duke University in Durham, North Carolina. “The donation process is risk-free to both mom and baby and is performed at no cost to the mother or her family.” After the baby is delivered and the cord blood collected, a sample of mom’s blood is taken to screen for infections that can be transmitted through the blood. Mom also has to complete a medical history questionnaire for herself and her baby’s family, as well as sign a donor consent form. The size of the collection and the results of the tests can affect whether the cord blood is used.
“After technical details about the cord blood unit are reviewed and cleared, the details about the unit are listed on the ‘Be the Match’ unrelated donor registry of the National Marrow Donor Program,” Kurtzberg explains. “From there, patients in need of a donor for transplant can have a search performed to locate their best matching donor.” Although cord blood was once considered nothing more than medical waste, Kurtzberg notes, “We know now that a cord blood unit can save a life. Donating cord blood gives a patient new hope.”
Private. If you choose to bank with a private company, there will be a fee involved. To see what options my family’s budget might allow, I looked into the average cost of banking with a private center. Costs ranged anywhere from $1,000 to $3,000 for the initial collection fee, $150 for transport, an additional doctor’s fee (which usually starts around $100), and $125 to $300 for annual storage.
Public. These banks store your child’s cord blood at no cost to you, but they may use it for research or give it away to a patient in need. To register with a public bank, you must sign up before week 34 of pregnancy and pass an extensive family health history application—covering everything from infection to tattoos and piercings. For the donation to be completed a mother must deliver a full-term, healthy, single baby. Depending on which center you choose to donate to, there may be a chance you’ll be able to retrieve the stem cells if you need them and they haven’t already been used to help a child in need. If you never elect to use them, however, you can rest assured that you’ve given a great gift to a family that can.
Still craving more information, I spoke further with Kraus, the chief scientific officer at Viacord, who offered insight into current advancements in the field: “Just a decade or so ago, there were only a few diseases that could be treated with cord blood—now there are nearly 80 treatable diseases.” Advancements in technology are leading to the development of new procedures. “We are now able to separate the cord blood tissue and take more stem cells out,” Kraus explains. These cord tissue stem cells contain regenerative properties and have the potential to treat many disorders including Parkinson’s disease and sports injuries. Kraus adds, “We are currently in phase II of clinical trials to use stem cells to treat cerebral palsy and type 1 diabetes.” Plus, he notes, diseases previously treated with chemotherapy are showing great response to stem cells without the use of radiation.
ViaCord estimates that one in 217 people may need a stem cell transplant (using stem cells from umbilical cords or bone marrow) by the age of 70. As of now, it’s the family members who gain an increased chance of survival if they receive stem cells from a compatible family member, but with the new regenerative medicine and continual improvements in research, the ability for a baby to benefit from his own cord blood in the future is a strong possibility.
Whether you decide to bank your child’s cord blood is a decision that shouldn’t be taken lightly. You have only one chance to save the cord blood and just a small window of time in which to do it. I spent a great deal of time considering my family’s options, and I encourage you to do the same—the sooner, the better! Ask questions of your doctors and midwives, call public and private banks to inquire about the process, and take a good look at your family’s health history. After researching to the best of your ability and exhausting your resources, you will no doubt know the right answer for you and your baby.