By Kate DaleyUpdated Jul 06, 2020
Most parents will do everything in their power to give their child a long and healthy life. Whether you’re buying organic food or checking that sippy cups are BPA-free, it’s nice to feel some semblance of control over your child’s long-term health. That’s why the decision about whether you should do cord blood banking can feel like a big one. Firstly, you have to make the decision during an extremely emotional time (pregnancy equals all the feels). Secondly, you can’t change your mind if you choose not to do it. We speak to the experts about what cord blood banking is, what it can and can’t treat, and what you should know before you decide.
After your baby is born, there is a small amount of blood left in the umbilical cord that’s still attached to the placenta. The placenta is a vascular organ that, in addition to helping to nourish your baby during pregnancy, contains stem cells, explains David Allan, a hematologist and bone marrow transplant physician at The Ottawa Hospital and medical director of stem cells at Canadian Blood Services. Cord blood banking involves collecting these stem cells immediately after birth and storing them for use in the future. You can store your cord blood with a private company for a fee or donate it to a public bank for free, depending on where you give birth.
Cord blood banking began after the first successful stem-cell transplant in the late kids hea, but it only became available on a larger scale about 20 years ago.
Once your baby is delivered and your healthcare provider clamps the umbilical cord, the leftover blood in the placenta can be collected using a needle. The blood is taken from the placenta (not your baby’s umbilical cord stump), which is no longer attached to the baby at this point. It takes less than 10 minutes to gather the cord blood. The cord blood unit is then stored in liquid nitrogen in a freezer for an indefinite amount of time. However, not everyone can bank their cord blood—there has to be a certain amount of blood, and it will be tested for bacteria and transmissible diseases, such as HIV, hepatitis and West Nile virus, which would make it ineligible. There is also the possibility that your sample will be contaminated during the collection stage and become unusable.
Delayed cord clamping has become common practice nowadays, and it affects whether you can do cord blood banking. (The idea behind it is that delaying allows more nutrient-rich placental blood to flow into the baby and can help prevent iron deficiency.) If you delay cord clamping by less than 60 seconds, it’s often still possible to collect a reasonable amount of blood, but this is highly variable from one birth to the next, says Allan. The medical team needs to balance these two competing factors to see what makes the most sense for you and your baby.
Cord blood contains blood-forming stem cells, which are the basis for creating all other cells, such as blood cells. That means that when these stem cells are transplanted, they can help healthy blood, brain, heart and bone cells grow, says Allan.
Since 1988, cord blood transplants have been used to treat certain blood-related cancers (such as leukemia and lymphoma), genetic disorders and blood disorders (such as aplastic anemia). But there’s a catch: If you have one of these diseases, you probably can’t use your own cord blood. “To treat leukemia, bone marrow failure disorders and inherited metabolic disorders, which are, by far, the bulk of what’s going on in paediatric and adult transplant centres, it’s only appropriate to use cells from someone else,” explains Allan. “After all, the problem is that the bone marrow and blood system in those patients is diseased, so you can’t use your own.”
“The person at birth is going to have that inherited disease that they present with later on,” says Kirk Schultz, a paediatric hematologist and oncologist and head of the Michael Cuccione Childhood Cancer Research Program at BC Children’s Hospital. About 50 to 75 percent of the time, leukemia was present at birth, so it would also be collected in the cord blood, explains Schultz. You wouldn’t want to reinfuse the same defective cells into a sick patient.
Almost all patients with blood-related disorders need to use donated cord blood stem cells from a public bank. Schultz says that, of the roughly 40 cord blood stem-cell transplants conducted at BC Children’s Hospital, the vast majority were from a public bank.
So far, the chances of your child needing their own banked cord blood are extremely low. The odds that your child will have a disease that’s treatable with their stored cord blood by the age of 21 has been estimated at about 0.005 to 0.04 percent, according to The Society of Obstetricians and Gynaecologists of Canada. Even if you bank your baby’s cord blood and they need it when they are older (as a teenager or an adult), they would probably need more cells than what their cord blood unit contains and require additional units from a public bank, according to Health Canada. New technology is allowing us to multiply cord blood stem cells, but this is done in a lab and is quite expensive, says Schultz.
Yes, privately banked cord blood from a sibling can be used for a sick child during treatment for blood diseases, such as leukemia, says Allan. But even then, that cord blood might not be necessary. If your child has an illness that can be helped by a stem-cell transplant, a sibling who is a match, depending on their age, can provide stem cells by undergoing a stimulating treatment, explains Allan.
Schultz also notes that cord blood use has dropped precipitously over the past few years because doctors can now do haploidentical (or half-matched) transplants, which means that they aren’t an exact match. For example, a child’s mother, father or sibling could be half-matched and use their stem cells, gathered through a stimulating treatment, with good results. Schultz says about one-third to one-half of all transplants at BC Children’s Hospital now are half-matched. He also notes that using cord blood is expensive, and they can get stem cells in other ways. These haploidentical transplants have been very successful, which may mean an end to cord blood use in the future.
“What will happen 10 or 20 years down the road?” asks Schultz. “I’d say it’s possible that cord blood units won’t be necessary. But, you know, let’s say I’m wrong. There’s always that possibility that science will move forward and, all of a sudden, that’s going to be the best thing that ever happened. But right now, it’s not.”
There is promise for the use of cord blood stem cells in regenerative medicine, but right now it’s still far from being used as a standard treatment. For example, there are currently studies looking at cord blood to help treat conditions such as type 1 diabetes, cerebral palsy, multiple sclerosis, traumatic brain injury, autism, eye disorders and hearing loss. The idea is that by regrowing the blood system, you may be able to reset the immune system to what it was like before developing the disease, says Schultz.
“I think we still have to wait a bit longer to see if any of these treatments will actually work,” says Allan. There are some diseases where it’s useful to have your own stem cells, says Allan, but doctors can often get those stem cells from the adults themselves in those cases, so there’s no need to store your cord blood for years at a very high expense.
Private cord blood banks store processed cord blood units for use by the family and charge a yearly fee for storage. The average cost is about $1,200 for the initial processing and first year of freezing. Then, each subsequent year, it costs about $100 to $300 on average to store the units. Do your research on your bank: Find out how long it has been banking cord blood, what kinds of standards it meets and accreditations it has, how many cord blood units have been released and storage fees and whether they are fixed and search around to see if they’ve had any negative feedback. Also, ask about the storage facility and criteria, along with the volume stored and how many of those cells usually survive.
Generally, the samples are banked for a couple of decades until the child uses them or decides to continue to bank them and pay fees. Canadian Blood Services says that there are examples of samples being transplanted after 13 years with no detected deterioration of quality. However, some private blood banks, such as Insception Lifebank, say that current literature reports that cord blood stem cells remain viable for at least 24 years of storage and scientists say they may be able to be stored indefinitely.
Public banks can be used by anyone who is a match and the units are anonymized, so no one knows the identity of the donor. You can donate your baby’s cord blood for free to the Cord Blood Bank at Canadian Blood Services if you give birth at one of four participating hospital sites across Canada and are eligible. (They are located in Brampton, Edmonton, Vancouver and Ottawa, and you can find out more info here.)
Both public and private cord blood banks that process and store cord blood for allogeneic use (use for someone other than the donor) are required to register with Health Canada and undergo routine inspections. Private cord blood banks that store cord blood for autologous use (use by the donor alone) are not subject to Health Canada regulations and routine inspections, so do your research before you commit your hard-earned money to one of these programs.
A registry is a listing of people who are willing to be donors but haven’t donated yet. You can register to donate your baby’s cord blood by discussing it with your healthcare provider and filling out consent forms. Cord blood banking involves collecting cord blood and storing it in a bank for private or public use. There’s also a stem cell registry for adult volunteers through Canadian Blood Services for those who are willing to donate their stem cells if there is a match. This is the most common source for allogeneic blood stem cell transplants in the world, and the international medical community can help people find donors on these registries. All stem cell registries are connected worldwide and have more than 30 million adult registrants.
If a family member, such as the baby’s sibling, is at high risk of developing (or has) one of the diseases that can be treated by stem cells, such as leukemia, it’s worth discussing with your doctor. In this case, cord blood banking might even be covered by your private healthcare provider if it’s considered useful for a sibling’s medical treatment. There’s also hope of its future use in regenerative medicine. But some experts, like Schultz, don’t think it’s worth storing privately, although he fully supports public donation.
“I’ve never recommended it, and that opinion hasn’t changed in 15 or 20 years or however long [private] has been around,” says Schultz. “ I have a lot of confidence that there will be many options available. It’s a very exciting time right now in research.”