By Dr Martie Conradie (MBChB, Diploma in Child Health)
The big question
When you were born, your parents did not even have to think about it, but nowadays you have to make a decision about storing your baby’s umbilical cord blood or tissue. As if there are not enough other decisions to be made!
The amount of information is daunting, the controversies surrounding it cause doubt and then there is also the guilty feeling that sometimes pokes its head out and makes you wonder: “What if my baby might need it and I didn’t store it?”.
Many parents store the blood for the future health of their child. Should you do it?
Education is the key to making an informed decision and reading this article might help you to decide.
What are stem cells, cord blood and cord tissue?
Stem cells are the cells that are the original building blocks of a person. These cells develop into different types of cells making up tissues in the body, such as: skin, blood, muscle, nerves, bone and cartilage. Stem cells are abundant in the umbilical cord blood and tissue. Stem cells are found all over our bodies after birth, repairing and maintaining tissues. When we are older, it is difficult and invasive to harvest it when needed, such as bone marrow collection. Cord blood contains 10 times more stem cells than those collected from bone marrow.
Cord blood is the blood collected from the umbilical cord after birth. It is only collected after the cord has been clamped and therefore it is not blood taken from the newborn. Cord blood contains cells called hematopoietic stem cells. They can turn into any kind of blood cell and is a source of stem cells for regeneration of bone marrow, which is why they can be used in transplants to treat many blood related diseases and immune system disorders.
Cord tissue is the tissue of the umbilical cord taken from the section of the cord that would have been discarded after birth. It contains mesenchymal stem cells. These are stem cells that develop into the connective tissues of the body, such as: skin, muscle, nerves and bone.
Background of stem cell banking
The first transplant of hematopoietic stem cells using cord blood was more than 30 years ago for a patient who had Fanconi’s anaemia. The success of this transplant and the development of effective cryopreservation methods led to the establishment of cord blood banks.
It is estimated that more than 40 000 transplants have been done using hematopoietic stem cells from cord blood.
Advantages and uses
While there are many advantages, the most important things we usually want to know are which diseases can be treated and what the chances are of getting those conditions.
In our bodies, bone marrow is the source of blood cells and the haematopoietic cells found here continuously make new blood cells. If the bone marrow function is damaged by a certain condition, a whole bone marrow transplant or stem cell transplant is often required. Cord blood is a source of stem cells which can be used for a transplant.
Stem cell transplants are already an option in the following four main types of conditions: cancers, blood disorders, immunodeficiencies and congenital metabolic disorders. See the table for the names of some specific conditions that can be treated. For some of these diseases, haematopoietic stem cell transplants are the only therapy and for others, they are used when first-line therapies have failed or when the disease is very aggressive.
|Cancers||Blood disorders||Congenital metabolic disorders||Immunodeficiencies|
|· Acute lymphocytic leukaemia
· Acute myelogenous leukaemia
· Chronic myelogenous leukaemia
· Myelodysplastic syndrome
· Hodgkin’s disease
· Non-Hodgkin’s lymphoma
· Burkitt’s lymphoma
Other cancer, not originating in the blood:
|· Sickle-cell anaemia
· Fanconi’s anaemia
· Evan’s syndrome
· Congenital cytopenia
· Aplastic anaemia
· Diamond-Blackfan anaemia
· Amegakaryocytic thrombocytopaenia
· Gunther’s disease
· Gaucher’s disease
· Hurler’s syndrome
· Hunter’s syndrome
· Krabbe’s disease
· Sanfilippo’s syndrome
· Tay-Sachs’ disease
|· DiGeorge’s syndrome
· Adenosine deaminase deficiency
· Wiskott-Aldrich’s syndrome
· Severe combined immunodeficiency
· Duncan’s disease
Due to many factors, including environmental factors or side effects of medications, some of these conditions are becoming more prevalent. Stem cell transplants are therefore being done more often.
The advantages of using umbilical cord blood stem cells over bone marrow stem cells include the following:
- Easier to collect and process
- No risk to mother or baby
- More readily available for use – bone marrow matching, collection and processing takes weeks to months
- Less costly than the process of trying to find a bone marrow donor
- Less risk of transmitting an infectious disease – such as Epstein-Barr or cytomegalovirus
- Less chance of rejection after transplant
- Currently there is only about a 1 in 100 000 chance of finding a matching bone marrow stem cell donor
Sometimes we wonder about the ethical and moral implications when it comes to stem cells. What is important to remember then, is that the stem cells collected from the umbilical cord is not the same as embryonic stem cells which come from the destruction of embryos. Cloning is also banned worldwide in humans, and the cord cell banks will be quite clear that they are not involved in cloning research.
There have been so many advances in the field and proven benefits, that some medical aids are even starting to offer discounted rates and are finding ways of working it into their benefits.
Who can use the stored cells?
The child whose cells were collected are a perfect match. The siblings also have 1 in 4 chance of being a match which is why many parents are trying to at least store one sibling’s stem cells.
In some countries there are public storage banks where cord stem cells can be stored which were donated by people after the delivery of their babies. A search for a match can then be attempted for anyone requiring a stem cell transplant, but these public banks are not available in most developing countries such as South Africa.
Possible future uses
There are many clinical trials that are ongoing to look for other diseases for which stem cells therapies might be the answer. Some diseases which might be treated with stem cells in the future include cerebral palsy, stroke, autism, diabetes and cleft palates. These conditions are a great health burden in the world.
The likelihood that stem cells will be used in our lifetime is increasing.
A discussion about storage of cord stem cells would be incomplete if some disadvantages are not mentioned.
The odds of using cord blood stem cells for the current indicated uses are 1 in 5000 in the USA for a child using his/her own cord blood stem cells by the age of 20. The odds are 1 in 2 500 for a child using donor cord blood stem cells (such as a sibling’s) by the age of 20. In countries such as India where thalassemia is common, it is more likely that it will be used. If any of the currently researched uses are successful, such as for cerebral palsy, the odds will change dramatically.
The current cost may seem high, but some of the facilities have open days where you can go and look at the processes and where it is stored. When you see what is required, the cost might seem more reasonable.
There will be high costs involved in the procedures when the stem cells have to be used, but as will be the case with other treatment options such as bone marrow transplants. The availability of specialists who are trained to use cord stem cells for treatment is also better now than in the past.
We do not want to think that our child might be one of the few who is diagnosed with a relatively rare condition which might require a stem cell transplant, but, the chance exists and the benefit of having stem cells available for treatment of one of these conditions is.
What does the procedure entail?
While you are focussing on delivering you baby, whether by normal delivery or caesarean section, the last thing you want to keep in mind is what to do to collect cord blood! Therefore, the cord blood banks have made this process very easy and they will make sure you are informed.
Midwives and gynaecologist are becoming comfortable with the procedure, so you do not have to worry about a thing.
Before the delivery of your baby, you are provided with a collection kit box containing everything necessary for the collection. Remembering to take this box with you to the hospital can be something for daddy to do, or you can just put it into your hospital bag to make sure you do not forget it. If you do forget, many of the banks have arranged for extra kits to be available at most hospitals.
Collection is done immediately after your baby has been delivered and is safely watched over. It takes only minutes to do the collection.
Once the umbilical cord is clamped and cut, the part that is not connected to the baby anymore is wiped with antiseptic and the collection can start. It is usually done before the placenta is delivered. The most common method is to insert a needle which is connected to a blood bag into the vein in the umbilical cord. The blood then runs into the bag. After enough blood is collected, approximately 100-150ml, the needle is removed, and some anticoagulant is mixed into the bag to prevent clotting. The bag and tubes are then sealed properly before packing it into the collection kit which will be collected by someone from the cord blood bank.
When collection of the umbilical cord tissue is also being done, a part of the cord is cut of after cord blood collection. It is usually between 10 to 15cm long and is drained of as much blood as possible before being put into a provided tube containing preserving liquid.
The mom and baby are not put at risk and this procedure will not interfere with the delivery. The baby is cared for after the cord is cut and the midwife or gynaecologist will consider your safety too.
Sometimes tubes may also be sent to collect some blood from the mom for tests such as checking for infections, but it depends on the bank used.
While you can then just focus on your new baby, the stem cells will be processed, cryogenically frozen and stored in state-of-the-art equipment. You will receive confirmation from the bank with a storage certificate and will be kept up to date with any new developments
If you decide not to store your baby’s cord stem cells or if you are not able to afford it, do not feel guilty. You are still going to be great parents.
Even though the likelihood of your child contracting a life-threatening disease might not be high and your child will hopefully never need stem cells, it can be greatly beneficial to consider storing your baby’s umbilical stem cells. Many conditions can already be treated, even cured, using stem cells and even more conditions are going to be added to the list.
Sources of information
- Waller-Wise R. Umbilical cord blood: Information for Childbirth Educators. J Perinat Educ. 20(1):54-60.
- Brown KS, Mahendra SR, Brown HL. The future state of newborn stem cell banking. J Clin Med. 2019 Jan 18.
- What are the odds we will need our cord blood? Parent’s guide to cord blood foundation. Available from: https://parentsguidecordblood.org/en/faqs/what-are-odds-we-will-need-our-cord-blood
- Netcells’ procedures protocols for collection