Expecting parents may hear about cord blood banking as they prepare to meet their new baby.
Of all of the amazing things a fetus is capable of doing, one is making all kinds of unique cells with blood cells that are not yet mature. These blood cells can become either red blood cells or white blood cells. The very same cells are made in adult bone marrow and similar to cells taken for bone marrow transplants.
There lies the promise of cord blood banking for parents. Imagine a source of cells taken at a baby’s delivery and then used for a bone marrow transplant in the future if needed?
Researchers hope to use cord blood cells to treat diseases of blood and white blood cell formation, like thalassemia or leukemia. The theory is that we could save cord blood cells in case a child develops a disease and needs a bone marrow transplant. Who wouldn’t want that kind of insurance for their child, no matter the cost, if it could be lifesaving?
At some time in the future, this might be the reality. Sadly, that time is not yet here. Cord blood banking is expensive and largely under the direction of private banking systems. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) do not recommend it (outside of select cases).
Cord Blood Banking: What Is Currently Available & Why
There are hospitals that offer public cord blood banking. Patients volunteer to donate, care teams collect cord blood at a baby’s delivery, then test it and place it in a bank, making it available to individuals who require a match.
Why is this not at every hospital? Unfortunately, there are relatively few instances for use of cord blood. The most significant barrier is the volume of cord blood that can be collected. The number of cord blood cells obtained is simply not enough for an adult transfusion.
Development of a robust system for public cord banking will become viable when we can understand how this investment will improve over the current system. In the meantime, ask your provider if your hospital is a part of the public cord blood banking system. Consider donation if it is possible. We need donations from minority populations because of underrepresentation in the bone marrow transplant matching programs.
We are not licensed to store cord blood at the University of Vermont Medical Center. You may contact a public bank to receive instructions and collection materials (Note: not all banks receive outside cord blood. Learn more at this link.
Private and For Profit Companies vs. Public Banking
Many cord blood banking systems are private, for profit companies. Before delivery, the company will send you a collection kit. You bring your kit to the hospital at delivery, provide the needed equipment to the provider doing your delivery, and the provider will return the collection to you (which you can mail back).
This cord blood is for your use only. It is not placed in a public system. The estimated odds of needing cord blood is one in 12,700 or less (one estimate is 1/20,000).
Typically, there is a one-time fee followed by a yearly service charge. As with public cord blood banking, a major limitation is that the volume of cells is often insufficient for adult treatment. Another limitation is that for many childhood diseases, the use of the child’s own blood might not be ideal. That blood may also contain the same cells that turned into leukemia, or that harbor the same genetic defect that causes disease. A donor without those conditions would be required in many cases of childhood disease.
On the other hand, cord blood banking for the treatment of relatives has been performed successfully: for example, a sibling of a child with leukemia might be able to provide donor cord blood. The good news is that there are resources for this testing and storage to be performed free of charge (see resources below). Use is not limited to children, so if you have a family member in whom cord blood might be a therapeutic option, please explore this possibility.
Beyond Cord Blood – Other Options Available to Parents
Sometimes it is not possible to collect cord blood even with careful planning. The amount of blood in the cord may be insufficient. Or, there may be an infection or complication that prevents collection.
Recent recommendations are to delay umbilical cord clamping for 60 seconds following delivery, especially in preterm infants. This approach provides the newborn with more umbilical blood, but can reduce the volume of cord blood available for collection. Both ACOG and AAP strongly recommend against changing established medical care for the purpose of cord blood banking.
While cord blood banking has potential, we must wait until we know more about how to use and develop public cord banking systems. Until we establish public banks, private banking is expensive with little benefit.
If you have a family member who might benefit from cord blood donation, contact the resources below:
ACOG Committee Opinion No 648, December 2015
- American Academy of Pediatrics (AAP): Cord Blood Banking for Potential Future Transplantation, Pediatrics 2007 119: 165-170.
For information about public cord donation:
- Health Services and Services Administration: Donating Umbilical Cord Blood to a Public Bank
- Public Cord Blood Donation Directory
Majorie Meyer, MD, is an obstetrician and maternal fetal medicine physician at the University of Vermont Medical Center. She is also an associate professor at the Larner College of Medicine at the University of Vermont.