Umbilical Cord Blood Banking - Why? What? How?

chillibreeze writer — Sumedha Rege

The umbilical cord and the blood it contains have always been regarded as the fount of life. The discovery of several uses for the stem cells present in cord blood and the advent of cord blood banking, thanks to scientific advances in recent times have only served to re-emphasize this fact.

The umbilical cord consists of two arteries and a vein, which connect the fetus to the mother`s uterus via the placenta and serves as a conduit to carry nutrients and oxygen to, and byproducts of metabolism from the fetus. The blood in the umbilical vessels is rich in stem cells, especially the Hematopoietic stem cells.

Stem cells are undifferentiated precursors of the various types of cells that form different organs. They are also called pluripotent cells. They are found in large numbers in the embryonic tissues, the placenta, gonads, and in cord blood as well. However, cord blood is richest in some partially differentiated stem cells, namely Hematopoietic stem cells, which give rise to the three types of mature blood cells: 1) Red blood cells (erythrocytes), 2) White blood cells (Leukocytes), 3) Platelets (Thrombocytes). In extra- uterine life, these Hematopoietic stem cells are found in the bone marrow and the lymphatic tissue.

Mature blood cells (with the exception of some leukocytes) have a short life span and are continuously replenished throughout life by the Hematopoietic stem cells.If these stem cells are affected, either due to internal or external causes, it results in life threatening disease. The main modality of treatment lies in replenishing the damaged stem cells, after removing the offending factor, whenever possible.

Until the 1980s, bone marrow transplant remained the sole way of replenishing damaged stem cells, but after the discovery of stem cell rich cord blood, and its successful transfusion in 1988, this method gradually came into vogue. Soon, methods of preserving cord blood also improved, giving rise to modern umbilical cord blood banking.

The why and what of cord blood banking
Today, cord blood is used in the treatment of various disorders like Fanconi syndrome, aplastic anemia, lymphomas, leukemias, and genetic disorders related to metabolism. With the advances in regenerative medicine, stem cells in cord blood can be `tweaked` or manipulated to form pluripotent cells with the potential to treat a plethora of diseases like Type1 Diabetes Mellitus, Osteoporosis, Heart Disease, and some Pediatric cancers with ongoing research in the treatment of Cerebral Palsy, other Pediatric brain injuries and Parkinsons Disease.

Cord blood transfusion has the following advantages
1) In case of autologus transfusions, there is 100% compatibility, as the transfused blood is the patient`s own. If it has been preserved for private use, there is no waiting period for a donor to become available.

2) Greater concentrations of stem cells are present per unit of cord blood as compared to bone marrow, resulting in lesser requirement.

3) In case of the recipient being a first degree relative of the dono, there are greater chances of compatibility: 75% chance for siblings and 50% for parents. A lower histocompatibility score (4/6) suffices as compared to the higher one (6/6) required for bone marrow transplants. This is because cord blood cells are not as differentiated as compared to adult bone marrow.

4) Again, due to the lesser differentiation, even pooled cord blood samples can be used with greater safety and efficacy.

5) Since the collection is generally non-invasive, there is no morbidity for the donor.

6) In the case of ethnic minorities prone to certain inborn metabolic errors, there are greater chances of finding compatible donors.

7) Least chances of Graft-versus-host disease.

In view of all the different merits cord blood transfusion has, it is imperative that it is properly preserved at or in some cases before birth, so that it can be utilized, should the need arise. This is what umbilical cord blood banking entails.

How is it done?
Cord blood is withdrawn from the umbilical vein, either before or at birth. After the birth of the baby, the umbilical cord blood is withdrawn after the cord stops pulsating, thus ensuring that the baby is not deprived of any blood, which might lead to anemia. Generally, 75 to 140 ml is withdrawn. This blood is then subjected to screening for viruses like HIV, Hep B, and Hep C virus. A cryopreservant is then added and the blood is preserved at -90 degrees centigrade. It is then placed in liquid nitrogen which further cools it to -196 degrees centigrade, ensuring that the blood has a shelf life of 20 years.

Cord blood may be stored under two programs:
1) Public cord blood storage program: Spearheaded in Tata Memorial Hospital in Mumbai, in 1990. Under this program, the donated cord blood is used for the benefit of the public at large. Several samples may be pooled together and a large bank of stem cells becomes available.

2) Private cord blood storage program: Private storage of cord blood in a cryo-banking facility for use of the individual or family, should the need arise. Several such facilities are operational in India such as Reliance Life Sciences, Delhi; Lifecell, Chennai; Cord Life Sciences, Cryobanks International; and Histostem, Mumbai. These private facilities provide storage for specific periods, ranging upto 20 years on the payment of a sum, either in installments or as a single payment, which ranges from around INR 75,000 to 100,000.

However, bear in mind that cord blood banking also has a few disadvantages as follows:

1) Hasty clamping of the cord can result in depletion of blood to the new-born.

2) Although viral contamination of the cord blood is rare, bacterial contamination is known to occur, if proper asepsis is not maintained.

3) Chances of an individual requiring cord blood transfusion are rare. If the blood is banked privately, it seems unwarranted to pay a large sum for something which may not be required in an individual`s lifetime.

4) In childhood cancers, some forms of leukemia and some immunological disorders, autologous transfusions and transfusions from siblings maybe useless as they may carry the same genetic defect.

5) Samples in private banking programs may not be large enough to cover the needs if multiple transfusions are required.

6) Cord blood is rich in Hematopoietic stem cells and not embryonic stem cells and as such, is not `blanket therapy` for any disease requiring new cell generation. For further information, visit the following web sites:

1 )www.indianpediatrics.net
2) www.midicinenet.com
3) parentsguidecordblood.org
4) www.cordlife.com
5) www.babycell.in

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Chillibreeze's disclaimer: This is a contributed article and was published on Chillibreeze in September, 2010. The views and opinions expressed in this article are those of the author(s) and do not reflect the views of Chillibreeze as a company. Chillibreeze has a strict anti-plagiarism policy. Please contact us to report any copyright issues related to this article. The relevance of the facts and figures cited (if any) could change after a period of time.

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—About our writer:

Although an ENT by profession, writing has always been a passion for Dr. Sumedha. She has pursued an advanced diploma in creative writing from Symbiosis, Pune. She likes to write health based articles and has worked as a medical curriculum designer for post graduate medical aspirants with a leading training centre in Mumbai. Her other interests are music, travelling and gourmet cooking.

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