Blood. It's thick and gelatinous … Filled with substances which move oxygen and nutrients to the cells of the body, it defends the body against foreign invaders, helps us get rid of cellular wastes, and assists us in clotting if we nick ourselves as we're dicing onions for dinner. If you're pregnant or have had a child in the past few years, you've probably heard about cord blood banking, which allows umbilical stem cells to be stored cryogenically, under liquid nitrogen. Blood from the umbilical cord of a newborn baby is full of healthy, life-enhancing stem cells that are capable of turning into red blood cells, white blood cells or platelets. When the body's own cells have been destroyed by disease, chemotherapy or radiation, stem cell transplants, injected directly into the patient's bloodstream, can help to regenerate bone marrow and immune systems.
The lines get longer! In the past few years, there has been a sharp increase in the number of parents banking their children's umbilical cord blood. The Wall Street Journal recently reported that, as of 2000, 125,000 units of cord blood were banked at storage facilities worldwide. Of the nearly 14,000 cord blood samples stored by the Boston-based ViaCell, 6,000 units were banked in 2001 alone. Physicians, midwives and childbirth educators in New York are reporting that more and more parents are starting to ask questions about the process. Harvested from the cord and placenta within 15 minutes after a vaginal or Caesarean delivery, and frozen, stem cells are now often used in place of bone marrow transplants to treat leukemia, aplastic anemia, and more than 45 other serious or life-threatening disorders. "There are 30,000 people who need a bone marrow transplant, and one half of these people die before they get one," says Dr. Richard Schwarz, M.D., chairman of the department of obstetrics & gynecology at New York Methodist Hospital, and a past president of the American College of Obstetricians and Gynecologists. The availability of cord blood stem cells can help to make up for the shortage of bone marrow donors. (Donating blood marrow is a surgical procedure that can be quite uncomfortable). When healthy donor blood stem cells are administered to the patient in a successful transplant, the stem cells migrate to the bone marrow, where they function as if they were the patient's own. Studies show that stem cells obtained from cord blood offer some advantages over those retrieved from bone marrow. There is a higher chance of the donor cells engrafting (taking), and less likelihood of the patient developing graft versus host disease (GVHD), a potentially fatal complication. Cord blood is also less likely to contain certain infectious agents. It also appears that cord blood may generate new blood cells more effectively than bone marrow.
The procedure Parents who wish to save their children's cord blood for banking should make the decision at least two months before their due date, since it gives them time to discuss the option with their obstetrician or midwife, arrange the paperwork, and receive the collection kit well in advance of delivery. (The soon-to-be new parents are responsible for bringing the kit to the hospital with them, informing the hospital staff on arrival that they will be banking the cord blood — which does not need to be refrigerated — and arranging for an overnight delivery courier to pick up the kit at the hospital. The actual process of obtaining the cord blood is quite simple, and generally takes less than 10 minutes, says maternal-child health nurse Sandra A. Wolf. The health care provider simply clamps and cuts the cord, then uses a needle to withdraw blood from the umbilical vein and transfer it into a syringe or collection bag. Doctors typically charge up to $300 to perform the service. "Collecting cord blood is a very simple procedure that carries absolutely no risk to mother or child,” Dr. Schwarz says. “We must make sure that every expectant mother is informed of her option to either save it for her own family or donate it for the public good." Parents who want to have their child's cord blood stored have two options: donating to a nonprofit public blood bank, such as the Placental Blood Program/ National Cord Blood Program at the New York Blood Center (the world's first public cord blood bank), or donating to the one at Mt. Sinai Hospital, in Manhattan. This cord blood would then be used by any appropriate patient who needs a stem cell transplant. In some cases, the stem cells might be available for future use by the donor or his/her family, should it be needed, but it is not guaranteed. Private companies such as the Cord Blood Registry, ViaCord, and Lifebank are encouraging parents to store their child's cord blood privately, to ensure that those stem cells will be available to them should the child, a sibling or a parent, need it. Since they are genetically similar, stem cells from a family member are a better match than one from an unrelated donor. The cord blood, sealed in a specially designed package, can be transported safely to whichever bank is chosen. Depending on the company selected, private cord banks generally charge $500-$1,500, as an initial processing fee, with an annual storage fee, ranging from $50 to around $125.
Insurance for the future? Touted as “biological insurance” by these for-profit cord blood companies, parents are informed that storing cord blood can actually save their child's life (or the life of a sibling) — if the child later becomes ill with a disease that might otherwise be treated with a bone marrow transplant or with stem cells from an unrelated donor. A 1997 study, reported in The New England Journal of Medicine, found that the one-year survival rate for youngsters who received cord blood stem cells from a sibling was 63 percent, as opposed to only 29 percent for those who had transplants from an unrelated donor. If stem cells are needed for a transplant, having family-banked cells can allow for immediate administration. Because the cells are genetically related, the chance of a favorable outcome increases significantly. Albeit controversial, younger brothers or sisters have been conceived specifically with the hopes that their stem cells could be transplanted into an older sibling suffering from leukemia, lymphoma or another blood disease; in many cases, these transplants have yielded excellent results. At Children's Hospital of Oakland, in California, the Sibling Donor Cord Blood Program has given parents the option to bank their children's umbilical cord blood — free of charge — if certain eligibility requirements are met. According to a recent report in the Journal of Pediatric Hematology/Oncology, the odds of a child needing to rely on the use of his/her own stored blood by age 21 is only about one in 2,700; the odds of a family member using the stem cells are nearly twice as great — with a rate of about one in 1,400. However, proponents of private cord banking point out that new therapies are constantly being developed, and autogenic stem cells (those originating within the recipient's own body) may be found to be useful in a variety of diseases and genetic disorders.
Making the decision How do you decide if you should choose to bank your child's cord blood privately so it would be available in case of future need? "The banking of cord blood is effective and potentially life-saving in families with a history of certain diseases," Dr. Schwarz points out. The March of Dimes suggests on its website that expectant parents who have a family history of certain genetic diseases — such as severe anemias (including sickle cell), metabolic storage disorders, immune disorders or some cancers — may want to consider the family benefits of storing cord blood. (However, most families have no such risk factors, with only a one in 20,000 chance of ever needing stem cell transplantation). The American Academy of Pediatrics (AAP), which published a “subject review on cord blood banking” in July 1999, suggests that private storage of cord blood as “biological insurance” is not generally warranted, but adds that the presence of a family member with a current or potential need for stem cell transplantation should lead the parents to consider the possibility. The AAP also points out that, although there are encouraging results in the use of cord blood stem cell transplantation for a variety of genetic, hematology and oncologic (cancer) disorders, the procedure is still considered investigational. Parents from a minority group or mixed ethnic heritage may consider the possibility of private cord blood banking, because it's difficult to match their tissue types from public banks. Frances Verter, whose daughter Shai developed leukemia at age 4, is an astrophysicist of Ashkenazi background; Shai's father is Puerto Rican, which made it difficult to find an appropriate donor for a stem cell transplant. Although she can't imagine that "lightning would strike twice," after losing her daughter to the disease, she has banked the cord blood of her two other children, hoping against hope that she'll never need to use it.
The future is here Umbilical cord blood has been used in more than 2,000 transplants to date, mostly in blood cancers, and the future possibilities are endless, with researchers currently studying the potential use of stem cell transplantation for patients with muscular dystrophy, stroke, and other neurological or autoimmune disorders. In several publicized cases, one in New York State, children have been cured of life-threatening anemia with their own banked cord blood. In recent, groundbreaking news, stem cells taken from a newborn infant at the Royal Victoria Hospital, in Montreal, Canada, were given to the baby's own mother, who had been diagnosed with leukemia during her pregnancy. According to Michael Lill, M.D., medical director of California Cryobank, Inc.: "The ability to store the vital stem cells from the newborn's umbilical cord for possible future use is not just a novel approach to leveraging the future health of your baby and your family. It is the wave of the future today, and it prepares families for future medical advances that perhaps have yet to be imagined."
The Fingerprint of the 21st Century It's every parent’s worst nightmare — a crowded mall, a toddler darting in and out of the clothing racks, a sudden sense of panic, and then: "Oh, my God, where's my child??" According to a recent survey, 87 percent of parents polled said their greatest fear was that their child would be missing for 24 hours or more. In 2000, more than 950,000 missing person reports (85 percent of which concerned missing children or adolescents) were entered into the National Crime Information Computer, Federal Bureau of Investigation records show. In 1998, 30-year police veteran Joe Matthews developed DNA LifePrint, a safe, painless, 100 percent reliable way of obtaining DNA, to store it in case it should ever be needed to positively identify an individual. The DNA sample, which can be kept indefinitely, can be used for a variety of circumstances, including tracing a missing or abducted child; it may also be useful in identifying mutated genes, maintaining a DNA legacy for future medical purposes, and to resolve questions about paternity. Fingerprints, also used to trace missing children, are less reliable, since many are not legible enough for the identification process. Obtaining and storing your child's DNA is an easy, painless procedure. Once you obtain the special kit ($14.95, plus shipping and handling), you swab the child's inner cheek for five seconds, place the cotton swab in the vial, repeat with a second swab, complete the enclosed envelope, and store in a safe place at room temperature. For more information, call (866) 584-1117 or visit www.dna-lifeprint.com.