Cord Blood Banking: Should we bank it for our baby?
Should we do cord blood banking? This is a question we often hear from parents-to-be. The private cord blood banks can get quite persistent and have tie-ups with OB-Gyn practice of most hospitals in India. It is expensive, so due thought needs to go into deciding if it is suitable, and if it is even necessary to do cord blood banking. Often times, emotions can come in the way of better judgement many times especially when it comes to the matter of children.
"The Nestery presents a detailed, unbiased look at "Cord blood banking" and stem cell therapy to help you decide if it is needed for your family.
What are stem cells?
Stem cells are the building blocks of life. In order for a cell to be classified as a stem cell. It needs to be able to do two things.
- It needs to be able to multiply into more stem cells.
- It needs to be able to morph into other type of cells based on requirement. (For instance, organ cells (brain cell, lung cell, liver cell), red-blood cells, white blood cells, platelets, bone cells)
Think of them like play dough. A big ball of play dough can be broken down to make more smaller balls of play dough or the smaller play dough of any other shape (cube, cone, irregular).
WHERE ARE STEM CELLS FOUND?
Stem cells are found in the embryonic cells (Cells of the human embryo that eventually become the fetus and then baby), umbilical cord, bone marrow, adipose cells, and even blood cells. Most of these methods are invasive, cumbersome or uneconomical. Umbilical stem cells are a preferred method for extracting stem cells because it is non-invasive, economical to extract, and most importantly the richest source for Hematopoietic Stem Cells (HSC) that can become/morph into all types blood cells (RBC, WBC, Platelets)
WHAT IS CORD BLOOD?
Umbilical stem cells are found in the umbilical cord connecting the mother/placenta to the child. Placenta supplies oxygenated blood and nutrients to the foetus and it removes deoxygenated blood and wastes from the foetus. Umbilical stem cells are extracted from the umbilical cord by clamping the umbilical cord after birth of the child and extracting blood from the umbilical cord. This is why it is known as cord blood.
WHAT IS STEM CELL THERAPY?
You will keep hearing about how the banked cord blood can be used for stem cell therapy. Stem cell therapy is the use of stem cells acquired from different sources to treat or prevent a disease or a medical condition. Cord blood is one of the sources of stem cells for stem cell therapy. Stem cells from bone marrow have been used successfully against cancers especially blood cancers like Leukemia. Cord blood stem cells have been used to treat children with blood related cancers like Leukemia or genetic diseases originating from the blood such as Fanconi Anaemia. In these conditions, the cord blood is transplanted into patients. The HSC in the cord blood multiply to create new blood cells that will replace the damaged blood cells caused by the cancer or genetic disease.
WHAT IS THE DIFFERENCE BETWEEN PRIVATE CORD BLOOD BANKING AND PUBLIC CORD BLOOD BANKING?
In private cord blood banking, your child's umbilical stem cells are specifically stored and reserved for your child or your family's use. This method of reserving one's cord blood for one's own use is called "autologous" use.
Public cord blood banks as the name suggests, stores all donor cord blood according to internationally specified standards. This cord blood will be used based on needs of patients and is accessible to public. It is not specific or reserved for your family, but you can call up a request based on your earlier donation to the public bank. This is much like how blood banks work in India. As of 2016, there were 4 public cord blood banks and 14 private cord banks in India.
SHOULD WE BANK OUR CHILD'S CORD BLOOD?
- Have access to the stem cells in case of need.
- Umbilical stem cells need not be perfectly matched to the patient as compared to bone marrow stem cells (which is the other type of commonly used stem cells). Bone marrow stem cells sometimes lead to rejection from the host body
- The odds of using it for a related family member is higher than that of using it for the child themselves
- The odds of your child using the stored cord blood or marrow blood are small (0.4%) especially if there is no family history of blood related diseases like Leukemia
- The umbilical cord blood cannot be used in case of a genetic disorder or a blood related disorder like dystrophy or spina bifida as the stem cells or leukaemia as the stem cells will be tainted themselves
- Cord-blood transplants to adults are rare because the stem cells per unit of cord blood is not enough for a grown adult. Getting more units from the same donor becomes complicated as cord blood is collected at birth
- It is expensive to collect and store cord blood over extended periods
- The cord blood has to be collected carefully, else the entire sample can become unviable.
- There is also a growing point of view that the blood collected from the cord rightfully belongs to the infant. That, depriving a child of this critical volume of blood deprives the child off 1/3rd of full potential blood volume at birth. It has been argued that this leads to anemic infants.
"As far as the mathematics of autologous transplantation is concerned the probability of a family to use its own stored CB is almost 1:400 to 1:200,000"
"Autologous cord blood cells are non-usable for treatment of cancerous malignancies such as leukemia since the genetic mutation that gives rise to cancer already exists in the DNA of cord blood"
"There is also a lack of proper training among nurses and sterile environment for the collection of the blood in hospitals and hence the chance of cord blood unit getting contaminated and hence non-viability is quite alarming."
WHAT DO LEADING ORGANIZATIONS RECOMMEND?
AAP (American Association of Paediatrics):
"Cord blood has been used to treat certain diseases successfully, there isn't strong evidence to support cord blood banking. If a family does choose to bank cord blood, the AAP recommends public cord blood banking (instead of private) to reduce costs."
REGULATIONS IN INDIA:
Three major regulatory bodies are responsible for formulating policies in cord blood banking sector. These are Indian Council of Medical Research (ICMR), Department of Biotechnology (DBT) and Drug Controller General of India (DCGI). They issue guidelines on umbilical cord blood banking facilities, which in turn enable stem cell research via public- private partnership. These regulatory bodies encourage public cord blood banking to extend affordable treatment and regulate the medical travel and tourism sector.
July 2006: Draft guidelines for stem cell research including guidelines for cord blood stem cell banking were formulated and submitted by ICMR and DBT.
July 2007: A joint committee of ICMR and DBT was created to discuss the annexure on “Laboratory standards for cell collection and processing for clinical use”
Cord blood banking is expensive and the evidence to support the claims of the banks is still under clinical trials and testing. We at The Nestery believe that if you choose to do cord blood banking, choose a public bank over a private cord blood bank as it is beneficial to everyone including your family.