Stem Cell Cord Blood Banking

After collecting the cord blood in maximum 15 minutes after the baby is born, processing it is the following faze in order to be viable for further medical operations. The processing of cord blood includes specific steps, such as RBC depletion, shipping and the actual freezing. The freezing or, scientifically said, the cryopreservation is applied within 1 day after the actual collection and can be successfully preserved for indefinite years.

There are various pediatric solutions that include using the cord blood. The most major ones are the children cancers and blood diseases, including infant leukemia (juvenile chronic myelogenous leukemia and juvenile myelomonocytic leukemia) or immune system disorders. All these are usually treated with chemotherapy, which, besides its benefic effects, also negatively affects some good cells. A significant cord blood usage in infant medicine is the marrow transplant. This procedure has the result of providing new and healthy blood cells, which leads to a safer immune system of the child. Besides these, there are some rare genetic diseases that require cord blood stem cells.

Among these rare disorders, there is the fatal Krabbe Disease, which is characterized by causing severe degeneration of mental and motor skills of the child. If receiving the stem cells from the umbilical cord before the actual manifestation of the symptoms, the brain development can be successfully preserved. Hurler Syndrome, Adrenoleukodystrophy, Metachromatic Leukodystrophy, Tay-Sachs disease, Sandhoff disease are also other rare and severe conditions that affect the infants and can be successfully treated if using the cord blood stems. Hurler’s Syndrome is a genetic and progressive disorder that results from the body’s incapacity to make a significant enzyme. The disease damages many organs and most importantly, it affects the heart and causes death in the early teens. The Sandoff disorder has a result the progressive deterioration of the central nervous system and, like the Krabble disease, it is fatal before the age of 3.

Cord blood is not used as a temporary solution in serious medical cases of infants. Cord blood actually provides a new and healthy blood structure that increases the safety of the immune system and prevents further imbalances.

Can cord blood stem cells be used for gene therapy?

Traditionally, patients with severe hereditary disorders of the immune system were given a stem cell transplant to replace the defective gene. This is kind of like fixing a broken transmission by replacing the whole car. Plus, while the patient’s hereditary disorder may be fixed, there are new medical problems associated with a transplant that is not a perfect match.

The more sophisticated approach is to transplant the patient’s own stem cells after they have been genetically engineered to fix the defective gene. The genetic engineering is done with a virus. The patient’s own cord blood is an ideal source of matching stem cells.

Example: Transplants of genetically engineered cord blood have been successfully used to cure some forms of “bubble boy syndrome”, or SCID. Initially, the SCID results were touted as the first success story of gene therapy. Unfortunately, this clinical trial was halted in 2003 when two of the children subsequently developed leukemia. It is not clear at present if the leukemia was triggered by the gene insertion process, or if the SCID patients simply had a greater predilection towards leukemia than the population at large.

In other words, how much cord blood is needed to be confident of a successful transplant?

The crucial thing is not the volume of the blood sample, but the number of stem cells it contains. These are measured with a stain “CD34+” that picks out all mononuclear cells, including stem cells.

The “optimal (transplant) dose is about 20 million nucleated cells per kilogram of body weight” (one kilogram equals 2.2 pounds).
“…patients who received no more than 10 million nucleated cells per kilogram had a 75 percent probability of death, whereas recipients of at least 30 million nucleated cells per kilogram had a 30 percent probability of death.” Reference: Editorial by Gluckman, E. NEJM 2001;344:1860

But, what is the concentration of mononuclear cells in a typical cord blood collection? The answer to that question comes from a study of families participating in the Sibling Cord Blood Donor Program. In these 542 cases, the cord blood was collected by the family’s personal OB/Gyn, at hundreds of different hospitals. This is a situation just like private cord blood banking. In their study, the mean cord blood volume and nucleated cell count were 103.1 mL (including anticoagulant) and 890 million, respectively. Reference: W Reed, Blood 2003; 101(1):351

Thus, on average, a cord blood sample contains 8.6 million nucleated cells per millileter. Putting together the cell dose recommended by Gluckman and the average concentration found by Reed, one can calculate that the optimal transplant dose requires harvesting 1 milliliter of cord blood for every pound of patient weight (1 ml and 1 cc are the same amount).

Cord Blood Collection Process

Cord blood is an alternative source of stem cells used for re-population of the patient’s bone marrow after chemotherapy or radiation therapy. Research has led to the discovery that the blood in a baby’s umbilical cord is rich in stem cells. These cord blood stem cells can be collected immediately after the baby’s birth, processed and stored for use by the baby, a matched sibling, or an HLA-matched unrelated patient. This placental blood is usually discarded as waste.

Cord Blood Collection

Cord blood is collected in small (250 ml) blood collection bags containing anticoagulant to prevent blood from clotting. This bag also allows the collected blood to be processed in a close system. This technique limits the possibility of bacterial contamination during extensive blood processing.

Two Ways to Collect Cord Blood

In-utero collection: After the baby is delivered, cord blood collection can be initiated when the placenta is still in-utero. This technique usually gives a little bit higher volume recovery then ex-utero collection.
Ex-utero collection: After the baby is delivered and the placenta detaches from the utero, the placenta and cord are carefully handled and placed in a provided collection system. Both techniques are painless and do not affect the baby’s health. Delivery of the Cord Blood to the Blood Center Our contracted laboratory operates 24 hours a day. The collection facility informs the Blood Bank about cord blood collection. The collected units are picked up from the delivery site by a Blood Bank employee or designated courier.

Time Savings.

If you child’s cord blood has been stored, there is immediate availability of matching stem cells for your child, eliminating the need to search for a suitable bone marrow donor. If another family member becomes ill with a disease treatable with cord blood stem cells, there is also a chance your child’s sample may be a match for them as well. Early treatment of many diseases can help minimize disease progression and improve a patient’s overall chance for recovery.

Treatment Viability.

Cord blood stem cells have a better chance of being an acceptable match because they are immunologically immature and undeveloped, especially in comparison to other sources of adult stem cells such as bone marrow or peripheral blood. Not only do these cells have a better chance of being a match for siblings, but also for parents, grandparents, and other biological family members.

Decreased Risk.

Cord blood transplants have resulted in a significantly lower incidence of life-threatening side effects, such as graft vs. host disease, which occurs frequently in bone marrow transplants.

Ease of Collection.

Cord blood stem cells are collected via a non-invasive process that takes less than five minutes. Neither child nor mother can feel anything. Collection of adult stem cells from bone marrow or peripheral blood both require time consuming, invasive, and often painful procedures.

Blood Bank is a site or mobile unit for collecting, processing, typing, and storing whole blood, blood plasma and other blood constituents. Most hospitals maintain their own blood reserves, and the American Red Cross provides a nationwide collection and distribution service. The Red Cross collects about 50% of the blood for the nation’s blood banks. The Food and Drug Administration licenses blood banks.
Whole blood may be preserved for up to 21 days without losing its usefulness in blood transfusions; an anticoagulant is added to prevent clotting. Blood plasma, the fluid portion of the blood, may be frozen and/or dried and stored indefinitely. Blood and donors are screened for hepatitis, AIDS, malaria, and other infectious diseases. The potential risk of acquiring AIDS or hepatitis through transfusions has made it a common practice among patients anticipating surgery to “bank” their own blood before it is needed.

Many blood banks also have facilities for apheresis, bone marrow donations, and related procedures. Some centers save umbilical cord blood (blood that is especially rich in stem cells) for use in treatments; however, the cost of preparing and storing such blood is much higher than that of normal blood. Sometimes parents store their newborn’s cord blood at a private cord blood bank in case the child has need of it, but the use of one own’s cord blood is ineffective or undesirable in many diseases where such blood is used as a treatment.

Umbilical cord is a cordlike structure about 22 in. (56 cm) long in the pregnant human female, extending from the abdominal wall of the fetus to the placenta. Its chief function is to carry nourishment and oxygen from the placenta to the fetus and return waste products to the placenta from the fetus. It consists of a continuation of the membrane covering the fetus and encloses a mucoid jelly through which one vein carries oxygenated blood and two arteries carry unoxygenated blood. After birth, the cord is clamped off and cut. It is sometimes abnormal in length and may break prematurely or form loops or knots, which may asphyxiate the fetus. The stump of the cord that is left attached to the infant withers and drops off, leaving the scar known as the navel.

Because umbilical cord blood is especially rich in stem cells (cells that give rise to red blood cells and lymphocytes) some parents choose to save it in private cord blood banks in case of future need as a transplant alternative to bone marrow, but in many diseases treated with stem cells such autologous transplants are contraindicated. Studies have shown that people not related to the donor (genetically mismatched) can benefit from transplants of umbilical cord blood in combating leukemia and other cancers. Cord blood has also been used to repair heart and other tissue defects in children with certain metabolic disorders.