Cord blood

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Umbilical cord blood up to 180mL of blood from a newborn baby that is returned to the neonatal circulation if the umbilical cord is not prematurely clamped. In some obstetric and midwifery practices, physiological extended-delayed cord clamping protocol, as well as water birth, allows for the cord blood to pulse into the neonate for 5-20 minutes after delivery. If the umbilical cord is not clamped, a physiological clamping occurs upon interaction with cold air, when the internal gelatinous substance, called Wharton's jelly, swells around the umbilical artery and veins.

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[edit] Cord blood harvesting

A cord blood bank may be a private commercial enterprise, or a public medical resource.

Cord blood banking is controversial in the medical and parenting community. Blood collected this way takes up to 180mL from the neonate (sometimes up to half of the total blood volume)which is a highly controversial subject in perinatal medicine. Cord blood is rich in hematopoietic stem cells, however, The American Academy of Pediatrics 2007 Policy Statement on Cord Blood Banking[1] states that:

"Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood;"

Cord blood is stored by both public and private cord blood banks. Public cord blood banks store cord blood for the benefit of the general public, and most U.S. banks coordinate matching cord blood to patients through the National Marrow Donor Program (NMDP). Private cord blood banks are for-profit organizations which store cord blood for the exclusive use of the donor or donor's relatives.

Public cord blood banking is supported by the medical community. However, private cord blood banking is generally not recommended unless there is a family history of specific genetic diseases. Private banking is unlawful in France and Italy, and opposed by the European Group on Ethics in Science and New Technologies.

New parents have the option of storing their newborn's cord blood at a private cord blood bank or donating it to a public cord blood bank. The cost of private cord blood banking is approximately $2000 for collection and approximately $125 per year for storage, as of 2007. Donation to a public cord blood bank is not possible everywhere, but availability is increasing. Several local cord blood banks across the United States are now accepting donations from within their own states. The cord blood bank will not charge the donor for the donation; the OB/GYN may still charge a collection fee, although many OB/GYNs choose to donate their time.

After the first sibling-donor cord blood transplant was performed in 1988, the National Institute of Health (NIH) awarded a grant to Dr. Pablo Rubinstein to develop the world's first cord blood program at the New York Blood Center(NYBC),[1] in order to establish the inventory of non embryonal stem cell units necessary to provide unrelated, matched grafts for patients.

In 2005, University of Toronto researcher Peter Zandstra developed a method to increase the yield of cord blood stem cells to enable their use in treating adults as well as children.[2]

[edit] Controversy

While there is general support in the medical community for public banking of cord blood, the question of private banking has raised objections from many governments and nonprofit organizations. The controversy centers on varying assessments of the current and future likelihood of successful uses of the stored blood.

Estimates of the odds that a child will need an autologous stem cell implant by age twenty vary widely. Proponents cite odds of around 1:2,700.[3] The European Union Group on Ethics[4] has cited a paper[5] claiming the odds are 1:20,000. The European Union group went on to conclude that "[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms."[4]

In May 2006, The World Marrow Donor Association's Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage[6] stated that:

  1. The use of autologous cord blood cells for the treatment of childhood leukemia is contra-indicated because pre-leukemic cells are present at birth. Autologous cord blood carries the same genetic defects as the donor and should not be used to treat genetic diseases.
  2. There is at present no known protocol where autologous cord blood stem cells are used in therapy.
  3. If autologous stem cell therapies should become reality in the future, these protocols will probably rely on easily accessible stem cells.


[edit] See also

[edit] References

  1. ^ NIH data
  2. ^ Raymer, Elizabeth (October 14, 2005). New strategy will boost cord blood stem cells. University of Toronto. Retrieved on September 20, 2006.
  3. ^ Journal of Pediatric Hematology/Oncology (1997, 19:3, 183-187)
  4. ^ a b Opinion N° 19
  5. ^ Annas, NEJM 2000; 340 : 1521
  6. ^ World Marrow Donor Association (2006). Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage. World Marrow Donor Association. Retrieved on June 2, 2006.

[edit] External links

[edit] General information