July is Cord Blood Awareness Month

 July is Cord Blood Awareness Month. In recognition of this important discovery I want to invite all expectant families to reach out to me with questions regarding banking your baby's cord blood stem cells. 
The decision to bank cord blood stem cells will be one of the most important decisions a family will make before their baby is born.   The American College of Obstetricians and Gynecologists( ACOG) recommends that families be presented with  balanced information on the options for preserving cord blood stem cells.   Currently there are 24 states with legislation on educating families on cord blood preservation. The states with legislation on education are:
Arizona
Arkansas
Colorado
Connecticut
Florida
Illinois
Louisiana
Maryland
Massachusetts
Michigan
Missouri
New Jersey
New Mexico
New York
North Carolina
Ohio
Oklahoma
Pennsylvania
Rhode Island
Tennessee
Texas 
Virginia
Washington 
Wisconsin


 The Institute of Medicine recommended to Congress a  program of education for cord blood preservation. Congress passed the  Stem Cell Therapeutic and Research Act of 2005  in  December of 2005 which requires education  to the expectant mother on her options for cord blood stem cells. www.iom.edu/Reports/2005/Cord-Blood-Establishing-a-National-Hematopoietic-Stem-Cell-Bank-Program.aspx

Cord Blood Stem Cells to treat HIV

Two years ago I attended a conference   on cord blood stem cell where a European study was presented on using  certain cord blood units to treat HIV. I am very pleased to post a follow up to this original study which was presented this week as the same conference.  www.foxnews.com/health/2012/06/07/doctors-turn-to-cord-blood-transplants-in-hopes-curing-patients-with-hiv/

Pulsing the cord and collecting cord blood. You can do both!

Many families ask me if they can pulse the their baby's cord blood before they collect.  My answer to this question is always yes. I do recommend that you inform your provider that you would like to do both procedures. Typically the cord will only pulse  two to three minutes after birth. After the cord stop pulsing your health care provider will insert the needle  from the cord blood into the umbilical cord and drain the cord blood into the cord blood bag. You can insert into the umbilical cord  2 times as long as the injection site is wiped with alcohol and iodine. Some milking of the cord may be needed in order to get as much of the remaining blood as possible. I also recommend  that you review your health history and if you do have a family history of cancer, diabetes and  heart disease, you may want to shorten the length of time the cord blood pulses so you can get a larger  cord blood collection

 

Cord Blood Banking Information Session

5/24/2012
6pm-7pm

Come to Sprout  in New York City to learn about Doulas, and stay to speak with Andrea Dworkin, a representative specializing in cord blood banking.

LifeLine Cryogenics is a nationally renowned cord blood bank providing the highest quality of processing, individual service and more than a decade of experience in cryogenic preservation. LifeLine is an  AABB accredited and New York state licensed cord blood bank, located within one hour of New York City.

Please RSVP to adworkin@lifelinecryogenics.com

 Glossary of common terms used in cord blood banking .

Tuesday, April 24, 2012 8:24 AM

AABB- Formerly known  as American Association of Blood Banks. A professional, non-profit organization established in 1947 and dedicated to the education, formulation of standards, policy and other facets of transfusion medicine. AABB grants accreditation for  cord blood banks.

Allogeneic transplant: Stem cells from an unrelated donor.

Autologous transplant:   Using the the patient's( donor) own stem cells for transplant.  

BMT- Bone Marrow transplant- Using  adult stem cells from bone marrow for transplant. 

CBT- Cord blood transplant -  Stem cells from the umbilical cord used in  transplant treatment for both adults and children. These cells are considered  to be a more primitive source of cells than bone marrow and peripheral stem cells.

Cord blood Banking- Long term  cryogenic storage of umbilical cord blood stem cells .

Cord Blood Banks-  Processing and storage facilities  for umbilical cord blood stem cells. 

Cord blood collection kit-  A unit sent to expectant parents to capture the umbilical cord stem cell after the birth of their baby. Typically a collection kit includes a collection blood bag, and a phelebotomy set to collect the mother's blood, which is required for cord blood banking.

Cord blood stem cell- A  multipotent stem cell from umbilical cord that has the ability to differentiate into many cell types. Cord blood stem cells are hematopoietic ( blood- forming) cells that  contain red blood cell, white blood cells, platelets and plasma.

Cord Tissue: Cord blood tissue is  a segment of the actual umbilical cord with accompanying cells.

Graft vs. host disease (GVHD): GVHD  is a complication that can occur  from an allogenic  transplant.

Hematopoietic stem cell: A stem cell that  can develop into red and white blood cells and platelets.

Hematopoietic stem cell transplant: A transplant  utilizing  stem cells derived from cord blood, placenta, peripheral blood or bone marrow.

Mesenchymal stem cells(MSC'S):  Multipotent cells that can differentiate into hematopoietic and connective tissue.  

Multipotent:  Stem cells that have  the ability to develop into more than one cell type of the body.

Related allogeneic transplant: The  stem cell donor is a related family member of the recipient.

Stem cells:  Master cells  that can differentiate  and to give rise to specialized cells.  Stem Cells have the remarkable potential to develop into many different cell types in the body. Many stem cells types can repair and replenish other cells. 

Umbilical cord blood stem cells: Stem cells from the umbilical cord a that contain  all of the blood cells in the body (hematopoietic) however can also give rise  many cell types.

Undifferentiated: A cell that has not yet developed into a specialized cell type.

Marion Kalstein Welch

What is umbilical cord blood?

What is umbilical cord blood?

Umbilical cord blood is a baby’s blood left in the placenta after the baby is born and the umbilical cord is cut.

Historically, umbilical cord blood was discarded with the placenta as medical waste. Over the past few decades, cord blood has been shown to contain stem cells and early precursor cells that can be used for life-saving stem cell transplantation for children and adults in need of a stem cell transplant.

Cord blood is more tolerant of a new host and can be used without full matching, providing increased access to transplantation for patients who cannot find a matched donor.

How is umbilical cord blood used in medicine?

Hematopoietic stem cell transplantation can be an effective therapy for pediatric and adult patients with certain cancers, immune deficiencies, bone marrow failure syndromes, and some genetic diseases including inborn errors of metabolism and hemoglobinopathies.

Traditionally, stem cells used for transplantation were obtained from bone marrow or blood. More recently, cord blood has become an alternative source of stem cells for transplantation.

A major limitation to stem cell transplantation therapy is the ability to find a suitable donor. Only 20 to 25 percent of patients in need of a transplant have relative who is a “match” and can serve as their donor. Of those without a related donor, only 10 to 50 percent of patients (depending on their race and ethnicity) will find a matched unrelated bone marrow donor through the National Marrow Donor Program and other donor registries.

Cord blood transplantation does not require as strict matching as bone marrow, so many patients who cannot find a matched bone marrow donor can find a suitable cord blood donor. It is estimated that more than 4,000 cord blood transplants are being performed each year around the world.

Cord blood is also being studied as a source of stem cells for other purposes, including regenerative therapies for tissues damaged by injury or disease. However, these applications remain unproven and are currently the subject of ongoing research.

How is umbilical cord blood collected and stored?

Umbilical cord blood can be collected without risk to the mother or infant donor. Cord blood can be collected from the placenta, either during the third stage of labor or within 10 to 15 minutes after delivery of the placenta, by sterilely puncturing one of the umbilical veins with a needle and allowing the cord blood to drain into a sterile bag containing an anticoagulant to prevent clotting.

After collection from the placenta, some of the red blood cells are usually removed and the volume of the cord blood collection is reduced.

For long-term storage, cells undergo specialized freezing procedures and are stored in special freezers under liquid nitrogen. Maximal storage time, or expiration date, is unknown, but cells are likely to remain usable for decades. Cord blood units from public banks have been successfully transplanted after 18 years in storage.

What are the options for cord blood storage?

There are two main types of cord blood banks, public and private.

In general, public banks are nonprofit entities supported by federal or private funding. After the mother consents, public banks collect cord blood from healthy full-term pregnancies at no cost to the donor’s family.

In giving consent, the infant’s mother acknowledges that the donation is voluntary and gives up all rights to the cord blood for the public good. The mother also agrees to allow her medical records and the baby’s newborn records to be reviewed, gives a detailed family medical history, and allows a sample of her own blood to be taken for infectious disease testing.

Units passing screening tests designed to eliminate risks of transmitting genetic or infectious diseases are typed, placed in the search registry, and are available to any suitable patient in need of transplantation. Units that do not meet criteria for public banking may be discarded or used for research purposes.

Private cord blood banks are generally for-profit companies that store “directed donations” intended for future use by the child or a family member. Using a kit provided by the bank, the cord blood is collected by the physician, midwife, or nurse delivering the baby and shipped back to the company’s banking facility. The parents of the infant are charged an initial fee for collection and processing of the cord blood and then an annual fee for storage.

Varying degrees of testing is performed on the units, and minimal standards are used to determine whether a unit is eligible for processing and banking. The majority of private collections are undertaken as an investment in the unknown potential for cord blood to be used to treat serious illnesses in the future.

Most obstetricians and pediatricians feel that routine cord blood storage in healthy babies is unnecessary. In this regard, it is important to note that a child’s own cord blood would not be used for transplantation of a child with leukemia or other cancers, in part due to concern for contamination with cancerous cells, and it would not be used to treat a genetic condition because the cord blood would contain the same genetic problem.

Currently, directed donation of umbilical cord blood for another family member is recommended when a first-degree relative has a high risk pediatric cancer that can be treated with transplantation therapy, a hemoglobinopathy or other transfusion-dependent blood disorder, a congenital immune deficiency, or an inborn error of metabolism.

How can I donate my child’s umbilical cord blood?

It is always a good idea to discuss options for cord blood banking with your obstetric provider or pediatrician.

To privately store your baby’s cord blood for possible future use by the child or a family member, you may contact one of the many private cord blood banks to arrange collection, shipment, and payment. Additional information about cord blood banking, including a list of private banks, can be found through the Parent’s Guide to Cord Blood Foundation. 

To donate your baby’s cord blood for public use, first check whether the hospital at which you plan to deliver works with a cord blood bank to collect cord blood for public donation.

In North Carolina, public collections are available at Duke, UNC, Durham Regional, Womack Army Medical Center, Women’s Hospital of Greensboro, and Rex Hospitals.

If your hospital does not participate in public cord blood banking, there are a few public cord blood banks, including the Carolinas Cord Blood Bank at Duke, that offer a free kit program so that public donations may be collected at other hospitals. Interested parents should contact the bank (919-668-2071) at least six weeks before the baby’s due date to learn more about the program.

Currently, public donations are limited to mothers who have a healthy pregnancy, are 18 years or older, and are pregnant with a single baby. More information about public cord blood donation is available through the National Marrow Donor Program.

-- Jessica M. Sun, MD, is a pediatric hematology / oncology specialist in the Duke Department of Pediatrics.

-- Dennis Clements, MD, PhD, is the chief of primary care pediatrics at Duke Children's Hospital.

www.parents.com/parents/quiz.jsp?catref=AB461&quizId=/templatedata/ab/quiz/data/103.xml

This introductory quiz is very helpful in assessing your knowledge of cord blood stem cells.