If you’re pregnant or have gone through a pregnancy, you’ve probably seen a pamphlet at your obstetrician’s office about cord blood banking. Maybe that piqued your curiosity: What exactly is cord blood banking, and is it something you should consider? We’re guessing that brochure gave you an overview about umbilical cord blood—“ cord blood” for short—and how banking it can offer security for your family down the line when it comes to treating medical conditions. We get it: It’s a big decision (among a host of big decisions you have to make during your pregnancy), one where you’ll want to weigh the pros and cons of cord blood banking, figure out the difference between private and public cord blood banking and how to choose among the different cord blood banking companies out there.
What is cord blood?
So what is cord blood? The simple answer is that it’s the blood found in baby’s umbilical cord, the lifeline that provides key nutrients from your placenta to baby in utero during your pregnancy. Once baby is born, the umbilical cord is cut. While baby no longer needs the umbilical cord in the outside world, that doesn’t mean it’s useless. The umbilical cord still holds blood vessels containing blood—specifically, umbilical cord blood or cord blood. That blood is an excellent source of stem cells, similar to those found in bone marrow.
These days doctors can use bone marrow and cord blood for transplantation. “Cord blood is used for allogeneic hematopoietic stem cell transplantation for patients lacking a matched donor in their family or on the adult donor registry Be the Match,” Joanne Kurtzberg, MD, a professor of pediatrics at Duke University and a leading researcher in the field, tells The Bump. “In this capacity, cord blood donors are used to transplant patients with blood cancers [like leukemia and lymphoma], bone marrow failure, immunodeficiency syndromes, certain inherited metabolic diseases and hemoglobinopathies, such as sickle cell anemia and thalassemia.” That's why many parents are looking into preserving that blood.
What Is Cord Blood Banking?
Cord blood banking is the process of collecting and storing the blood left in a newborn’s umbilical cord, so it can be used in the future for medical purposes.
To collect cord blood, a newborn’s umbilical cord must first be clamped and cut in the usual way—and with no delays. If the clamping and cutting of the umbilical cord is delayed by even a minute or two, the blood will clot, making it useless.
Once the cord is clipped, a medical provider then inserts a needle into the umbilical vein on the part of the cord that’s still attached to the placenta. (Worried about that needle getting anywhere near baby? Don’t be: Once the cord has been cut, the needle has no contact with your newborn.) That needle is used to drain the blood—about one to five ounces—into a collection bag, which is then sealed and sent to a cord blood bank. The process typically takes less than 10 minutes. (Note: The umbilical cord is cut in the same way before it’s drained, so cord blood collecting shouldn’t interfere with how quickly mom and baby can have immediate skin-to-skin contact.)
After the blood makes it to the bank, it’s tested and, as long as it meets quality standards, cryopreserved for long-term storage—and we do mean long. “While we don’t know if cord blood has an exact expiration date, it’s been stored for 25 years and successfully used for a transplant,” Kurtzberg says. “It is likely that when stored properly, cord blood units can be stored for decades.”
Here’s the tricky part of cord blood banking: You have two options with what to do with that blood. You can donate it for public use, or you can keep it for baby, should she need it one day down the line.
Private vs. public cord blood banking
If you’re committed to moving forward with cord blood banking, you have a decision to make: Are you donating baby’s cord blood to a public cord blood bank, where anyone in need can use it? Or are you sending it to a private cord blood bank, so that one day, if baby is in need, she can access it? Here’s how private cord blood banking differs from public cord blood banking.
Private cord blood banking
What Is It?
Private cord blood banking is the storage of a newborn’s umbilical cord blood in a private facility, so that one day—should the need arise—baby or an immediate member of baby’s family can use the cord blood’s stem cells for the potential treatment of a variety of medical issues.
Now, when we say family members, we almost always mean siblings, since they have the best chance of being a perfect match. “Cord blood may also be used for a matched sibling who needs a transplant if sufficient cells are stored,” Kurtzberg says. “There is a 25 percent chance that any two siblings will match each other. Cord blood may also be able to be used if it’s half-matched, which happens 50 percent of the time between siblings.” Unfortunately, distant relatives and even parents are unlikely to match with their children.
How Does It Work?
Once the cord blood is collected, it’s sent to a private facility where, once it’s tested to ensure its healthiness, it is stored for a fee. It can then be accessed later if needed.
How Much Does It Cost?
It depends on the facility, but generally speaking, there’s a $1,000 to $3,000 enrollment fee at many private cord blood banks, plus an annual storage fee (about $100 per year on average). While that may sound steep, it depends on how you look at it. Many parents see it as an investment in the future of their child—and of their family—should any stem cell–treatable medical issues arise.
While cord blood banking cost is the biggest obstacle for many parents, keep this in mind: If your child or someone in your family has a medical condition that could potentially be treated with the stem cells found in cord blood, the expenses associated with private cord blood banking are tax deductible.
Public Cord Blood Banking
What Is It?
Public cord blood banking happens in much the same way that private cord blood banking does. The only difference is who the cord blood is intended for. While private cord blood banking is for those looking to hold on to baby’s umbilical cord blood, public cord blood banking is for donated cord blood, which can then be used by anyone in need. (Note: Minorities are the least represented demographic in public banks.)
How Does It Work?
Blood stored in public cord blood banks is collected in the same way in the delivery room. The difference is what happens next. First, it’s checked to ensure it has enough blood-forming cells for a transplant. If it does, and it’s not contaminated in any way, it’ll be typed into and listed on the CW Bill Young Cell Transplantation Program (also called the Be the Match Registry). It will then be frozen and stored, until it’s selected as a match for a patient.
If the cord blood does not have enough blood-forming cells, then it may be used for research to improve the process of cord blood banking or to test new cord blood treatments, or it may be discarded.
How Much Does It Cost?
Nothing. Donating cord blood to a public cord blood bank in the US is free.
Cord blood banking pros and cons
Can’t decide between keeping baby’s cord blood (private cord blood banking) or donating it (public cord blood banking)? Consider this: Often, if a child is sick, her cord blood wouldn’t be suitable for transplant. That’s because a genetic condition would likely have been present at birth, meaning the mutation would also be found in the cord blood. So if the child is sick and needs cord blood stem cells for treatment, someone else’s unmutated cord blood would be needed. As more people donate cord blood, the chances of finding an ideal match will increase. That’s why the American Academy of Pediatrics (AAP)—and Kurtzberg—recommends donating cord blood instead of discarding it, so that we can all pull from a robust shared collection and potentially save lives.
That said, if a close member of your family already has a need for treatment using stem cells, baby’s cord blood has a fair chance of being a perfect match—at least 25 percent between siblings.“Those who should consider privately banking cord blood are families affected by diseases and conditions that are known to benefit from cord blood transplants,” says Mitchell S. Cairo, MD, chief of pediatric hematology, oncology and stem cell transplantation at Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, New York. “Also if there’s a family history of certain genetic conditions, such as leukemia, sickle-cell anemia or thalassemia.”
Keep in mind, not all diseases treated with cord blood stem cells are genetic. Case in point: certain cancers. In those cases, baby may be able to turn to her own cord blood for treatment one day. New discoveries of how cord blood can treat future medical conditions are being researched by university medical institutions like Duke, which has a $41 million project in the works to study the use of cord blood stem cells in patients with autism and certain brain disorders and injuries.
So the pros and cons of cord blood banking are:
- By storing baby’s cord blood in a cord blood bank, she will one day be able to access it if in need.
- Close family members in need could also use that cord blood, potentially avoiding the process of finding a match. Plus, if an immediate family member already has a life-threatening illness, public and private cord blood banks have special financial programs to help families with a qualifying medical need.
- New cord blood treatments are being researched all the time. Some experts hope and believe that cord blood may one day be able to treat lupus, Parkinson’s disease, brain injuries, cardiovascular disease and breast cancer.
- Even if you don’t store baby’s cord blood privately, donating it to a public cord bank could save the life of someone else in need. “Your baby’s cord blood contains valuable therapeutic cells,” Kurtzberg says. “Essentially, one life can save another.” There is nothing dangerous or painful about collecting cord blood.
- Private cord blood banking can be expensive—$1,000 to $3,000 to bank the blood, and $100 every year after that for storage.
- While cord blood banking isn’t dangerous in any way, if baby develops a genetic disease, there’s a chance she may not be able to use her own cord blood. (Though someone else in the family might.)
- Should your child one day need cord blood, she can turn to the public cord banks and find a match.
- Not a strict con but important to note: If you want to bank baby’s cord blood, you have to find a hospital with experience in cord blood banking. “You don’t want to risk having an inadequate collection,” Cairo says. “And choose an established cord blood bank. You want it to be there in 20 years.”
Cord blood banking companies—how to choose the one for you
If you decide on private cord blood banking, you’re going to need to choose a bank. It’s a big investment—financially, physically and emotionally—so you’ll want to choose not only a good cord blood bank but the right one for you.
How do you narrow down your list? To start, “The bank should be well established, registered with the FDA and accredited by either FACT or AABB,” Kurtzberg says. Here is her checklist for evaluating a good cord blood bank:
- The bank should provide a kit with the materials needed to collect the cord blood.
- The bank should process the blood to lower volume and partially deplete the collection of red blood cells.
- The blood should be tested for sterility.
- The bank’s lab should perform donor screening tests on mom’s blood.
- Extra samples should be saved for future testing.
- The blood should be frozen in a bag that has attached segments for identity and potency testing.
- The cord blood unit should be stored in monitored liquid nitrogen freezers in the liquid or vapor phase (i.e., -180°C or colder).
Here are four cord blood banks we recommend based on customer reviews and their success rates in storing cord blood that can one day be used in treatment:
- Cord Blood Registry (CBR) Founded in 1992, this California-based company is one of the largest and oldest cord blood banking facilities in the country. It’s accredited by the AABB (the trusted, international, nonprofit organization that represents all those involved with transfusion medicine), and it also has its own private labs that test for HIV, hepatitis, syphilis and other diseases. Testing is included in the registration fee.
- Lifebank USA Also accredited by the AABB, this New Jersey company has one feature that sets it apart: It stores both umbilical cord blood and placenta blood (the latter is done for free). Stem cells from placenta tissue can turn into skeletal tissues down the line.
- Family Cord In addition to being accredited by the AABB, the California-based Family Cord has a top rating from the Better Business Bureau. It’s also one of the few banks that will cover the cost of storage for the first year baby has a sick family member who could benefit from cord blood.
- Cryo-Cell International Based in Florida, Cryo-Cell International is accredited by not only the AABB but also the Foundation for the Accreditation of Cellular Therapy (or FACT). Cryo-Cell boasts a top-notch collecting kit, designed to protect stem cells for up to 30 times longer than the average kit.
Experts: Joanne Kurtzberg, MD, a professor of pediatrics at Duke University and the director of the Carolinas Cord Blood Bank; Mitchell S. Cairo, MD, chief of pediatric hematology, oncology and stem cell transplantation at Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, New York.
Published June 2017