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*[http://www.marchofdimes.com/professionals/14332_1160.asp The March of Dimes - Umbilical Cord Blood]
*[http://www.marchofdimes.com/professionals/14332_1160.asp The March of Dimes - Umbilical Cord Blood]
*[http://www.gentlebirth.org/archives/cordIssues.html GentleBirth.org] - Umbilical cord issues
*[http://www.gentlebirth.org/archives/cordIssues.html GentleBirth.org] - Umbilical cord issues
*[http://www.parentsguidecordblood.com Parents Guide to Cord Blood], a non-profit foundation
*[http://parentsguidecordblood.org Parent's Guide to Cord Blood Foundation], a non-profit educational foundation
*[http://www.eurocord.org/web/eurocord_home.php Eurocord International Cord Blood Registry]
*[http://www.eurocord.org/web/eurocord_home.php Eurocord International Cord Blood Registry]
*[http://cordbloodawareness.org/state_legislation.htm Cord Blood Legislation by State] (United States)
*[http://cordbloodawareness.org/state_legislation.htm Cord Blood Legislation by State] (United States)

Revision as of 18:45, 1 July 2008

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.

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[2] 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]

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. Unfortunately, prior to March 2008, many medical societies issued opinions against family storage of cord blood based on under-estimates of the odds of use. In March 2008, a paper was published by Nietfeld et al.[3] in the journal Biology of Blood and Marrow Transplantation which computed the lifetime probability (up to age 70) that an individual in the US would undergo a stem cell transplant. The likelihood of an autologous transplant using your own stem cells is 1 in 435, the likelihood of an allogeneic transplant from a matched donor (such as a sibling) is 1 in 400, and the net likelihood of any type of stem cell transplant is 1 in 217.

The National Marrow Donor Program [3] estimates that by the year 2015, there will be 10,000 cord blood transplants world-wide per year using publicly banked cord blood. It is therefore vitally important to build public repositories of cord blood donations throughout the world. In the United States, the Health Resources and Services Administration (HRSA) of the US Dept. of Health and Human Services is responsible for funding national programs to register marrow donors and bank cord blood donations: [4]

The European Union Group on Ethics (EGE) has issued Opinion No.19 [4] titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded 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] However, in the final section 1.27 of their Opinion, the EGE admits that: "if in the future regenerative medicine developed in such a way that using autologous stem cells became possible, then the fact to have one's own cord blood being stored at birth could increase the chance of having access to new therapies."[4]

In May 2006, The World Marrow Donor Association (WMDA) Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage[5] 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.

As of spring 2008, there are several known instances where autologous use of cord blood is indicated:

  1. Whereas the WMDA cautioned against autologous transplant for diseases with a genetic signature, there are pediatric cancers (ex: neuroblastoma) and acquired conditions (ex: aplastic anemia) which can be treated by autologous transplant. There has even been one autologous transplant for leukemia[6]
  2. Type 1 Diabetes, also known as Juvenile Diabetes, has been shown to improve if treated shortly after onset with an infusion of autologous cord blood.[7] The American Diabetes Association [5] reports that 1 in 7000 children is diagnosed each year with Type 1 diabetes, and 1 in 600 children are living with it.
  3. Cerebral Palsy and other forms of pediatric brain injury have responded well to infusions of autologous cord blood in a clinical trial conducted at Duke University.[8]

See also

References

  1. ^ NIH data
  2. ^ Raymer, Elizabeth (2005-10-14). "New strategy will boost cord blood stem cells". University of Toronto. {{cite web}}: External link in |work= (help); Unknown parameter |accessmonthday= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  3. ^ Nietfield J, et al. Lifetime probabilities of hematopoietic stem cell transplantation in the U.S. Biology of Blood and Marrow Transplantation. 2008;14:316-322
  4. ^ a b c Opinion N° 19
  5. ^ World Marrow Donor Association (2006). "Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage" (PDF). World Marrow Donor Association. {{cite web}}: External link in |work= (help); Unknown parameter |accessmonthday= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  6. ^ Hayani A, et al. First report of autologous cord blood transplantation in the treatment of a child with leukemia. Pediatrics. 2007;119:296-300
  7. ^ Haller, M.J. et al. Autologous umbilical cord blood infusion for type 1 diabetes. Exp. Hematol. 36, 710-715 (2008)
  8. ^ Duke University, Neonatal Hypoxic-Ischemic Encephalopathy; Phase I clinical trial NCT00593242, [1]

General information

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