What is umbilical cord blood

Cord blood is the blood from the baby that is left in the umbilical cord and placenta after birth. It contains special cells called hematopoietic stem cells that can be used to treat some types of diseases. During pregnancy, the umbilical cord connects a developing fetus to the placenta. The placenta is an organ within a pregnant woman’s womb. It provides oxygen and nutrients to a growing baby, and removes waste products from the baby’s blood. The umbilical cord contains blood vessels that help carry oxygen and nutrient-rich blood to the baby, and take blood with waste away from the baby.

The blood that flows through the placenta and umbilical cord has a high concentration of stem cells. Stem cells develop to become mature blood cells including:

• red blood cells
• white blood cells
• platelets

Stem cells are an important treatment for many diseases, including cancer, blood disorders, and genetic and metabolic diseases. For many patients, umbilical cord stem cells are life-saving. Thousands of critically ill patients with blood diseases like leukemia and lymphoma are in urgent need of a life-saving transplant. Umbilical cord blood, which is typically thrown away, is rich with the blood-forming cells that can give blood cancer patients hope for a cure. Donating your baby’s cord blood to a public cord blood bank can help patients get the transplants they need.

Usually, the umbilical cord and placenta are discarded after birth. If a mother chooses to have her cord blood collected, the health care team will do so after the baby is born. With a sterile needle, they’ll draw the blood from the umbilical vessels into a collection bag. The blood is packaged and sent to a cord blood bank for long-term storage.

Donating cord blood is safe for the baby and doesn’t interfere with labor and delivery. Because families must register ahead of time—so a collection kit can be sent and used after the baby is born—parents should talk about cord blood banking with your obstetrician, pediatrician, or other medical personnel at the first prenatal visit. Cord blood donation should be arranged by the 34th week of pregnancy.

Are umbilical cord blood cells the same as embryonic stem cells?

No, umbilical cord blood cells are taken from the baby’s umbilical cord and placenta after the baby is born, and not from an embryo.

While cord blood stem cells are not embryonic, they are more pristine than the stem cells in adults, because they are younger and they have had less exposure to illness or environmental factors. The stem cells in cord blood can be collected without any risk to the baby or mother. Cord blood is used for therapy today in hospitals around the world. There are clinical trials that use cord blood for both stem cell transplants and emerging therapies in regenerative medicine. Cord blood banking includes the whole process from collection through storage of newborn stem cells for future medical purposes. If needed for treatment, the cord blood bank will release the stem cells to your physician.

What are hematopoietic stem cells?

Most cells can make copies only of themselves. For example, a skin cell only can make another skin cell. Hematopoietic stem cells, however, can mature into different types of blood cells in the body. Hematopoietic stem cells can generate new blood cells to resist disease. Hematopoietic stem cells also are usually found in blood and bone marrow in adults and children. Cord blood can be used to cure patients with blood cancers and other life-threathing diseases like sickle cell disease and aplastic anemia.

Why doctors may choose cord blood?

Doctors look at a variety of factors when determining which cell source is best for a patient. A doctor might choose cord blood for transplant because:

• Cord blood doesn’t have to be as closely matched to the patient as a marrow donor, so it may be an option for patients with uncommon tissue types.
• Cord blood units are stored and ready to use, so it’s quickly available when a patient needs a transplant right away.
• Studies have found that a transplant complication called graft-versus-host disease (GVHD) is less common and less severe after cord blood transplant than after a transplant using peripheral blood stem cells.

What happens if I do not donate my baby’s cord blood?

The umbilical cord, placenta and lifesaving blood they contain are discarded.

Can I donate if I’m having twins?

No, public cord blood banks can only accept donations when one baby is expected. With twins, each umbilical cord has different tissue types and it’s possible the two cord blood units could be mixed up during collection.

What if I have diabetes?

If you have gestational diabetes, you will usually be allowed to donate. If you have medication-dependent diabetes, check with a public cord blood bank to determine if you can donate.

Can I donate if I had cancer?

If you’ve ever had any type of cancer or leukemia (including skin cancers), you will not be able to donate.

I had an organ or tissue transplant. Can I still donate?

It depends on the length of time since you received the transplant. If you received a heart, lung, kidney, bone marrow or other organ or tissue transplant within the last 12 months, you are not eligible to donate cord blood. If it’s been more than a year, check with a public cord blood bank.

What if a donor egg (or sperm) was used? Can I still donate?

It depends on the facility where the egg or sperm was handled and the medical history of the donor. The donor egg or sperm needs to be from a facility that is accredited by the American Association of Tissue Banks. And the medical history of the person who donated the egg or sperm must be reviewed by the public cord blood bank.

How far ahead of my due date do I need to contact a public cord blood bank about donating umbilical cord blood?

Ideally, you should contact your cord blood bank between your 28th and 34th weeks of pregnancy. If you are still in the early stages of your pregnancy, please contact your cord blood bank when you reach your 28th week of pregnancy.

What if my hospital does not collect cord blood for a public cord blood bank?

Answer the basic questions to determine whether you meet cord blood donation guidelines (https://bethematch.org/support-the-cause/donate-cord-blood/learn-if-you-can-donate-cord-blood/). Then you can complete the Contact Information page, which will be forwarded to a cord blood bank that may be able to send you a cord blood collection kit. The cord blood bank will contact you 7 to 10 days after you submit your information.

Does it cost me anything to donate cord blood?

There is no cost to donate to a public cord blood bank. Public cord blood banks cover the costs of collecting, processing and storing cord blood units. If you opt to use a family cord blood bank, you will be charged a fee for collection as well as annual storage fees.

How will my delivery experience be affected by donating?

Your labor and delivery will not be affected in any way. During delivery, all of the focus is on you and your baby. It’s only after your baby is born that blood is collected from the cord and placenta. No blood is ever taken from your baby.

What are the current recommendations for delayed umbilical cord clamping after birth?

The American College of Obstetrics and Gynecology has recommended a delay of 30-60 seconds between delivery and umbilical cord clamping in healthy, full-term babies. It is believed that delayed clamping may have a beneficial effect in the newborn. If expectant parents wish to donate or store cord blood, delayed clamping may impact the volume and quality of cells. Expectant parents should discuss options for delayed umbilical cord clamping with their obstetrics provider.

What happens at the cord blood bank?

After the cord blood unit arrives at the cord blood bank, it is:

• Checked for the blood-forming cells needed for a transplant. If there are too few cells, the cord blood unit may be used for research related to the use of cord blood in transplant.
• Tested to be sure it is free from infection or disease.
• Tissue typed and listed on Be The Match Registry (https://bethematch.org/), a listing of potential marrow donors and cord blood units available for patients in need of a transplant.
• The cord blood is identified only by a number, never by a name.

What is cord blood used for?

Umbilical cord blood is an alternative hematopoietic stem cell source for patients with hematologic diseases who can be cured by allogeneic hematopoietic cell transplantation. Hematopoietic stem cells can be used to treat more than 70 types of diseases, including diseases of the immune system, genetic disorders, neurologic disorders, and some forms of cancer, including leukemia and lymphoma. For some of these diseases, stem cells are the primary treatment. For others, treatment with stem cells may be used when other treatments have not worked or in experimental research programs.

Because there is a limited amount of blood in a single umbilical cord (three to five fluid ounces), cord blood transplants are typically used for children but combining more than one cord blood unit for transplants into adults is possible as well.

Cord Blood is especially useful for:

• Patients who need a transplant quickly, because cord blood units are stored and ready to use.
• Patients who have a hard time finding a matched marrow donor. Cord blood does not have to match a patient’s tissue type as closely as donated marrow.
• Patients from racially or ethnically diverse communities who often have uncommon tissue types. Because cord blood does not have to match the patient as closely, it may offer more people from diverse backgrounds a second chance at life

Over the last 25 years, the field of umbilical cord blood banking and transplantation has grown exponentially. Over 600,000 umbilical cord blood units have been stored for transplantation worldwide, and >30,000 umbilical cord blood transplantations have been performed ¹. Umbilical cord blood serves as an alternative stem cell source; only 30% of patients who require an allograft will have a human leukocyte antigen (HLA)-matched sibling donor. Despite >20 million adult volunteer donors in the National Marrow Donor Program and affiliated registries ², many patients, particularly patients of diverse racial/ethnic backgrounds, will not have a suitably matched, unrelated volunteer donor identified in the required time period. Umbilical cord blood has extended access to transplantation, especially to patients of racial and ethnic minorities ³ and is rapidly available. In 2018, 28 percent of umbilical cord blood transplants were for patients of color. Today, 11% of transplant patients receive cord blood that was generously donated to a public cord blood bank ⁴.

You can save umbilical cord blood for a sibling who has a medical need. When a biological sibling has a disease that may be treated with a cord blood transplant, parents can choose to save their baby’s cord blood for the sibling. Collecting and storing cord blood for sibling-directed donation is offered at little or no cost to eligible families. Contact a participating public cord blood bank (https://bethematch.org/support-the-cause/donate-cord-blood/how-to-donate-cord-blood/participating-hospitals/) or a family cord blood bank (https://parentsguidecordblood.org/en).

Advantages of using cord blood to treat disease

Using the stem cells in cord blood to treat a disease has the following benefits compared with using those in bone marrow:

• Stem cells from cord blood can be given to more people than those from bone marrow. More matches are possible when a cord blood transplant is used than when a bone marrow transplant is used. In addition, the stem cells in cord blood are less likely to cause rejection than those in bone marrow.
• It is harder to collect bone marrow than it is to collect cord blood. Collecting bone marrow poses some risks and can be painful for the donor.
• Cord blood can be frozen and stored. It is ready for anyone who needs it. Bone marrow must be used soon after it is collected.
• Stem cells in cord blood can be used to strengthen the immune system during cancer treatments. Bone marrow stem cells do not have this capability.

Disadvantages of using cord blood to treat disease

A disadvantage of cord blood is that it does not contain many stem cells. Units from several donors can be combined to increase the number of stem cells if a transplant is needed for an adult.

In an autologous transplant, the cord blood collected at birth is used by that same child. This type of transplant is rare for the following reasons:

• A child’s stem cells cannot be used to treat genetic diseases in that child. All of the stem cells have the same genes that cause the disease.
• A child’s own stem cells cannot be used to treat that child’s leukemia, a cancer of the blood.

Why is it important to increase the ethnic diversity of the cord blood registry?

Studies show that when donated cells closely match a patient, their chances of transplant success improve. Patients are more likely to match someone of the same ethnic background.

Increasing the diversity of cord blood units on the registry makes it possible for more patients to receive a transplant. In 2018, 28% of umbilical cord blood transplants were for transplant patients of color.

What is cord blood banking

Cord blood is kept in one of two types of banks: public or private. They differ in important ways that may affect your choice.

There are two types of banks that store cord blood are:

• Public banks: These process and store umbilical cord blood donations for public use or for research. When you donate to a public cord blood bank, your baby’s cord blood is available to any patient who needs a transplant. It is not reserved for your family. There are no storage fees. Mothers donate their baby’s cord blood to public banks to help other people. Currently only certain hospitals (https://bethematch.org/support-the-cause/donate-cord-blood/how-to-donate-cord-blood/participating-hospitals/) are able to collect umbilical cord blood for storage in public cord blood banks.
• Private banks: These store cord blood for personal use by the family. The cost for long-term storage can be high.

Public cord blood banks

When you donate your baby’s umbilical cord for public use:

• It’s available to any patient in need of a transplant; it is not reserved for your family members.
• There is no cost to you because public cord blood banks cover the fees associated with processing, testing and storing donated cord blood.
• It’s collected under strict quality standards to make sure the cord blood unit is usable for transplant. If standards aren’t met, the cord blood unit may be used for research to improve the transplant process for future patients, or the unit will be discarded.

Public cord blood banks store cord blood for allogenic transplants. In an allogenic transplant, another person’s stem cells are used to treat a child’s disease. This kind of transplant is more likely to be done than an autologous transplant. Public cord blood banks do not charge to store cord blood. The stem cells in the donated cord blood can be used by anyone who matches. Some public banks will store cord blood for directed donation if you have a family member who has a disease that could potentially be treated with stem cells.

Cord blood recipients have a 25 percent chance of matching a sibling and a 75 percent chance of finding a match from a public cord blood bank. By choosing to donate your baby’s cord blood to a public bank, you are doing your part to help ensure more people in need of lifesaving cord blood transplants are able to find a match.

Donors to public banks must be screened for blood or immune system disorders or other problems. With a cord blood donation, the mother’s blood is tested for genetic disorders and infections, and the cord blood also is tested after it is collected. Once it arrives at the blood bank, the cord blood is “typed.” It is tracked by a computer so that it can be found quickly for any person who matches when needed.

Private cord blood banks

If you store the cord blood in a family (private) cord blood bank, it is reserved for your own family members. Private or family banks store cord blood for autologous use or directed donation for a family member. Private banks charge a fee for the collection and an annual fee to store the umbilical cord blood. Blood stored in a private bank must meet the same standards as blood stored in a public bank. If you have a family member with a disorder that may potentially be treated with stem cells, some private banks will store the cord blood free of charge.

Will umbilical cord blood stored privately for my family always be used if someone in my family needs a transplant?

This depends on several factors. If your baby’s cord blood is stored privately and someone in your family needed a transplant, your doctor would consider:

• The disease. For some diseases, the patient’s own cells can be used for transplant. However, many diseases treated with transplant may already be present in the baby’s cord blood. For these diseases, a transplant using cells donated from a relative or unrelated donor is the best choice.
• The match between the cord blood unit and the patient. There is a 30% chance that siblings will match each other. Your doctor will determine how close the match needs to be.
• The quality of the cord blood. The cord blood unit must be large enough (have enough blood-forming cells) and be free from disease and infection.

Is cord blood banking worth it?

If you’re thinking about banking your newborn’s cord blood, talk about your options with your health care provider. Your doctor can discuss the advantages and disadvantages of public and private cord blood banking.

For example:

• Private cord blood banking can help if you or a family member have an existing disease that’s treated using stem cells.
• It’s very unlikely that a child will develop a condition that can be treated with his or her own stem cells.
• Donating to a public cord blood bank may provide life-saving stem cells to a patient in need.

Many doctors and researchers support saving umbilical cord blood. Most of people would have little use for stem cells now, but research into using them to treat diseases is ongoing and the future looks promising.

If you want to donate your child’s umbilical cord blood, talk to your health care provider or contact the hospital or birthing center where your baby will be born. It’s best to start the process early in your pregnancy so you have time to explore and understand your options.

Benefits of public cord blood banking

Public cord blood banking is preferred, here’s why:

Frequency of use

Cord blood from public blood banks is used more often than privately banked cord blood. Thirty times more publicly banked cord blood units are used for transplants compared to privately banked cord blood.

Quality

Collection, evaluation and preservation of publicly banked cord blood is highly regulated by accrediting institutions such as the NetCord/Foundation for Accreditation of Cell Therapy, the FACT/Joint Accreditation Committee, and the American Association of Blood Banks. Private cord blood banks may or may not choose to meet these standards. This is why publicly stored cord blood has been shown to be of higher quality—increasing the potential for a successful stem cell transplant. Parents who are thinking about private cord blood banking are encouraged to ask these facilities about accreditation, costs, failure rates of their stored cord blood to achieve successful transplantation, and method of backup electrical systems in case of storage equipment failure. Conflicts of interest and financial disclosures should be provided.

Cost

There is no cost to the donor family with public cord blood banking. Private cord blood banking requires a processing fee of $1350-$2350 and an annual maintenance fee of $100-175.

Ethical considerations

Publicly banked cord blood is available to anyone. National and international public cord blood banks are searchable for children with life-threatening diseases throughout the world who need a stem cell donor. Private banking serves the needs of only one family.

What steps need to be done before cord blood is collected?

Certain steps must be done beforehand:

• The cord blood bank must be notified and a collection kit must be obtained in advance (usually 6 weeks or more) of your due date. Some hospitals have collection kits on hand, whereas others do not.
• A family medical history must be provided and the mother’s blood must be tested.
• Consent must be given before labor begins.

If you choose a private bank, you will sign a contract and pay a fee before the baby is born.

How is cord blood collected?

Cord blood is collected by your obstetrician or the staff at the hospital where you give birth. Not all hospitals offer this service. Some charge a separate fee that may or may not be covered by insurance.

The process used to collect cord blood is simple and painless. After the baby is born, the umbilical cord is cut and clamped. Blood is drawn from the cord with a needle that has a bag attached. The process takes about 10 minutes.

What problems can occur during cord blood collection?

Sometimes, not enough cord blood can be collected. This problem can occur if the baby is preterm or if it is decided to delay clamping of the umbilical cord. It also can happen for no apparent reason. If an emergency occurs during delivery, priority is given to caring for you and your baby over collecting cord blood.

What else should I think about when deciding whether to donate or store cord blood?

Think about the following points when making your choice:

• Donating cord blood to a public bank adds to the supply and can potentially help others. Donating to a public bank is especially important for ethnic minorities, who are not well represented in cord blood banks. Public cord blood donation increases the chance of all groups finding a match.
• Only certain hospitals collect cord blood for storage in public banks.
• Storing a child’s stem cells in a private bank as “insurance” against future disease is not recommended.
• If you already have a child with a medical condition that may be helped by a cord blood transplant, donating a biological sibling’s cord blood for directed donation is encouraged.
• If you decide to store cord blood in a private bank, you should find out the total cost, including charges for collecting and processing the cord blood and the annual storage fees.

1. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood. 2013;122(4):491-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952633/[↩]
2. Appelbaum FR. Pursuing the goal of a donor for everyone in need. N Engl J Med. 2012;367(16):1555–1556.[↩]
3. Barker JN, Byam CE, Kernan NA, et al. Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities. Biol Blood Marrow Transplant. 2010;16(11):1541–1548.[↩]
4. Cord blood is changing lives. https://bethematch.org/support-the-cause/donate-cord-blood/cord-blood-is-changing-lives/[↩]