July is recognized as National Cord Blood Awareness Month. The purpose of this observance is to educate families about umbilical cord blood, how it is collected, how it may be used in medicine, and the differences between public donation and private banking. AABB notes that cord blood contains hematopoietic stem cells and that much of the umbilical cord blood available after birth is discarded when it is not collected for donation or storage.
Cord blood is the blood that remains in the umbilical cord and placenta after a baby is born. According to the U.S. Food and Drug Administration, cord blood contains hematopoietic progenitor cells, which are blood-forming stem cells. These cells are also found in bone marrow and peripheral blood. Hematopoietic stem cells are used in transplantation for certain cancers, blood disorders, immune system disorders, and inherited metabolic disorders.
Cord blood collection happens after birth. Once the baby is delivered and the umbilical cord is cut, remaining blood from the umbilical cord and placenta can be collected. The American Academy of Pediatrics states that donating cord blood is safe for the baby and does not interfere with labor and delivery. Families who want to donate usually need to arrange donation before delivery, because registration and collection planning must happen in advance. AAP notes that cord blood donation should be arranged by the 34th week of pregnancy.
Cord blood may be used in stem cell transplants. In these procedures, unhealthy or diseased blood-forming cells are replaced with healthy blood-forming cells. The FDA states that cord blood transplants have been used for patients with certain blood cancers, including leukemia and lymphoma, as well as some inherited metabolic and immune system disorders.
Matching is an important part of stem cell transplantation. The FDA explains that human leukocyte antigen, or HLA, typing is used to match patients and donors. HLA markers help the immune system recognize which cells belong in the body. A close match can reduce the risk of complications after transplant. Cord blood stem cells may not require as exact a match as stem cells from bone marrow or peripheral blood because the antigens in cord blood are less mature.
There are two main options for cord blood banking: public donation and private storage. Public cord blood banks store donated cord blood for potential use by any patient who needs a transplant. Private cord blood banks store cord blood for possible future use by the child it came from or by a first- or second-degree relative. The FDA regulates cord blood and explains that public cord blood intended for unrelated patients must meet additional requirements, including licensure under a biologics license application or use under an investigational new drug application. Private banks must also follow FDA requirements related to registration, donor screening, infectious disease testing, reporting, labeling, and tissue practice regulations.
Public cord blood donation can help patients who do not have a matched donor in their family. HRSA states that thousands of people each year are diagnosed with leukemia, lymphoma, and certain immune system or genetic metabolic disorders that may require a bone marrow or cord blood transplant. HRSA also notes that 75% of patients do not have a fully matched donor in their family. For these patients, an unrelated donor or donated cord blood unit may be an important transplant option.
Cord blood donation is especially important for genetically diverse communities. HRSA explains that suitable matches are inherited, and patients from genetically varied backgrounds may have a harder time finding a matched marrow donor. HRSA specifically notes the need for cord blood donations from Black and African American, American Indian and Alaska Native, Asian, Hispanic and Latino, Native Hawaiian and other Pacific Islander, and multiple-ancestry communities.
The American Academy of Pediatrics supports education about public cord blood banking. AAP explains that public cord blood banking is preferred because publicly banked units are used more often, are available to patients beyond one family, and do not cost the donor family. AAP also notes that publicly banked cord blood units are used for transplant much more frequently than privately banked units.
Private cord blood banking is different from public donation. Private banking stores a baby’s cord blood for possible future use by that child or certain family members. AAP states that the use of a child’s own stored cord blood is limited. For example, if a child develops leukemia, that child’s own cord blood may not be recommended because the cells could carry the same disease risk. The FDA also notes that for some genetically heritable diseases, a child’s own cord blood may not be recommended for treatment.
Professional medical organizations distinguish between routine private banking and directed donation. ACOG states that routine private cord blood banking is not supported by available evidence and that public banking is the recommended method of obtaining cord blood. AAP also explains that direct donation may be appropriate when a child with a known disorder has a matched sibling donor, because the newborn sibling’s cord blood may be collected and stored for possible transplant use.
Families considering private banking should understand what is included and what questions to ask. AAP recommends asking private cord blood banks about accreditation, costs, failure rates of stored cord blood to achieve successful transplantation, and backup electrical systems in case of storage equipment failure. AAP also notes that private banking includes processing and ongoing storage costs, while public donation does not cost the donor family.
Cord blood collection may not always be possible. ACOG notes that the medical condition of the mother or newborn may prevent adequate umbilical cord blood collection. The priority during delivery is the health and safety of the mother and baby. If complications occur or collection is not feasible, cord blood may not be collected.
Cord Blood Awareness Month gives expectant parents an opportunity to learn the facts before delivery. Cord blood contains blood-forming stem cells that may be used in transplant medicine. Public donation can expand the pool of available matches for patients in need, including children and adults with certain cancers, blood disorders, immune deficiencies, and inherited metabolic diseases. Private banking stores cord blood for possible family use, but routine private storage is not recommended by major medical organizations for most families without a known medical indication. Parents who are considering cord blood donation or banking should review the differences between public and private options before the baby is born.