What is Cord Blood Banking?

Cord blood banking is the process of collecting, processing, and storing the blood remaining in the umbilical cord and placenta after a baby's birth. This blood is a rich source of hematopoietic stem cells (HSCs), which are the building blocks of our blood and immune system. These stem cells are unique because they can develop into red blood cells, white blood cells, and platelets. Unlike embryonic stem cells, cord blood stem cells are more ethically straightforward.

The preserved cord blood can then be used later in life, either for the child themselves or for a biologically matched relative, to treat certain diseases. It's essentially a form of biological insurance, offering a readily available source of stem cells should the need arise. The goal is to have these stem cells available for transplantation or other medical applications, potentially saving lives and improving health outcomes.

Key Facts:

Cord blood is a rich source of hematopoietic stem cells.
Collection is safe and painless for both mother and baby.
Stem cells can be used to treat nearly 80 diseases.
Cord blood can be stored for extended periods (21+ years).
Choosing between public and private banking is a crucial decision.

Why is Cord Blood Banking Performed?

Cord blood banking is considered for its potential to treat a range of conditions, primarily those affecting the blood and immune system. It provides a source of stem cells for transplantation, offering hope for individuals with life-threatening illnesses.

Main conditions/indications:

Leukemias: Various types of leukemia, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).
Lymphomas: Hodgkin's lymphoma and non-Hodgkin's lymphoma.
Anemias: Aplastic anemia, sickle cell anemia, and thalassemia.
Inherited Metabolic Disorders: Conditions like Hurler syndrome and Krabbe disease.
Immune Deficiency Disorders: Severe combined immunodeficiency (SCID).
Myeloproliferative Disorders: Chronic myelogenous leukemia (CML).
Some Solid Tumors: Neuroblastoma and retinoblastoma.

When Doctors Recommend It:

Doctors may recommend cord blood banking in the following scenarios:

Family History: If there is a family history of blood disorders, immune deficiencies, or cancers treatable with stem cell transplantation.
Existing Condition: If a family member currently has a condition that could benefit from a stem cell transplant.
High-Risk Pregnancy: In cases of high-risk pregnancies where the baby might be at increased risk of certain health problems.
Ethnic Background: For individuals from ethnic backgrounds where finding a matched bone marrow donor can be challenging, cord blood offers a readily available alternative.
Physician Recommendation: Based on individual circumstances and medical history, a physician may recommend cord blood banking after a thorough evaluation.

Preparation for Cord Blood Banking

Preparing for cord blood banking involves careful planning and coordination with your healthcare provider and chosen cord blood bank. Here’s a breakdown of the essential steps:

Essential Preparation Steps:

Early Discussion: Discuss cord blood banking with your obstetrician or healthcare provider as early as possible in your pregnancy, ideally during the second trimester. This allows ample time to make an informed decision and complete the necessary paperwork.
Public vs. Private: Decide whether you want to donate your cord blood to a public bank or store it in a private bank. Public donation is generally recommended by the Indian Academy of Pediatrics (IAP) unless there's a specific family need.
Bank Selection (Private Banking): If choosing private banking, research and select a reputable cord blood bank. Look for accreditation from organizations like the American Association of Blood Banks (AABB) or similar recognized bodies. Inquire about their processing methods, storage facilities, and success rates.
Enrollment and Paperwork: Enroll with the chosen cord blood bank and complete all required paperwork. This will include providing your medical history, family health history, and signing consent forms.
Collection Kit: Once enrolled, the cord blood bank will provide you with a cord blood collection kit. Store this kit at room temperature and keep it readily accessible.
Maternal Blood Sample: Upon admission to the delivery center, a maternal blood sample will be collected to test for infectious diseases. This is a standard procedure to ensure the safety of the stored cord blood.
Inform Delivery Team: Inform your obstetrician, nurses, and other members of your delivery team that you have opted for cord blood banking. Ensure they are aware of the process and have the necessary information.

India-Specific Tips:

Consult with a Hematologist: Consider consulting with a hematologist or stem cell transplant specialist for personalized advice, especially if there is a family history of relevant conditions.
PCPNDT Act: The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act does not directly affect cord blood banking. However, be mindful of ethical considerations and ensure informed consent throughout the process.
Aadhaar Card: Keep your Aadhaar card handy, as it may be required for identification purposes during the enrollment process.
Hospital Choice: If possible, choose a hospital that has experience with cord blood collection and a good working relationship with reputable cord blood banks.
Payment Options: Inquire about payment options and installment plans offered by the cord blood bank to manage the costs effectively.

What to Expect:

The cord blood collection process is typically quick and painless, taking only a few minutes after the baby is born.
The collection kit should be given to the delivery team as soon as possible after birth.
The cord blood bank will arrange for the transportation of the collection kit to their facility for processing and storage.
You will receive confirmation from the cord blood bank once the cord blood has been successfully processed and stored.
Be prepared for annual storage fees if you have opted for private banking.

The Cord Blood Banking Procedure

The cord blood banking procedure involves several key steps, from collection at the time of birth to processing and long-term storage. Here’s a concise overview:

Step-by-Step:

Collection:
- After the baby is born and the umbilical cord is clamped and cut, the delivery team cleans the umbilical cord area.
- A needle is inserted into the umbilical cord, and the cord blood is collected into a sterile collection bag.
- The collection process typically takes a few minutes and is painless for both the mother and the baby.
Transportation:
- The collection kit containing the cord blood is carefully packaged and transported to the cord blood bank.
- The cord blood bank usually arranges for a medical courier to transport the kit, ideally within 24-48 hours of collection.
Processing:
- At the cord blood bank, the cord blood is tested for cell count, viability, and infectious diseases.
- The cord blood is processed to separate the stem cells from other blood components (like red blood cells).
- A cryoprotectant is added to protect the stem cells during the freezing process.
Preservation:
- The stem cells are placed in a cryo-bag and slowly frozen using a controlled-rate freezing technique.
- The frozen stem cells are then stored in the vapor phase of liquid nitrogen at temperatures below -170 degrees Celsius for long-term preservation.

Duration, Comfort Level:

Collection: The actual collection process takes only a few minutes and is entirely painless for both mother and baby.
Overall Procedure: The entire process, from collection to storage, takes a few days.
Comfort Level: The procedure is non-invasive and poses no risk to the mother or the baby.

What Happens During the Test:

There are no specific "tests" performed on the mother or baby during the cord blood collection. However, a maternal blood sample is taken upon admission to the hospital to screen for infectious diseases, ensuring the safety of the cord blood sample. The cord blood itself undergoes extensive testing at the cord blood bank to assess its quality and suitability for storage and future use.

Understanding Results

Understanding the results of cord blood banking involves interpreting the information provided by the cord blood bank after processing and testing the collected cord blood. Here's what you need to know:

Normal vs. Abnormal Ranges (if applicable):

While there aren't strict "normal" vs. "abnormal" ranges in the traditional sense, the cord blood bank assesses several parameters to determine the quality and suitability of the cord blood for storage. Key parameters include:

Total Nucleated Cell (TNC) Count: This measures the total number of cells in the cord blood unit. A higher TNC count generally indicates a greater number of stem cells and a higher potential for successful transplantation. There's no absolute minimum, but higher is generally better.
CD34+ Cell Count: CD34+ cells are a specific type of stem cell that are particularly important for hematopoietic reconstitution (rebuilding the blood and immune system). A higher CD34+ cell count is desirable.
Cell Viability: This indicates the percentage of live cells in the cord blood unit after processing. A high viability percentage is crucial for the stem cells to function properly after thawing.
Sterility Testing: The cord blood is tested for bacterial and fungal contamination. The results must be negative for the cord blood to be considered suitable for storage.
Maternal Infectious Disease Testing: The mother's blood is tested for infectious diseases like HIV, hepatitis B, and hepatitis C. A positive result may affect the suitability of the cord blood for certain uses.

What Results Mean:

Suitable for Storage: If the cord blood unit meets the minimum criteria for cell count, viability, and sterility, it will be deemed suitable for storage. This means the cord blood bank believes it is likely to be useful for transplantation in the future.
Unsuitable for Storage: In some cases, the cord blood unit may not meet the minimum criteria for storage due to low cell count, poor viability, or contamination. In this case, the cord blood bank will inform you that the unit cannot be stored. This doesn't necessarily reflect on the health of the baby, but rather the quantity or quality of the collected cord blood.
Genetic Testing: Some cord blood banks offer optional genetic testing on the cord blood sample. These tests can identify genetic markers or predispositions to certain diseases.

Next Steps:

Confirmation of Storage: If the cord blood unit is suitable for storage, you will receive confirmation from the cord blood bank. This confirmation will typically include information about the TNC count, CD34+ cell count, and other relevant parameters.
Annual Storage Fees: Remember to pay the annual storage fees to ensure the cord blood remains stored and available for future use.
Informing Your Doctor: Keep your doctor informed about your decision to store cord blood and the results of the cord blood banking process.
Future Use: If the need for stem cell transplantation arises in the future, contact the cord blood bank to retrieve the stored cord blood unit. The cord blood bank will work with your doctor to coordinate the transplantation process.

Costs in India

The cost of cord blood banking in India varies depending on whether you choose public or private banking, and the specific services offered by the private bank.

Price Range in ₹ (Tier-1, Tier-2 Cities):

Public Banking: Donating to a public cord blood bank is generally free of charge.
Private Banking:
- Initial Fees (Collection, Processing, and First Year of Storage): ₹50,000 to ₹90,000 (can vary based on city and bank)
- Annual Storage Fees: ₹4,000 to ₹8,000 per year
- Some banks offer "lifetime" storage plans for a lump sum payment ranging from ₹1,50,000 to ₹2,50,000.

Government vs. Private:

Government Hospitals: Public donation is typically facilitated through government hospitals. There are limited purely public cord blood banks in India.
Private Hospitals: Private cord blood banks partner with private hospitals to collect and store cord blood.

Insurance Tips:

Cord blood banking is generally not covered by standard health insurance policies in India.
Some comprehensive maternity insurance plans may offer partial coverage for cord blood banking. Check with your insurance provider for specific details.
Consider exploring installment payment plans offered by private cord blood banks to manage the costs more effectively.
Some banks may offer discounts or financial assistance programs based on income or medical need.

How Ayu Helps

Ayu helps you manage your healthcare information efficiently. You can securely store your cord blood banking results digitally within the Ayu app. This allows you to track the information over time and easily share it with your doctor or family members via a QR code.

FAQ

Q1: What are the chances that my baby will need their cord blood in the future?

The likelihood of a child needing their own cord blood is relatively low, estimated to be around 1 in 2700. However, the potential benefits in specific situations make it a consideration for many families.

Q2: Is cord blood banking ethical?

Cord blood banking is generally considered ethical, but it's essential to make an informed decision. Public donation is ethically straightforward, while private banking raises questions about accessibility and cost.

Q3: Can cord blood treat genetic diseases in my child?

Unfortunately, cord blood cannot be used to treat genetic diseases the child is born with because the stem cells carry the same genetic defect.

Q4: What happens if the cord blood unit is not suitable for storage?

If the cord blood unit doesn't meet the minimum criteria for storage, the cord blood bank will inform you. You will not be charged for storage fees. The collection fee might still apply, depending on the bank's policy.

Q5: How long can cord blood be stored?

Studies have shown that cord blood can be stored effectively for at least 21 years, and potentially much longer, without significant loss of stem cell viability.

Q6: Is cord blood transplantation better than bone marrow transplantation?

Cord blood transplantation has some advantages over bone marrow transplantation, including easier matching (less stringent HLA matching requirements), faster availability, and lower risk of graft-versus-host disease (GVHD) in some cases.

Q7: What is community cord blood banking?

Community cord blood banking involves donating your baby's cord blood to a shared pool that can be accessed by other members of the community, including your own family. It offers a middle ground between public and private banking.

Q8: What happens if the cord blood bank goes out of business?

Reputable cord blood banks typically have contingency plans in place to transfer stored cord blood units to another accredited facility if they were to cease operations. Inquire about these plans before choosing a bank.

What is Cord blood banking: Purpose, Procedure & Costs in India