When my wife and I were expecting our first daughter way back in the nineties, we received a paper pamphlet about cord blood banking.
Back then, I was a graduate student at UC San Diego School of Medicine working toward my Ph.D. in Molecular Pathology and my wife was in medical school at the time so we thought а fair amount about cord blood banking. However, it was fairly new at the time and there wasn’t that much information out there on it. You couldn’t easily search the internet at the time to find a helpful resource.
So, we wondered about the balance of the possible pluses and minuses.
Saving cord blood as an option
Even today expecting parents are wondering the same thing.
There’s a lot of misinformation out there about saving cord blood and stem cell banking more generally.
A recent, balanced NY Times article provides some helpful content and rightly probes view some of the claims.
It’s important to note that in discussing the pros and cons of saving cord blood below, I mean private cord blood banking. In that scenario a family pays a company to store the cord blood in liquid nitrogen.
There’s another important option and that’s public cord blood banking, which is a very different situation. I also discuss that kind of public banking as well.
What is cord blood?
Cord blood is the blood in the umbilical cord during the birthing process.
Mother and the child-to-be are connected during pregnancy by the umbilical cord and placenta, allowing the mother to share nutrients with the fetus and remove waste products.
While the placenta at the time of birth contains both baby’s and mother’s blood in close proximity, the blood inside the umbilical cord is the baby’s blood and is especially rich in their stem cells.
These cord blood stem cells can function in ways similar to the blood stem cells in the bone marrow, which means cord blood can in some cases be used in a fashion akin to bone marrow (see infographic above by Mina Kim).
For example, certain patients with blood cancers may be able to get a cord blood transplant in place of a standard bone marrow or hematopoietic stem cell transplant after they get chemo. If the patient banked their own cord blood then the transplant will be autologous, meaning there’s no chance of rejection. Otherwise, there is a need to try to find a matching donor of bone marrow or of cord blood.
Some data suggest that cord blood stem cells have other unique properties that make them even better or more flexible in uses than the hematopoietic stem cells from marrow or those circulating in the blood stream. Many clinical trials are ongoing.
How is cord blood banked?
After a baby is born it is still attached to its mother for a short time by the umbilical cord. During that window of time, the umbilical cord still contains cord blood. If the delivering doctor or midwife knows that the family wants to save the cord blood, in addition to clamping off the cord as usual, they will insert a needle into the cord and pull out the blood from inside.
It’s remarkable, but the 3 tablespoons or so of blood that is harvested via that needle and then stored in ultra cold in liquid nitrogen in the long run can sometimes be enough to save lives. What are the pros of save this special blood?
The cord blood isolation process is safe and painless.
Pros of cord blood banking?
One common claim of some cord blood banks is that there’s a good chance that if you freeze your baby’s cord blood that it will come in handy for that same person later in life.
While that sometimes happens for children who go on to get blood cancers or rarely other health issues like certain immune disorders, the odds are that that will never happen for any particular person who has banked cord blood.
Still, on the rare chance that your child could benefit from cord blood somehow down the road in life, a pro of saving cord blood is that it will be there if needed.
Another possible pro is that the cord blood could be needed and be useful for a close relative who faces a health issue. Maybe even one of the siblings.
These are really the only very concrete potential pros of banking at a for-profit company. Keep in mind that you have to plan ahead to have the cord blood banked.
Cons of cord blood banking?
One of the cons of saving cord blood is the potentially unrealistic expectation that it’ll be useful to the same family leading to false hope.
The most concrete con of banking is the cost (more below).
Another issue to consider is that some of the private cord blood banking firms have reportedly had sometimes serious issues with the quality control of their process. Remarkably, in the study cited in the previous sentence, almost 2/3 of the cord blood units analyzed had at least one issue.
Questions and concerns about private cord blood banking have been around for a long time. You can watch an ABC News investigative report from 10 years ago above.
Public banking gets a thumbs up
With public cord blood banking, there is no cost to the family.
Instead, a given state, for instance California, has its own funded banking program and covers the costs. However, in this case the cord blood may be available to anyone, not just the family that donated it.
The blood may be used fo potentially life-saving research. My own institution, UC Davis Health, is part of the California Umbilical Cord Blood Collection Program.
There’s not much of a downside here and real positives.
Exaggerated claims about cord blood from for-profit firms such as for autism
For-profit cord banking firms make a variety of claims and in my view some of the claims are not substantiated by strong data. From the NYT:
“ViaCord, one of the nation’s largest private banks, states on its website that “special properties of cord blood stem cells” may help those with autism, in part by encouraging their brain cells to repair and by boosting their immune system. As evidence for that claim, they reference a 2017 clinical trial of 25 children with autism who were given cord blood transfusions.”
They are referencing a past Duke trial that actually did not show any clear benefit of cord blood for autism. A more recent Duke clinical trial published in 2020 conclusively showed there was no benefit of cord blood for autism. Duke is not giving up though. Notably, as quoted in a recent article in Business Insider, the Duke Autism Center has connections to the cord banking firm, Cryo-Cell.
Private cord blood banking cost: $1,500 to start, $150-$200/year
Storing your child’s cord blood can get expensive.
It is standard for private banks to charge an initial banking fee of about $1,500.
What really adds up over the years is the annual fee, which usually is about $150-$200/year. That may not seem like that much, but what if your child grows up and then needs the cord blood when they are 40 years old? That would be as much as $8,000 more in yearly fees.
And, again, keep in mind that very few families with cord blood in a private bank ever use it.
Final decision: to bank cord blood or not?
In the end the decision whether to bank your baby’s cord blood or not is a personal one for your family, depending on a number of factors.
It’s something you should discuss with your family doctor too. For instance, if your family has a high incidence of blood cancers or you have mutations in the family that predispose that way, it could impact your decision on banking cord blood.
Your finances also should be considered given the cost and in this regard you need to think long-term given the time frame here.
3 thoughts on “Fact-checking, pros and cons of cord blood banking”
Another consideration is the size of the sample obtained, which may be related to the clamping time, collector’s technique and other issues. Transplant surgeons are seeking the largest sample possible, now 1.5+ billion TNCs. Some private banks store samples as little as 150 million TNCs (with parent approval). These are minimally useful as is. There is increasing success with expanding HSCs, but this adds at least one more factor not fully tested if frozen units can be thawed and expanded to be more useful.
Good article. In the UK we have the National Health Service Blood and Transplant (NHSBT) which runs a public bank for storing cord blood to help child patients with leukaemia and certain other conditions such as Hurler’s syndrome: https://www.nhsbt.nhs.uk/cord-blood-bank/
NHSBT also stores cells from the cord tissue for research purposes.
Unfortunately, similar to the situation in the US, we also have some private clinics in the UK that put misleading information on their websites about the therapeutic potential of cord blood stem cells: e.g., the ‘Cells4Life’ cord bank says this about the Duke austism trial:
“An early trial in 25 children concluded in 2017 and found that cord blood infusions created “significant improvements in children’s behaviour”, including their vocabulary, social communication skills and eye tracking.”
I wish we could follow Italy’s lead and ban private cord stem cell banks.
Another issue with the private banks is that they can go bust and samples can be lost. This is whappened with a UK bank called ‘Precious cells’: https://www.bionews.org.uk/page_135119
And something else to be aware of is that it is not a good idea to clamp the cord too early because it can be detrimental to the baby. Dr David Hutchon has been highlighting this issue and it was also discussed in this BBC article: https://www.bbc.co.uk/news/uk-england-sussex-50139213
Prof Andrew Weeks from the University of Liverpool said in the above article: ” “If you cut the cord immediately, you leave a quarter of the blood in the placenta and the other three quarters is left on the baby’s side.”
“Stem cell research is hugely exciting but I don’t think it’s appropriate to harm a baby in order to take its stem cells.
“Let the baby use whatever blood it wants and use whatever’s left after maybe five minutes.”
It is important that the cord is clamped by someone who knows what they are doing.
Thanks, Patricia, for your comment and all you do for the good of biomedical science!