The pros and cons, costs, and reasons behind saving your newborn's umbilical cord blood.
If you're expecting a baby, you might have thought about umbilical cord blood - along with the many other ways you can hope to make life safe for your child.
Expectant parents do all kinds of things for safety's sake. They plug up empty electrical sockets, childproof their cabinets, pore over car seat research, and measure the space between the bars of hand-me-down cribs -- all months before their son or daughter is born.
And some are now choosing a procedure that, they feel, could further protect their children from harm: umbilical cord blood banking.
The procedure takes blood from the umbilical cord at birth and stores it for a fee in a private blood bank. (Public banks are another option - see below.) Because this blood is rich in stem cells -- cells that have the ability to transform into just about any human cell -- it could someday be used as treatment if your child ever became ill with certain diseases. It might also be useful for a sick sibling or relative. Banking cord blood is a way of preserving potentially life-saving cells that usually get thrown away after birth.
But is banking worth it for most people? The banks argue that it's a form of "insurance" in case your children ever get sick. However, many medical associations -- like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists -- don't support the practice for most people. They say that possible benefits are too remote to justify the costs.
"I don't tell any of my patients not to do it, but I point out that the odds that they will ever use the stored cord blood are very low," says Stephen Feig, professor of pediatrics at UCLA. "It's a very expensive insurance policy."
So the important thing is to make an informed choice. You need to know the benefits and costs of cord blood banking before you make any decisions.
Why Is Cord Blood Worth Saving?
Stem cells are immature cells that can both reproduce themselves and have the potential to turn into other types of cells. There are several types. The ones in umbilical cord blood and bone marrow are called hematopoietic progenitor cells (HPCs).
Some people (usually children and, sometimes, adults of small size) with certain diseases -- like leukemia, lymphoma, sickle cell anemia, and others - can be injected with these HPC stem cells to replenish their blood supply with new, healthy cells. The stem cells can also help the body recover from some cancer treatments like chemotherapy or radiation.
No one debates that cord blood cells can be lifesaving. "Cord blood is a proven, effective source of blood-forming stem cells for people with certain diseases," Feig tells WebMD.
According to the Institute of Medicine, HPCs have saved more than 20,000 lives in the U.S. in recent years, although the majority are from bone marrow transplantsrather than cord blood. There have only been about 6,000 reported cord blood transplants.
Cord blood banking has become a potentially lucrative business. More than twenty private banks operate in the U.S., the oldest since 1992. Expectant couples see ads for stem cell banking everywhere -- in parenting magazines, in doctor's offices, on television, on the Web, and in their own mailboxes.
"I don't think there's an obstetrician in the country who doesn't have patients asking about it," says Jeffrey Ecker, MD, a high-risk obstetrician at Massachusetts General Hospital. "I get the sense that there's more marketing and publicity than ever."
But according to most experts, the odds that a child will ever use his or her own stored cord blood are small. According to a 2005 editorial in the journal Obstetrics and Gynecology, the chances are about one in 2,700.
Other estimates range widely. Advertising from one private cord blood bank puts the odds at 1 in 27. The American Academy of Pediatrics suggests it's more like 1 in 200,000. Indisputably, there are very few documented cases of a child receiving his or her own banked cord blood as treatment. The Institute of Medicine says that there may only have been as few as 14 total of these procedures ever performed. One reason is that the conditions cord blood stem cells could help treat just aren't that common. "The diseases in children that we can treat with their own cord blood stem cells are really rare," says Feig.
While the odds of ever using privately banked cord blood may be small, the costs aren't. Prices vary, but banks might charge up to $1,800 for the initial processing. After that, they charge an annual storage fee of roughly $100. According to the National Marrow Donor Program, properly stored cord blood should be good for up to about 10 years; after that point, researchers aren't sure how long the cells will last.
Although both cord blood and bone marrow contain the same sort of HPC stem cells, those from cord blood may have some advantages. Cells from cord blood are less mature than cells from an adult's bone marrow, so a recipient's body is less likely to reject them.
"My personal feeling is that stem cells that come from an umbilical cord are going to be more robust than those you get from a 50-year old man," Feig tells WebMD.
Taking cord blood is also simple and painless. It's much less involved than bone marrow donation. And some experts say banking might be wise in certain cases.
For instance, Ecker says that if someone in your family already has leukemia, sickle cell anemia, or other blood disorders, banking could make sense, either for the child or for another family member.
"I don't think you'll get arguments from any doctor about the wisdom of banking if you have one of these diseases running in the family," Ecker tells WebMD. "Certainly not from me."
In some cases -- for instance, if you already have a child who is sick and might need a transplant -- some federal or state programs, or even insurance companies, might help pay the costs.
The Downsides of Banking Cord Blood
Privately banked cord blood does have some big limitations as a kind of health insurance policy. Even if your child does get sick, it may not be the right treatment.
"If a child develops certain genetic diseases, his or her own frozen cord blood isn't going to help," says Arthur Caplan, PhD, a bioethicist and chairman of the department of medical ethics at the University of Pennsylvania. "The cord blood will have the same genetic flaws that caused the disease in the first place, so it won't be a good treatment."
While using your own stored blood has advantages - such as reducing the risk of rejection -- it has other disadvantages too, explains Feig. Introducing a new set of immune cells from a donor can sometimes be more effective in fighting certain cancers than getting more of the patient's own.
But what about saving your baby's cord blood for a family member who gets -- or already is -- sick? Siblings are more likely to be a genetic match, which is crucial. However, the odds are still only about 25%. So even if you bank your child's blood for a sibling, there's a 75% chance that he or she will need a donation from another donor's cells in a bank instead.
Cord blood is usually only used in treating diseases in children. Since only 3 to 5 ounces are taken from the cord, and since cord blood has a limited number of stem cells, there just isn't enough to treat most adults.
Expectant parents also need to understand that cord blood isn't the only possible treatment for these diseases. Most people who need a transplant of stem cells could still get them from donated bone marrow, either from a family member or a bone marrow bank.
"If your child becomes sick with leukemia, for instance, there are treatments besides using his or her own cord blood," says Ecker. "It's by no means his or her only hope."
The current uses of cord blood are limited. But many experts hope that stem cells will be a crucial part of future treatments for diabetes, Alzheimer's, spinal cord injuries, heart failure, stroke, and many other conditions. If it really were possible to make stem cells develop into any kind of cell, the possibilities would be almost endless.
But this is only theoretical. It's important to distinguish between what doctors can do now with cord blood stem cells versus what they might be able to do in the future. Some people don't realize the distinction. They have exaggerated ideas of what is possible today.
"People talk about stem cell therapy like its alchemy," says Caplan, "as if we can turn a stem cell into anything, just like alchemists hoped to turn base metals into gold. But it's not like that."
Even if researchers do have future successes with stem cells, they may not come from cord blood.
"The science is moving fast right now," Caplan tells WebMD. "I personally am not so sure that using stem cells from cord blood will be the approach we take in the future." Instead, Caplan is more optimistic about techniques using embryonic stem cells or stem cells derived from adult tissue.
Public Cord Blood Banking
There is an alternative to private banking. Some parents decide to donate their child's cord blood to a public cord blood bank for free, which makes it available to anyone who needs it. Most doctors and medical organizations favor public donation. The Institute of Medicine has proposed that Congress create a National Cord Blood Stem Cell Bank Program along the lines of the national bone marrow donation system.
In the unlikely event that your child ever needs the cord blood you donated to a public bank, odds are good that you will be able to get it back.
"The chances that anyone will ever use a particular unit of cord blood that you donate is small," says Feig. "So if your child needs it 10 years down the pike, there's an overwhelming chance that the cells will still be available."
Obviously, there's no guarantee, but it's something to keep in mind. If you are interested in public cord blood donation, get in touch with the National Marrow Donor Program at www.marrow.org. You can also ask your health care provider about medical centers in your area that might accept donations.
But Ecker points out that we're still a ways off from organized public cord blood banking. In most of the country, a public donation isn't even possible. There's no system in place. So for many people, the choice isn't between public and private banking. It's between private banking and letting the cord blood go to waste.
Deciding to bank your child's cord blood is a personal decision. Some people feel that the potential benefits are too few to justify the money. Others believe that it's a worthwhile investment.
The key is to understand the details so you can make a rational decision. Whatever you do, don't let yourself be pushed into a choice.
"I think it's fine if a parent makes an informed decision to do this," says Caplan. "But I don't like parents being guilted or shamed into this by misleading advertising. No one should make you feel like irresponsible or reckless parents if you don't choose to bank your child's cord blood." He says that people who are expecting a child are especially vulnerable to this sort of pressure.
But if you research the possible benefits and feel that banking your baby's blood would give you peace of mind -- and you're comfortable with the cost -- then do it. Talk to your health care provider and start researching some of the banks. Also, read about the best way to assess your need for banking cord blood.