Patients who require a haematopoietic stem cell transplant will need to obtain cells from one of three sources: bone marrow, circulating blood or umbilical cord blood. Finding a stem cell donor who is a match (and able to donate stem cells) is often difficult and, in many instances, no suitable donor can be found either within a family or through a National or International Bone Marrow Registry.
Storing your baby’s umbilical cord blood at birth provides a source of stem cells, an option for the Transplant Team, should a stem cell transplant be required either for your child or, depending on the degree of matching, for a sibling.
The probability that a child, or his or her sibling, will develop a disease that requires a stem cell transplant is low, however, if a transplant is needed, cord blood stem cells stored in a family stem cell bank have certain advantages:
- they can be made available without undue delay.
- your baby’s cord blood stem cells remain a perfect match for your baby and have a 1:4 (25%) chance of being a perfect match for a sibling. With cord blood transplants, it is however not always necessary to have a perfect match and, depending, for example, on the number of stem cells in the collection, a lesser match may be acceptable.
- stem cells present in cord blood are younger than those in bone marrow and have a significantly greater capacity to multiply and grow and to differentiate into different types of cells.
- umbilical cord blood stem cells are more ‘immunologically naïve’ than bone marrow stem cells as they have not been exposed to outside immune stimulation (such as infections). In allogeneic transplants (such as between siblings) they are less likely to cause the transplant-related complication of graft-versus-host disease.
- Umbilical cord blood has been used in the treatment of over 80 diseases. Most cord blood transplants have been performed using cord blood donated to public cord blood banks. However, South Africa does not have a public cord blood bank.
- There is the potential for cord blood stem cells to be used for other, non-haematological, disorders. Clinical trials are currently being undertaken to assess the effectiveness of umbilical cord blood stem cells for conditions such as cerebral palsy, autism and diabetes.
- Collecting cord blood poses no risk to the mother or child. It is a totally painless procedure.
Stem cells can be thought of as basic building blocks of our body and are often referred to as ‘master cells’. Stem cells can replicate and renew themselves and have the potential to become almost any other type of cell in the body.
Haematopoietic (blood-forming) stem cells, the predominant type of stem cell found in umbilical cord blood, give rise to the cellular elements of blood i.e. red blood cells, white blood cells and platelets. Haematopoietic stem cell transplantation currently plays a vital role in the treatment of diseases such as bone marrow failure (aplastic anaemia), leukaemia, lymphoma, other types of blood cancers and hereditary blood disorders such as sickle cell disease.
Mesenchymal stem cells, the predominant type of stem cell found in umbilical cord tissue, give rise to tissue such as muscle, bone and cartilage. Mesenchymal stem cells are expected to play an important role in future stem cell therapies in the disciplines of regenerative medicine and tissue engineering.
When you give birth, you have one opportunity to save your baby’s umbilical cord blood and cord tissue stem cells. Prospective mothers and fathers should consider the potential benefits of storing cord blood and cord tissue stem cells and review, for example, information widely available on the internet. As far as possible, you should decide well before delivery whether you wish to cryo-preserve your baby’ stem cells. Bear in mind that this blood, umbilical cord and placenta are usually discarded as medical waste.
Collection is a very simple, non-invasive and totally painless procedure for you and your baby. On the day of birth, you will need to hand the ‘Collection Kit’ to your doctor. Once your baby has been born, the umbilical cord will be clamped and cut as normal. Your doctor (or midwife) will then collect the blood that is left over in the cord. A needle is inserted into the vein in the umbilical cord and blood is quickly drained into a specialized blood bag. In most cases, the number of stem cells collected is directly proportional to the volume of blood collected. The therapeutic usefulness of the stem cell collection will relate to the number of stem cells that are collected and frozen.
Usually at least 80ml of blood is collected from a full-term infant. Please bear in mind that delayed clamping of the cord may significantly reduce the amount of blood that can be collected which will, in turn, result in a lower number of stem cells in the collection. However, the two procedures can be combined successfully.
No. Umbilical cord blood is only collected once the cord has been clamped and separated from your baby. The collection procedure does not affect the birthing procedure that you have decided upon and that is carried out by your healthcare professional. The collection procedure is perfectly safe and pain-free for both mother and baby. A far as the mother and child are concerned, it is completely non-invasive.
After the birth, your doctor (or midwife) will hand the collection kit back to you and we will collect it from your bedside. A designated courier will forward the sample to the Cryo-Save laboratory. To maximise the viability of the stem cells, it is important that the sample reaches us within 48 hours of collection.
On arrival at our laboratory in Pretoria, all cord blood samples are processed using a BioSafe Sepax Blood Processing Kit and the internationally validated FAMCORD Protocol. This allows for comprehensive quality control monitoring of the sample during processing. The kit is a closed, single-use system which minimizes the risk of contamination during processing and testing of the sample. The concentrated stem cells are then frozen by a method of controlled rate freezing and placed, for long-term storage, in a cryo-preservation tank. A sample of your baby’s cord blood will be tested by a private pathology laboratory to verify that the stem cells are viable and that the collection is sterile.
Stem cells are stored in special cryo-preservation bags which are overwrapped and placed, individually, in aluminium protective cases. Each sample is labelled with a unique identifying code and stored, in a cryo-preservation tank, in the vapour phase of liquid nitrogen (at approximately minus 180oC).
The first cord blood transplant was performed in 1988. A pioneer in the field of cord blood transplantation and cryo-preservation is Professor Hal Broxmeyer. He and his colleagues have demonstrated that cord blood haematopoietic stem cells that have been frozen for 23 years showed efficient recovery and gave proliferation results similar to fresh cord blood. Validation studies are ongoing but it is likely that cord blood stem cells stored in the vapour phase of liquid nitrogen can potentially be stored for decades to come.
This fee goes towards covering the cost of ongoing consumables (particularly liquid nitrogen), which ensures that our facilities are continually upgraded and that we stay at the forefront of this technology. You are not locked into long-term storage agreements. While the initial agreement is to store your baby’s stem cells for 20 years, the cells can be stored indefinitely. This is made possible by paying an annual storage fee with an annual escalation, which will be broadly in-line with CPI (currently around 6%).
Cord tissue is a rich source of mesenchymal stem cells (MSCs), the type of stem cell which gives rise to structural and connective tissue. These cells also have immune suppression and immune modulating characteristics.
Mesenchymal stem cells have the potential to repair damaged tissue such as cartilage, bone and muscle. Storing your baby’s umbilical cord tissue stem cells will provide a source of stem cells for emerging stem cell therapies, therapies in the fields of regenerative medicine and tissue engineering, which are currently being researched and developed.
The Cryo-Save Central Laboratory in Europe has validated the cord tissue cryo-preservation method. They have successfully grown various tissues from umbilical cord mesenchymal stem cells demonstrating that we are storing the correct cells in the correct manner. Also, for each cord tissue collection, the viability of the stem cells is assessed using a unique fluorescent staining method.
The untapped potential of stem cell therapies lies in the future. For those interested in the numerous clinical trials which are being undertaken with umbilical cord blood and cord tissue stem cells – for blood disorders, for neurological conditions such as cerebral palsy, autism, stroke, anoxic and traumatic brain injury, for diabetes and, for example, for muscle repair and arthritis – please refer to the www.clinicaltrials.gov website.
There are three main reasons why a cord blood collection may not be successful:
- An insufficient amount of blood may be collected.
- A lower-than-usual amount of blood may be collected and the stem cell count in the collection is very low.
- The sample may be contaminated with bacteria at the time of the collection.
For a cord blood stem cell transplant to be successful, there needs to be a sufficient number stem cells in the collection. The number of stem cells is, in general, directly proportional to the amount of blood collected. Usually, at least 80ml of blood can be collected from the cord of a full-term infant from an in-utero collection. Additional ex-utero collection can be performed to increase the total volume collected.
There are many medical and physiological reasons why a sufficient volume of umbilical cord blood is not able to be collected. This may occur, for example, in low birth-weight infants and in situations of delayed clamping of the umbilical cord. Usually, your obstetrician or midwife will tell you if he/she considers that a less-than-optimal amount of blood has been collected.
If a cord blood or cord tissue collection has not been successful, the Cryo-Save Medical Director will contact you telephonically and will discuss the reason/s for the unsuccessful collection with you. Please bear in mind that the various blood tests, stem cell counts and blood cultures are performed, on Cryo-Save’s behalf, by a Private Pathology Laboratory. It takes some time to obtain and collate the results, particularly the blood culture results, and you will only be contacted approximately 10 days after the birth of your baby.
Please be advised that cord blood and cord tissue collections are not successful in approximately 4% of cases, particularly in situations where the baby’s birth weight is less than approximately 2.8kg and the obstetrician/midwife delays the clamping of the umbilical cord. Because of the costs involved in the collection, processing and testing of the cord blood sample, if the collection is unsuccessful, the Collection Fee is unfortunately not refundable. This should be taken into consideration when deciding on cord blood stem cell collection and cryopreservation. C
If you would like any additional information or would like to discuss the collection, processing and testing procedure with the Cryo-Save Medical Director, please contact Cryo-Save on 087 8080 170.