To Bank Or Not To Bank

Understanding the facts about cord-blood collection will help you know if it's right for you.

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Preparing for the birth of a child is filled with important decisions, and these days they include whether to collect and store a newborn's umbilical cord blood. Initial fees range from $1,420 to $1,925, and there is a yearly storage cost. Insurance may cover the procedure when there is an existing condition or a strong family history of diseases currently treatable with cord-blood stem cells. However, if there is no known family history, the decision becomes more complex. Still, since the procedure has become possible, more couples are choosing to bank their newborns' cord blood, for peace of mind and in hopes that it will enable them to reap medical benefits later.

"We decided to privately bank our son's cord blood so we will be in a position to take advantage of the advances in regenerative and reparative medical technology," says Alastair Tedford of New York. "It was an easy decision to make. We ordered a collection kit and brought it with us to the hospital. The midwife who delivered our son was familiar with the process and took charge of it during the birth."

How It Works: Umbilical cord blood is rich in hematopoietic stem cells—the type of cells that can rebuild a blood system damaged by disease or injury. These types of cells currently are used to treat more than 75 diseases, including Fanconi's anemia, acute lymphoblastic leukemia, acute mylogenous leukemia, severe aplastic anemia and thalessemia. Other diseases may be treatable with these types of cells in the near future.

"The stem cells found in the umbilical cord are starter cells [immature cells that duplicate once transplanted], which give them enormous potential for applications in gene therapy and regenerative medicine," says Peter Weiss, M.D., an OB-GYN in Beverly Hills, Calif., and an assistant clinical professor at the David Geffen School of Medicine at UCLA School of Medicine. "They can help build the immune system, improve the heart and regenerate blood tissue.

"Nobody questions the benefits of cord-blood transfusions," Weiss adds. "In certain disease processes, they are shown to be as good as, if not better than, bone-marrow transplants."

The field is still growing and future developments may alter which diseases and injuries can and cannot be treated with stem cells collected from umbilical cord blood. OK As it stands now, until it becomes possible to perform successful genetic engineering for cancers such as leukemia, or inherited diseases such as sickle cell anemia, a child's own cord blood cannot be used to treat that disease, because the marrow restored by the stem cells in his blood may also produce diseased blood cells.

A child might be able to be treated with the cord blood of a healthy sibling (or a match from a public bank). OK In other words, parents who harvest the cord blood of one child with no illness may be able to use it for another child who does have such an illness. There is growing evidence that this does not hold true for some injuries—such as spinal injuries—that are due to accident, not illness.

Research and technology continue to advance the possibilities, so the list of conditions treatable with cord blood continues to grow.

Cord blood is collected by a woman's obstetrician or midwife just after the placenta is delivered. The cord is cleaned, and the blood is collected in a bag. The whole process takes about 5 minutes. A courier then picks up the blood and delivers it to the bank, where the blood is prepared and stored. Should the stem cells be needed by a family later, the cells are tested and transported to the designated hospital. Some banks charge a retrieval fee, which may be covered by insurance.

What Doctors are Saying: An American Academy of Pediatrics (AAP) statement from 1999 encourages philanthropic donation and offers preliminary guidelines to doctors whose patients are interested in storing their newborn's cord blood. Joanne Kurtzberg, M.D., director of the The Pediatric Blood and Marrow Transplant Program at Duke University, says in light of rapid advancement in this field, the AAP is reviewing and updating its statement.

"I think the general consensus in the transplant community is that healthy children have a low probability of needing their own cord blood in childhood, but use of the cord blood later in adulthood is still uncharted territory," Kurtzberg says. Naturally, obstetricians get many questions about the issue now, and according to Kurtzberg, one of the goals is to help establish official collection guidelines.

So... Should You Bank? As with any health decision regarding your baby, you should thoroughly research your choices. Many families are considering private blood banks to ensure that they are able to retrieve their own child's blood, if need be. A cost-free alternative is to donate your baby's cord blood to a public bank.

"I think it's really up to the individual whether they want to save their own child's cord blood or not," says Paul R. Sanberg, D.Sc., Ph.D., director of the Center for Aging and Brain Repair at the University of South Florida Medical School. "But if you don't save it, I think it should be donated to a cord-blood bank and used for research or clinical trials." Sanberg has been researching applications with cord-blood stem cells for three years and says his lab is just a few years away from being able to use stem cells in treating strokes, Lou Gehrig's disease and other brain and spinal cord injuries.

"If more people would donate their newborn's cord blood," he says, "more people who can't store their own would have access to the benefits of future cord blood-based therapies."

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