You see the ads everywhere — in magazines for expectant mothers, in printed pamphlets at the obstetrician’s office — and they evoke the wonder of life and perfection of a new baby. They’re carefully designed to rev up the protective instinct of any woman with a reproductive inclination and a pulse. The private cord blood banks cast a wide net, appealing to the “conventional” parenting set with glossy photos of a cherubic toddler contemplating her belly button in magazines like Parents, while “hippies” get reeled in by the touchy-feely Dr. Sears, who touts the benefits of cord blood banking in more “alternative” publications (I really hate these labeling words). In the end, though, does cord cord blood banking do any more than separate a set of new parents from a big chunk of money? What are the potential benefits of cord blood banking?
Private banks make cord blood banking sound crucial by telling parents that cord blood contains stem cells. Very few people really know what stem cells are, but most people know (from popular media sources) that they’re important and potentially lifesaving. Unfortunately, this particular combination — knowing that something has medical potential without really understanding what the heck it is — is a dangerous one, and one that opens the door to predatory marketing. Knowledge is power, however, so here we go. A stem cell is a semi-undetermined body cell. Clear as mud, right? Ok, let’s try again. A stem cell has the potential to develop into multiple types of body cells. Here’s how this works. When a sperm and an egg join to make a fertilized egg, that egg cell is totipotent, which means that as it divides to make new cells, it can make all the cell types in a baby and in the extraembryonic tissues (the placenta and whatnot). As the fertilized egg starts to divide and form a cell ball, a variety of determination events occur. These help to determine which cells will become which tissue types. Once a cell becomes determined, it loses the potential to become other tissue types. For instance, a cell that has been determined to be part of the ectoderm (a layer of cells in a very early embryo) can become skin or brain or nerve, but can’t become, say, part of the pancreas. Loss of potency (the ability to become other types of cells) doesn’t involve loss of DNA (genetic material); all body cells have the same complete set of DNA. However, determined cells lose their ability to express (which basically means use) DNA that isn’t related to their function. In any case, the process of determination is progressive. After becoming part of the ectoderm (to stick with that example), a cell will go on to become even further determined (perhaps it becomes a brain cell, and can now no longer become skin), and will eventually become differentiated, which means it starts to behave the way it has been determined to be. A fully developed fetus is made up mostly of fully differentiated cells, plus a few stem cells scattered here and there throughout the body (such as hematopoietic stem cells — HSCs — which are found in the bone marrow and which give rise to blood cells throughout life). The reason stem cells are important medically is that they’re currently used to treat a number of conditions. For instance, the bone marrow transplants that can help to treat leukemia are stem cell-based treatments, because bone marrow contains HSCs. The reason stem cells are exciting medically is that researchers ANTICIPATE that they may one day be able to use them to treat a large number of diseases and conditions. Injuries to the spinal cord, Parkinson’s disease, and many types of cancer are on the docket as potential diseases that stem cells might someday contribute to treating. Notice all those qualifying words, like “might”? Because very little of this has actually happened yet. Currently, the list of diseases treated with stem cells is very short, and includes certain blood diseases, a few (mostly blood) cancers, and a few genetic disorders. There’s a complete list at the International Cord Blood Society’s website.
Cord blood contains HSCs, so it’s a source of stem cells. Currently, these cells can be used to do basically what bone marrow-derived HSCs can do, without the need to harvest bone marrow. There are some other stem cells in cord blood as well, and scientists might one day be able to do amazing and lifesaving things with them, but not yet. And that’s the first important point when it comes to deciding whether you should bank your child’s cord blood: the currently usable stem cells in the blood are basically the same as the stem cells in bone marrow. Which means that you’re not really losing anything if you get rid of them; all you’re losing is an easy source, because once the cord blood is gone, getting to those HSCs requires going into the bone marrow. But the private cord blood bank ads lead you to believe that cord blood cells are somehow unique, and this is simply not true (or at least, the currently usable cord blood cells aren’t unique). There are some advantages to using cord blood as a source of HSCs over bone marrow; these include that bone marrow harvesting is a surgical procedure, marrow donation requires more perfect matching of human leukocyte antigens (HLA, which is similar to blood type), and marrow donation increases the risk of transferring a viral infection, explains the National Cord Blood Program. In the end, though, the point remains that cord blood can’t do anything (currently) that marrow can’t.
A second important point is that because the cord blood stem cells are basically the same as the bone marrow stem cells, if your child has a blood-related or genetic disease (including the vast majority of the diseases for which cord blood cells are CURRENTLY used), it’s very, very, VERY unlike you’ll be able to treat it with their own banked blood. The odds that your child will someday be able to use their own banked blood are hard to calculate, because they depend heavily on the future of medical research, which can’t accurately be assessed. However, people who calculate these sorts of things have estimated the odds at anywhere between 1 in 1000 and 1 in 200,000 (Johnson). Note that those are the odds that your child will be able to use their own blood if they need it. The odds that they’ll even need the blood in the first place is a separate calculation. The bottom line is that your child probably won’t ever need their own cord blood, and even if they do, they probably won’t be able to use it.
Another selling point used by the private cord blood banks is that the stem cells in the blood could be of use to a sibling. This is potentially true; a type-matched sibling is the best bone marrow donor, so a type-matched sibling would also be the best source of HSCs from cord blood. However, there’s only a 25% chance that a child’s sibling will be an HLA match (Karanes et al). So if you banked child 1’s blood, it’s not a sure bet that child 2 would be able to use it, should he or she need it. Oh, and if child 1 were a match for child 2, and child 2 needed the stem cells, you could likely use child 1’s bone marrow as a source. Granted, this is much more invasive than using child 1’s cord blood, but it’s certainly possible.
This is not to say that cord blood is junk; in fact, it has valuable research and medical potential. First and foremost, it’s a source of HSCs for non-family members with diseases like leukemia. There are public banks to which you can donate your baby’s cord blood (when you do this, you give up the rights to the blood, but as we’ve already established, it’s not likely to be useful to you). The blood then becomes available to non-family, and increases the likelihood that someone will be able to find an appropriate donor and get the treatment they need. Donating your baby’s cord blood to a public bank is a lovely thing to do, but not all hospitals currently allow for it. You can learn about donating cord blood through the National Marrow Donor Program. Donated cord blood is also used in research, which helps to increase the likelihood of one day realizing cord blood’s full potential.
One thing to consider with regard to cord blood banking — both private and public/donated — is that it’s more likely to be bankable and usable if there’s plenty of it, but guaranteeing lots of cord blood requires clamping the umbilical cord early. This potentially decreases the amount of the new baby’s blood that actually makes it into the baby after delivery. Overzealous cord blood banking presents an increased risk of anemia to the newborn (Fox et al).
In the end, the American Academy of Pediatrics does not support the practice of private cord blood banking (AAP Statement). In fact, they’re quite against it, stating in essence that the private cord blood banks are taking advantage of families at an emotionally vulnerable time. The AAP further notes that some physicians may profit from advising patients to use private cord blood banks (the bank may pay them to encourage it). Finally, private banking is simply expensive. Typically, the collection fee for a private bank is on the order of $2000, and it costs about $150 a year to maintain the blood. Because the practice isn’t regulated, there’s no telling whether privately-banked blood is actually collected or stored in such a way as to make it usable IF (and that’s a big if) your family ever needs it.
Science Bottom Line:* There’s really no justification for banking your child’s cord blood for private use under most circumstances. The exception to this is if you either: a) have a child with one of the diseases for which HSC transplant is a treatment (and the second child is a good HLA match), or; b) have a family history of or genetic predisposition to one of those diseases. Again, remember that the odds of any given child being able to use his/her own cord blood are infinitesimally small, but child 2’s blood might be able to help child 1, or vice versa. There are free programs to allow banking of a child’s cord blood in the case of a diagnosed sibling with a cord blood-treatable condition, such as The Sibling Connection through the Children’s Hospital Oakland Research Institute.
What do you think about cord blood banking?
References:
American Academy of Pediatrics Section on Hematology/Oncology. Cord blood banking for potential future transplantation. Pediatrics. 2007 Jan;119(1):165-70.
Fox et al. Umbilical cord blood collection: do patients really understand? J Perinat Med. 2007;35(4):314-21.
Johnson, F. Placental blood transplantation and autologous banking–caveat emptor. J Pediatr Hematol Oncol. 1997 May-Jun;19(3):183-6.
Karanes et al. Unrelated donor stem cell transplantation: the role of the National Marrow Donor Program. Oncology (Williston Park). 2003 Aug;17(8):1036-8, 1043-4, 1164-7.
beautiful entropy 
Nov 23, 2011 @ 21:36:51
I’m with you and didn’t bank the blood for either child. If we had the option to donate it, I would’ve chosen that but it wasn’t an option at our first hospital or with a home birth of #2. Again, such great info!
On a completely different note…I’m unsure if you’d heard of Dr. Burzynski, but would love your input on his therapy from a trained chemist’s perspective. From what I gather, he discovered a strand of peptides that people w/ cancer lack in blood & urine. He extracts the peptide from healthy people’s urines and administers them to cancer patients and supposedly cures the cancer.
Nov 24, 2011 @ 05:51:19
Haven’t heard of him, but I’ll look into it…
Nov 24, 2011 @ 06:48:00
Great article! The cost was prohibitive for us to even consider cord blood banking, so it is nice to hear that we aren’t missing out. It does seem like such a scam though. That’s a lot of money to be throwing away so a company can store some not-so-special cord blood in a -80 for you. And the early cord clamping is a real concern to me – I don’t think most parents realize that infant anemia is likely to be the bigger concern vs a very rare disease…
Dec 07, 2011 @ 22:51:05
It’s not a scam! But everyone has their own opinions. You have to use a credible company. For us, that’s Stemcyte.
Dec 08, 2011 @ 02:40:15
Regardless of the company you use, the odds that you’ll actually be able to use your baby’s banked blood are as I noted. If you have scientific evidence that contradicts the evidence I cited, I’d love to see it. I’ll add that I don’t ever insert my opinion into posts unless I make it explicitly clear that I’m going on opinion rather than established scientific fact. The majority of problems noted in this article are associated with cord blood banking in general, and aren’t alleviated by using any one particular company (even a highly “credible” one).
Jan 02, 2012 @ 16:16:33
It’s like insurance, but insurance that may really never pay off in the end. If medical advances don’t progress in the timeline of the stem cell usefulness, you’ve wasted a lot of money.
Mar 29, 2012 @ 07:17:31
Well said! I was just made aware of your blog from your excellent c-section post (thanks for that, by the way – I’m going to reference it in my blog, gravitycircus.blogspot.com, the next time I marshal the energy to post.) That post was just a gateway drug; hours later, I’m still wandering about your site, intermittently pounding my desk with glee. Thank you!
Mar 29, 2012 @ 08:04:33
Thanks for the kind words!!
Sep 06, 2012 @ 07:44:00
We are pondering this decision as I enter my 39th week of pregnancy. I have type 1 diabetes, as does my father, and have done some research on uses for ESCs to treat the disease. Our child is unlikely to develop type 1 d (roughly 5% chance based on general factors) but it seems perhaps slightly higher given our family history farther back. It is a terrible disease to deal with and if there is a way to even just lessen the severity, it would be worth the investment. There is current research that shows some promise. Still, I’ve been told for 25 years that a cure was “5 years away” and am cynical that any treatment would be developed and approved in time to be useful. It is a tough decision for us.
Sep 07, 2012 @ 09:31:13
I can certainly see where this is a tough issue for you. There’s actually a study that is showing some results in slowing (but not treating) the advancement of type 1 diabetes with a child’s own cord blood cells (the study is summarized at http://diabetes.webmd.com/news/20070625/cord-blood-may-help-kids-with-diabetes). If the research becomes pretty convincing, hospital/free banks will *probably* start allowing parents to store cord blood for kids who are at risk (as they do currently in cases of sibling illness). However, this obviously won’t happen soon enough for your current pregnancy. I’m sure the other thing making the decision tough is that private banking is expensive, as is caring for a child with type 1 diabetes. I don’t envy your position, and certainly don’t want to say anything to sway you one way or another. I do highly recommend talking to your pediatrician about whether he/she thinks private banks store blood under conditions that would allow it to be used/viable in the future. This is one of the questions the AAP often raises in stating that they do not support private banks.
Best of luck with the last week of your pregnancy!!
Oct 04, 2012 @ 08:11:56
What are your thoughts on this statement posted on the Viacord Website Blog (http://www.blog.viacord.com/how-does-it-match-up-success-rates-and-cord-blood-transplants/)?
Cord blood vs. bone marrow stem cells
Both umbilical cord blood and bone marrow contain Hematopoietic Stem Cells (HSCs). Although both cord blood and bone marrow stem cells are part of the same stem cell family, there is at least one distinct and important difference between them—experience. And in this case, more experience isn’t necessarily better.
For cord blood stem cells, a perfect HLA match isn’t crucial because they are immunologically naïve. This means they don’t have as much life experience with illness or disease and are less likely to recognize the new host as foreign. Bone marrow stem cells do have life experience, so they are more likely to reject or be rejected by the recipient’s immune system. Because of this, when the HLA match is the same, evidence exists that cord blood stem cells offer higher survival rates than bone marrow stem cells.
For example, in this clinical study performed on children with leukemia, the children who received matched cord blood had a 20% higher survival rate than those children who received matched bone marrow stem cells.1
Oct 04, 2012 @ 15:31:16
So, as I address in the post, there are advantages to cord blood over bone marrow. However, just as a person can’t use their own bone marrow as a source of HLAs in the case of disease, in almost all cases, they can’t use their own cord blood cells. Both bone marrow and cord blood are most likely to be useful to a sibling or other closely-related relative. My first objection to cord blood bank advertising, therefore, is that it’s not made clear to parents that Child A’s cord blood likely won’t ever benefit Child A, both because the likelihood of needing it is exceedingly rare, and because the likelihood of being able to use it in the case of need is even more rare. Cord blood does present some advantages over bone marrow if Child A has a cord blood/marrow treatable disease, and Child B is something of a match. As you point out, Child B’s cord blood is slightly more likely to be a match for Child A than Child B’s bone marrow. There are, then, two possibilities. A parent could worry that they will have FUTURE children who will get a cord blood/marrow treatable illness and bank earlier child(ren)’s blood in anticipation thereof, but the probability of circumstances converging in space-time such that a younger child ever requires an older child’s cord blood is so low that, honestly, it makes more sense for MOST people to just use bone marrow if needed. The other possibility is that the older child is ill, and the parents have a second child who is an HLA match. In such a case, cord blood would ABSOLUTELY be an appropriate therapy. In this case, though, there are free banks (see references in the article) available to the family. Bottom line remains that the private cord blood industry is making a whole lot of money providing a service that the vast majority of people will never need. They’re also allowing people to believe that cord blood is more useful than it actually is (self-transplantation, for instance). Finally, there is no proof that private banks store cord blood under conditions that necessarily render it useful years later. Though some families are so well-off financially that it’s no burden to prepare for a very unlikely contingency, for most folks, it makes more sense to put the money toward health practices and/or “insurance” policies (such as high quality, healthy food) that are much more likely to produce a positive outcome.
Oct 25, 2012 @ 10:57:11
It’s amazing what they leave out! Thanks for the thoughts.
Jun 23, 2013 @ 16:56:35
My daughter is a cord blood recipient. She has had two autologous stem cell infusions (her own cord blood re-infused back in to her) and has enough for one more should we need it. It has dramatically changed her path and our families daily life. There are many clinical trials right now for conditions such as traumatic brain injury, cerebral palsy, hydrocephalus, autism, diabetes, etc where the childs own stem cells are the only ones that are available to be infused (at this current time).
Storing cord blood privately is insurance. And, I pray it is insurance you would never need. I do have families that have contacted me interested in the same program we did that did not save their childs’ cord blood. They have seen the miracle it created with my daughter and they tell me it is their only regret in their life.
I have read you can delay clamp and also store or donate but I’ve seen mixed responses as to whether this is true.
Jun 24, 2013 @ 17:35:33
I’m glad that you stored cord blood, given that your daughter needed it, and I’m glad it helped! The point of the article was not to say that cord blood is never useful; rather, it was to say that the chances of a child needing their own cord blood are infinitesimally small (and you have, I’m sure, met others whose child has also needed cord blood because parents of children with similar health issues tend to find one another on the Internet and via support groups – while this is useful, it can make the condition/frequency appear more common than it actually is.
In any case, for every child who can use their own cord blood, having it available is awesome. Still, the chances of a child needing and being able to use their own cord blood are so incredibly small that for families of an average income, the cost well outweighs the potential benefit (exceptions noted in article).