Keeping Umbilical Cord Blood

In life in the womb, the baby is connected to the umbilical cord and the placenta. Placenta is the body that provides food and oxygen exchange between the baby and the mother. This organ is completed out of the uterus by completing its task immediately after birth.

The blood that remains between the infant's cord and placenta after birth is called cord blood. The characteristic of this blood is that it is different from the blood circulating in the baby's veins and contains “stem cells” involved in blood production. Among the stem cell sources used for stem cells transplantation are bone marrow and blood (peripheral blood) in our arms, apart from the placenta.

The most important feature of stem cells is that they have the ability to turn into any tissue or organ when certain suitable environments are provided.

The purpose of preserving cord blood is to form an important option for the treatment of most severe diseases that may occur in children as they age. Another perhaps more important goal is to create “cord blood banks” in the future and to create the injuries of those who need them by taking the consent of stem cell owners according to their tissue types.

What is the importance of cord blood?

There are three main types of cells in human blood, essentially called "plasma". These; red blood cells (erythrocytes), white blood cells (leukocytes) and coagulation elements (platelets, platelets).

In fact; erythrocytes are involved in the transport of oxygen and carbon dioxide between cells, leukocytes in the functioning of the immune system of the organism, and platelets (platelets), along with other clotting factors, in blood clotting.

All of these three cell groups emerge by the differentiation of a type of cell called the stem cell, located in the bone marrow. That is, stem cells in the bone marrow are capable of forming all kinds of blood cells, and this production continues continuously.
In the presence of childhood leukemias (blood cancer) and certain blood and immune system diseases, it cannot perform its bone marrow function in a healthy way.

On the other hand, applications such as chemotherapy or radiotherapy applied in the treatment of these diseases damage the stem cells in the bone marrow. Depending on the type of disease and treatment, bone marrow transplantation is inevitable in some patients. In this case, it is aimed to reproduce healthy blood cells by giving healthy bone marrow and stem cells from a healthy donor compatible with the patient's bone marrow. In such a situation, the probability of finding a suitable donor between the patient's own relatives or siblings is around 25%.

In the early 1980s, scientists realized that neonatal babies' cord blood also had stem cells similar to those in bone marrow, and the idea that these cells obtained from cord blood can be used in the treatment of certain diseases.

Realizing that the obtained cord blood can be collected, stored under certain conditions, stored by freezing, and then used and thawed when needed, “Dr. David Harris” frozen his son's cord blood in his laboratory in 1992.

Later, after opening this application to the public, the first cord blood bank in the world was established in the USA in 1994. In the years that followed, many cord blood banks were established around the world and thousands of babies' blood was taken under protection in these banks.

How many types of stem cell transplant are there?

In the past, the term "bone marrow transplant" was used instead of stem cell transplant. Today, the main name of the procedure is “stem cell transplant” and bone marrow is one of the sources from which only stem cells are obtained.

There are three types of stem cell transplants:

  • Allogenic transport: Collected stem cells can be used by another person.
  • Autologous transplant: Stem cells collected in the healthy period of the patient can be used for himself in the future.
  • Syngeneic transplant: A patient can give his own twin brother (single twin) a stem cell.

What is the use of hiding cord blood?

The purpose of storing blood in cord blood banks is that the baby can be treated using his own healthy stem cells in the event that he / she gets a disease that will require bone marrow transplantation and thus the need to search for a suitable bone marrow donor is eliminated. In this way, bone marrow transplantation will not be required. Also, in this way, there will be no problem of tissue adaptation.

Since 1994, only two of the autologous cord blood, which has been stored in cord blood banks worldwide and estimated to be 160,000, have been used for autologous transplantation. One of these two transplants, which was a complication of stem cell transplantation, resulted in failure due to the “delay in stem cells starting to work in the patient” and the patient died of infection. Success was achieved in the other patient.

The reason why autologous transplantation is so rarely performed is that the probability of the baby getting a genetic disease that can be treated using cord blood in the future is approximately one in a thousand.

Another perhaps most important goal in stem cell hiding is that, thanks to the stored cord blood, “cord blood banks” can be created in various places, when it is deemed appropriate for others, and can be used for treatment purposes by obtaining the consent of blood owners. (Allogenic transplantation)

After a certain period of time, perhaps bone marrow transplant centers will leave their places to cord blood banks.

How long can cord blood be stored?

Since body weight increases as body weight increases, the number of stem cells in cord blood is insufficient in treatment. Therefore, cord blood retention time is limited to a maximum of 15 years in line with the scientific data available today, and therefore it can only be used in the treatment of childhood and early adolescent patients. When people go over 30-40 kg, these bloods become inadequate again.

How is cord blood taken?

First of all, when it is decided to store cord blood, the situation should be reported to the relevant laboratory and the physician who will have the delivery at least a few weeks before the expected delivery and the necessary preparations should be provided. In this way, the necessary equipment and documents can be made available at the time of delivery.
In the procedure, after the baby is born, the umbilical cord is tied and within the first 10 minutes, the blood inside is collected in the bag with the help of a special system.

The collected 40-100 ml volume of blood is sent to the laboratory within 36 hours and the stem cells are separated by special methods and stored in nitrogen tanks by freezing at -193 degrees.

This procedure can be applied in normal or cesarean births. Application; It does not take much time, it is easy to do, it is safe for mother and baby.

The frozen cells can then be thawed if needed.

For whom is cord blood storage suitable?

There are two different views regarding this new application.
Some researchers, who are also with the American Pediatric Association, advocate for this practice only in the babies of couples who have a family history of disease that may require bone marrow transplantation.

Some researchers suggest that everyone should use this alternative considering the rapid development in stem cell studies. The possibility that they can be used in different ways in the laboratory environment by using the stem cells available in the future supports this kind of approach.

Some of the diseases that can be treated with cord blood today are:

  • Childhood leukemia and lymphomas
  • Thalessemia (Mediterranean anemia) ***
  • Aplastic anemias (no cell production in the bone marrow)
  • Sickle cell anemia
  • Amegakaryocytic thrombocytopenia
    neuroblastoma

(***Since thalessemia is a congenital disease, the cord blood of babies born with thalassemia cannot be used by transplanting them in the future. Only in allogenic transplants, that is, stem cells from a healthy person can be treated by transplanting a baby with thalassemia. available from the bone marrow.)

As stated in the advertising brochures of some commercial banks, cord blood has no use in the treatment of hereditary diseases (such as thalessemia = median anemia), in the treatment of hereditary immune deficiencies (immune deficiency syndromes) or in the treatment of hereditary metabolic diseases. Because stem cells obtained from the cord blood of a baby with a hereditary disease cannot be used for therapeutic purposes.

The most common area of cord blood that can be used in childhood is childhood leukemias (blood cancers) and aplastic anemias. The majority of leukemias with an annual incidence of 5 per 100,000 can only be treated with chemotherapy. In addition, if a child with cord blood hiding will require stem cell transplantation due to leukemia, the first alternative for success is the allogenic transplant with the appropriate type of sibling or stem cells of another donor. (Source: Turkish Hematology Association)

Cord blood, which will be stored for all these reasons, outweighs the notion that “the baby is not a life insurance”, that everyone should not be able to see the financial situation as a “must-have” and that it can only be considered as an alternative in special situations.

What can happen in the future?

In the future, stem cells are like producing spare parts for a car; It can be used to form limbs such as liver, heart, pancreas, brain, as well as hand, arm, foot, and thus limb losses, diabetes, liver, kidney, heart failure, neurological losses (stroke), Parkinson, Alzheimer's disease, Maybe all treatment methods in many genetic diseases and cancer treatments will change in this direction.

In the future, we physicians will try to “treat the patient” rather than “treat the disease”. We are at the very beginning of these developments that will take a process.

What are the centers operating with this application?

Cord blood banking has become a service in our country in the last few years and related companies have started to operate. The disadvantages are that the blood stored in banks in this way is “suitable for autologous use”, that is, it cannot be used for another patient in need.

While some of these companies kept the collected blood in the countries where the companies they represent, especially in the USA, have their headquarters, some of them have established their own banks.

Unfortunately, in our country, yet still more concerned with legal regulations, and thus the blood of a legal basis could not be established, especially in terms of licensing the company's stores in Turkey.

Some domestic and foreign corporate banks operating in our country regarding autologous cord blood banking are:

  • Cryobank (California Cryobank, USA)
  • BabyCord (New England Cord Blood Bank, USA)
  • Genkord (Istanbul)
  • Acıbadem Cord Blood Bank (Istanbul)
  • Yaşam Bank (Ankara).

In our country, allogenic stem cell banks have been established with the aim of serving the people who are in need of a tissue type without a commercial purpose. These banks are;

  • Ankara University School of Medicine
  • It is located in Hacettepe University Faculty of Medicine.

How much does it cost to store autologous cord blood?

Cord blood storage is a relatively high cost application. According to the preferred laboratory, the fee of the ice cream process varies between 1000-2500 $. Storage fees are around $ 90-100 per year.

Op. Sibel Malkoç, MD

Gynecology and Obstetrics Specialist

Dr. Sibel Malkoç attended many domestic and international training seminars and congresses during 25 years of specialised physician service.

Pregnancy follow-up, urinary incontinence surgery and laser treatments, genital aesthetic surgery and laser applications and vaginismus treatment are of special interest.

It serves its patients especially in surgical and laser-assisted Vagina aesthetics.

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