Louisiana has state legislation around cord blood education that follows the Institute of Medicine guidelines and mandates/encourages physicians to educate expectant parents about ALL forms of cord blood banking. The Louisiana bill was enacted 12 June 2008 and became effective 15 Aug. 2008.
- How much cord blood is needed for a transplant?
The crucial thing is not the volume of the cord blood collection, but the number of stem cells it contains. Transplant doctors develop recommendations based on the Total Nucleated Cell count, or TNC, because it is the easiest measure to reproduce between different labs. For treating cancer, the transplant dose should be at least 25 million TNC per kilogram of patient body weight (1 kilogram equals 2.2 pounds). The average cord blood collection holds 8.6 million TNC per mL. Thus, the optimal transplant dose requires harvesting:
1.3 mL of cord blood for every pound of patient weight, -or-
2.9 mL of cord blood for every kg of patient weight
However, as more transplant centers are adopting the practice of giving adult patients "double cord blood transplants" with two cord blood units, it is less critical for both units to have adequate cell dose.
Reed, W et al., Blood 2003;101(1):351
Barker, JN et al., Blood 2005;105:1343-1347
Eapen, M et al. Lancet 2007;369:1947-54
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Delaney, C et al., Brit. J. Haematology 2009;147:207-216
Michallet et al. 2010 Blood 2010;116:Abstract#361
- Once we have stored cord blood for our family, how long should we keep it?
- Indefinitely. From an economic perspective, it does not make sense to invest in the up-front processing fee and pay for years of annual storage, and then throw out the investment. That would be like buying life insurance and then cancelling it because you have not died yet. Especially given that the probability of some one in the immediate family needing a transplant increases with age. Even if the cord blood collection was small, and the child becomes too large to use it for a transplant, it could still be enough cells for a regenerative medicine therapy. The science of cryobiology tells us that cells which are cryogenically preserved remain viable for decades. It has been confirmed that cord blood stem cells were still viable after being frozen 23+ years.
Broxmeyer, H.E. Cell Stem Cell 2010; 6(1):21-24
Mazur, P. Science 1970; 168(3934):939-949
Nietfeld, J.J. et al. BBMT 2008; 14:316-322
- Why is it important to ship cord blood with a special courier?
The Parent's Guide to Cord Blood Foundation recommends shipping with a courier that has a division specializing in "Life Sciences" transport. This helps to insure that your critical shipment is not misplaced, arrives promptly, and is maintained within the acceptable temperature range during transport from the hospital to the lab.
The first priority for parents to consider is the cord blood shipping time: Once the cord blood is harvested, the blood cells and stem cells gradually begin to die. Public cord blood banks set a limit of 48 hours on the time between birth and processing the blood for cryogenic storage. It would be a "best practice" if family banks also followed the 48 hour window.
The second priority for parents to consider is the cord blood shipping temperature: The standard procedure for transporting fresh cord blood is to keep it within an ambient temperature range of 15 °C (59 °F) to 25 °C (77 °F). Priority shipping services may guarantee the arrival time, but not the temperature conditions during transit. The cord blood might get too hot or too cold while sitting in the back of a truck, on a loading dock, or in the cargo hold of an airplane. A specialty courier with Life Sciences expertise will carry the cord blood in a controlled environment.
Parents can improve the survival of their child's cells during transit to the cord blood laboratory by selecting a family bank that provides a well insulated shipping container and that provides a specialty courier who maintains the shipment within the desired temperature range. In many countries it is standard practice for the shipping container to have a temperature logger.
In the United States, the post 9/11 security requirements of the Transportation Security Administration (TSA) require that specialty couriers can only offer cord blood shipping through those cord blood banks that are registered with the TSA as a "Known Shipper". Before 9/11, specialty couriers could market their services directly to consumers, and in some countries this is still possible. Parents should check if a Family Bank offers specialty courier services before they sign a contract.