North Carolina 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 North Carolina bill was enacted 8 June 2009 and became effective 8 June 2009.
- What questions should parents ask a Family Bank about collecting cord blood?
- What instructional tools are provided for the physician and delivery staff?
- Will the cord blood company actively contact the labor and delivery staff for you -- or are parents responsible for keeping them informed and coordinated?
- What collection method do they use: gravity drip or blood draw?
- Is the collection blood bag sterile, both inside and out, so that it can be used in the operating room for a C-section?
- Do they provide the option of collecting additional stem cells from the placenta or tissue of the umbilical cord?
- If I banked privately for one child, do I need to do it for additional children?
All the reasons that you banked for the first child are still valid for additional children.
1. If you want the baby to have the option of using his/her own cells, then you need to bank them.
2. If you are banking to cover siblings, then the ability to use cord blood from one child for another depends on whether they have matching HLA type. Two full siblings have a 25% chance of being a perfect match, a 50% chance of being a half match, and a 25% chance of not matching at all. For a cord blood transplant, donor and patient must match at 4 out of 6 (67%) HLA types. The more siblings with banked cord blood, the more chance that they cover each other for possible transplants or other therapies for which sibling stem cells are accepted.
Odds of sibling match are based on haplotype inheritence: that the child will receive 3 HLA types as a group from each parent.
- What are TNC, MNC, CD34+, and CFU, and why should I care?
These are all ways of counting cell types, and they tell you whether or not your cord blood collection has lots of stem cells and if they are healthy.
Stem cells happen to be Mono-Nuclear Cells or MNC: when you look at them under a microscope there is only one nucleus. Unfortunately, one of the most difficult aspects of stem cell biology is that you can't identify a stem cell just by looking at it. There are other types of blood cells which are also MNC, such as nucleated red blood cells. The only proof that a cell is a stem cell comes from how it behaves when it multiplies.
Scientists have worked for years to develop various chemical stains which have a high affinity for stem cells. The best known marker for blood-forming stem cells is that they test positive for CD34, a protein found on the surface of stem cells. But, CD34+ counts are not an accurate measure of stem cells: CD34+ results vary between labs, they can vary within a single lab, and only 1-2% of the MNC that have CD34+ are actually stem cells.
The Total Nucleated Cell count or TNC is the test most often reported as a measure of the cell count after cord blood processing. The main advantage of measuring TNC is that the count is highly reproducible within and among labs, so it can be used accurately throughout the blood banking community. Even better, the TNC count can be automated with the use of a device called a flow cytometer.
At present Colony Forming Units or CFU are considered to be the best measure of whether stem cells are "viable", or quite frankly alive. The TNC count includes both living and dead cells. In the CFU test a small portion is watched under controlled conditions to see if stem cells divide and form colonies. This used to be a subjective measure, but recently it has been standardized with technology to image the cells and count colonies in the image. The only remaining problem with the test is that it takes days for colonies to grow.