Arizona 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 Arizona bill was enacted 26 Jan. 2006 and became 1 Jan. 2007.
- Processing: Must cord blood be processed before storage?
The earliest cord blood transplants were performed with whole cord blood. Thus, it is not absolutely necessary to process cord blood in order to save patient lives. There has never been a prospective randomized trial to compare transplant patient outcomes with cord blood that had been stored whole versus processed.
Most cord blood banks, both public and private, now process cord blood to remove both the plasma and the red cells, and cryo-preserve the remaining buffy coat holding stem cells. Some banks also save the removed red cells and plasma in companion storage. Some banks save a sample of maternal blood.
The removal of plasma is also called volume reduction. The volume reduction enables more collection units to fit in a freezer and requires less cryogenic nitrogen per unit.
Also, the majority of banks remove red blood cells prior to freezing, primarily because these cells often burst during freezing and release iron from hemoglobin that can be toxic. The alternate to removing the red cells before freezing is to wash any broken cells out of the collection upon thaw. Removing the red cells also removes the donor's blood type (the ABO and Rh types). When cord blood goes from a donor to a patient for a transplant, the donor and patient can be compatible on all the HLA types used for transplant matching and still have incompatible red blood types.
- Do I need to store the cord blood in the country where I plan to use it?
No. First, you must store blood in a lab that is permitted by the regulations of the country where you will give birth. Second, you should store cord blood in a lab that can receive and process the collection within 48 hours of birth. After cord blood is collected at birth, the stem cells start to die while the blood is waiting to be processed and frozen. The quicker it gets to the lab the better. By comparison, if you ever need the cord blood for therapy, it will be shipped in a vessel that keeps it frozen. When cord blood is released for therapy can travel to the other side of the world with no loss of viability, because it travels frozen. It is only thawed at the clinic where it will be used.
- 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.