ND, United States
North Dakota does not have any state legislation around cord blood education, but their Dept. of Health has officially adopted the educational materials from Parent's Guide to Cord Blood Foundation.
- 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
Rocha & Gluckman Brit. J. Haematology 2008;147:262-274
Delaney, C et al., Brit. J. Haematology 2009;147:207-216
Michallet et al. 2010 Blood 2010;116:Abstract#361
- Will my delivery hospital allow me to use any family bank?
In the US, the answer to this question is almost always YES. However... a handful of hospitals have signed exclusive contracts requiring their patients to use certain family banks, so it is best to check in advance.
Those hospitals who have made exclusive partnerships will argue that it improves their level of care, because their staff train with and stock the collection kits for the banks they have approved. The hospital probably has a financial incentive too. However, for parents it means a lack of consumer choice.
- What is HLA Type and how is it used?
The term "HLA" is short for Human Leukocyte Antigens, and these are proteins in the immune system that determine whether a patient will react against a donor transplant. A very good basic tutorial about HLA types is on the Stanford Website, and the national Be The Match program (aka NMDP) has more info on the role of HLA type in transplants of stem cells from bone marrow or cord blood.
Briefly, there are 6 HLA types that are important for stem cell transplants: in a bone marrow transplant the patient and donor must match at all 6 (100% match), whereas a cord blood transplant is just as effective at curing patients with only a 4 out of 6 match (67% match) between donor and patient. This is the reason that donations to the national cord blood inventory managed by NMDP are so important to help patients who come from minority or mixed racial backgrounds.
The HLA type of cord blood is always measured by public banks, and then the type is listed on a registry that can be searched by patients seeking a transplant. Family banks typically do not measure the HLA type at the time of banking, because it is an expensive lab test and and can always be checked later from a testing segment of the stored cells.