Georgia 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 Georgia bill was enacted 24 May 2007 and became effective 30 June 2009.
- 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.
- What are the most important things to do when collecting cord blood?
1. Read the instructions on the kit! Too many healthcare providers think that they don't need to read and follow instructions.
2. Sterilize before every needle stick. When in doubt, sterilize again!
3. Volume, volume, volume. You want to "milk the cord" for as much blood as possible. If the blood vessel you are using stops working, try another or move upstream, but sterilize first.