The facts about umbilical cord banking

Every day we see ads in the media here saying that some x blood bank can store your baby's umbilical cord (UC) for its 'future use'. And people keep asking me about the truth.

Okay, I will give this information  from a scientific point of view.

The umbilical cord is the lifeline of a fetus in the womb. Running through the nearly 2-feet-long cord, there’s a vein ferrying nutrients and oxygen from mom’s blood (via the placenta), plus two arteries carrying oxygen- and nutrient-depleted blood from the fetus back to mom. Because mother’s blood and fetal blood don’t actually mix much, the blood in the placenta and umbilical cord at birth belongs mainly to the fetus.

Fetal blood holds all sorts of interesting — and allegedly potentially therapeutic — cells and molecules. This thought has, in some cases, changed the way the umbilical cord and placenta are handled during birth. Instead of throwing it away as a waste product, some doctors, scientists and parents are choosing to bank this fetal blood — harvesting it from the baby’s umbilical cord and placenta, freezing it and storing it away for later. Proponents of cord blood banking are convinced that instead of being medical waste, the fetal cells within are biological boon. Is it, really?

This thought actually belongs to the 1980s, umbilical cord blood caught the attention of researchers who suspected that the often-discarded tissue could be a valuable source of shape-shifting stem cells. These cells, which can become several different types of blood cells, are similar to the specialized stem cells found in bone marrow that can churn out new blood cells. Such stem cells are found in adult blood, too, but not as abundantly. At the time, researchers didn’t know much about the properties of the cells found in umbilical cord blood. But research has zoomed forward, illuminating more about the contents of this young blood. Of particular interest are the flexible hematopoietic stem cells important in that initial transplant. In certain cases, transplanting these cells might be able to reboot a person’s body and get rid of a disease-related defect. Cord blood transplants are similar to bone marrow transplants. A person with leukemia, for instance, might have his own cancerous blood cells wiped out with chemotherapy and radiation. Healthy, non-cancerous stem cells from a donor can then repopulate the blood. Extracting stem cells from bone marrow requires surgery under anesthesia; extracting them from the blood requires taking a drug to stimulate their production. And in order to work, these stem cell donations need to come from a person who carries a similar pattern of proteins on the outsides of his or her cells, a molecular calling card known as HLA type. Stem cells found in cord blood don’t need to be as closely matched to work. Because these cells are so flexible, there’s more wiggle room between donor and recipient. That’s particularly good news for people of certain ethnic minorities who often have trouble finding matched stem cell transplant donors.

Trials around the world are studying umbilical cord blood’s capabilities in a wide range of diseases like Cerebral palsy, autism, diabetes and lupus are currently under investigation. The cells are even being tested for an ameliorating role in Alzheimer’s disease and other neurodegenerative conditions. Storing cord blood, people thought, can serve as a type of "insurance" in case babies suffer from any of the several illnesses later in life. 

But, like they say,  reality is less promising. For all of the promise, there are lots of reasons why umbilical cord cells may turn out to be less useful than thought. Why? 

First the cost of storing UC cells is very high. The rates range from Rs.50000 to Rs.100000. Sometimes yearly maintenance fees of Rs.10000 is also charged. Several doctors and scientists also gave these negative reasons to say why this might not work in reality...

1. Currently there is no use of cord blood stem cells taken from an individual for curing an individuals illness. A genetic defect present in a person will also be present in their cord blood cells. If a person gets blood cancer in the future and needs a transplant, the oncologist will never use the person's cord blood as it will also have the same potential to develop cancer. The doctor will prefer bone marrow stem cells from HLA matched siblings or unrelated matched donor or parents. It is unlikely that an individual will need his or her own cord blood later in life, between 1 in 400 and 1 in 200,000. In fact, there are certain instances in which the use of one’s own umbilical cord blood is not useful, such as in cases when there is a genetic defect in the cell. For example, autologous cord blood stem cells cannot be used to treat malignant cancers such as leukemia because the genetic mutations for cancer already exist in the DNA of the cord blood cells. Using one’s own stem cells would effectively result in “contaminating” oneself with the same genetic flaw.
2. The amount of stem cells in cord blood is very less. Cord blood is not the only source of stem cells. Bone marrow is a better source. A minimum of 50-200 ml of blood is needed for collection. Any amount less than that is discarded as insufficient.  But in most cases, there simply isn't enough blood.  Only 8-12% of cord blood units have sufficient stem cells for transplant for an individual weighing 80 kilograms.   
3. The cord blood is stored in liquid nitrogen to prevent destruction of stem cells. However, with every passing year the number of stem cells dramatically decline despite being stored in liquid nitrogen.
4. It is not known how long frozen banked cord blood samples will remain viable. Available data put this at about 15 years, so whether it will be of use over the person's lifetime is unknown. In about 5-10 years the whole stored cord blood would become less potent and if not stored properly may not have any viable stem cells. So even if after a decade we find a use for cord blood stem cells to cure an individuals illness, there may not be any useful stem cells to use as they would have been damaged or decreased in number over the period of time.
5. The infrastructure needed to maintain the cord blood is enormous. The frequent power cuts and temperature variations in India make the stored cells prone for faster damage.
6. Majority of the parents forget the stored cells after a few years.  Most companies in cord blood business will shut shop in the coming years, experts say. Most parents will not read the fine print about storage and use of cord blood, and the terms and conditions are obviously favorable to the companies.
7. For public cord blood banking the individual need not pay any money. All they need to do is volunteer to give their child's cord blood for a public cause.
8. Early clamping of cord can be detrimental to a child's health as the blood taken is the child's own blood. The child can be prone to anemia during infancy.
9. The only benefit of cord blood is that it can be used for the benefit of some other unrelated individual suffering from blood cancer for doing a transplant. However, the oncologist are slowly moving away from cord blood because it is cumbersome to do and there are better and easier alternatives. In this case the parents need not pay so much money to store their child's cord blood for use in some other individual.
10. Taking all the above things into consideration, Cord blood donation should be encouraged when the cord blood is stored in a bank only for public use, where the cells are stored for use in other individuals. The routine storage of umbilical cord blood as “biological insurance” against future disease is not recommended.