Cord blood and stem cells revisited

umbilical cord

This is a re-post of an article based on questions posed to a haematologist on a query on Cord blood and peripheral blood Stem cells. We frequently still see these questions crop up from time to time in chat rooms and forums.

Firstly you have to be clear what Stem Cells you are referring to. In general the stem cells from Cord blood and that collected from the Peripheral veins are Haematopoetic Stem Cells  (HSC) which are capable of self-renewal and generating blood cells.

The accepted and proven medical usage of Umbilical Cord Blood and Peripheral Blood HSC is in transplantation of blood diseases which include malignant (such as leukaemia and lymphoma) and non-malignant conditions (such as aplastic anaemia).
Malaysia has an active HSC transplant programme and there are currently 11 centres in the country performing transplants
Umbilical Cord Blood HSC
Doctors who look after mums-to-be (obstetricians) in general follow the guidelines of the professional associations when in comes to advising on the practice of storing umbilical cord blood cells of their newborn babies.
The UK Royal College of Obstetricians and Gynaecologists guidelines are set here:
http://www.rcog.org.uk/womens-health/clinical-guidance/umbilical-cordblood-banking
Please bear in mind that there are two types of Cord blood banking – Private Cord Blood Banking and Public Cord Blood Banking. The vast majority of Cord Blood HSC transplants conducted today use cells stored in Public Cord Blood Banks. This is because the search for an appropriate matched cord bloodcan be done from a Public Cord Blood Bank upon request from anyone and not just the from the family from whom the cord blood was stored. In fact the chances of a normal child’s umbilical cord blood HSC ever being used if stored in a private cord blood bank is very small. In the UK RCOG guideline they quote “the individual’s chances of using personal cord blood for haematopoietic disorders before the age of 20 years is low; estimates used vary from 1/2000026 to 37/100000″ 
The issue of Cord blood storage storage for “personal” use is also stated in the guidelines as “not inappropriate in conditions where the disease has a genetic origin, including some leukemias, and patients would be better served by a source other than their own-banked cells.”
Nowadays there are other sources of HSC other than Cord blood should a patient with leukaemia for instance not have a matched sibling donor. The other sources include Matched Unrelated Donors (adults) and increasingly these days Haplotype donors where the source is from a parent or child’s marrow or peripheral blood HSC.
 
The summary is, when it comes to Umbilical Cord Blood Banking, the professional recommendation is for a community to support banking in Public Cord Blood Banks (there is one now in the National Blood Bank or Tabung Darah Negara, if you need more info, please contact them). We do not recommend “directed commercial cord blood collection and stem-cell storage in low-risk families” as per current guidelines. 
Peripheral Blood HSC
 
There is no medical rationale for routine storage of one’s own Peripheral Blood HSC for normal individuals. The only use of Peripheral Blood HSC from normal individuals is when they are acting as a donor for someone who requires an allogeneic blood stem cell transplant (it may be his or her sibling or an unrelated person in the case of a matched unrelated transplant).
There are some potential risks in Peripheral Blood HSC collection and storage but in general these are small and the vast majority of donors do not experience any long lasting side effects.
A last note about stem cells in general
Many people are confused about what “Stem cells” are. There are different types of stem cells such as Mesenchymal stem cells, being studied and tested today in different medical conditions. These are by and large still undergoing clinical trials but unfortunately in some cases being prematurely commercialised.
This article is a good summary on the important points about stem cells:
The biggest scam going on currently are the so-called “stem cell supplements or enhancers” being sold to consumers in a bottle. This was blogged here:

 

Comment
About

Malaysian physician, haematologist, blogger, web and tech enthusiast