What are the recommendations for cord blood (umbilical cord blood) banking?

Cord Blood Banking Recommendations

Public cord blood donation should be encouraged, while private banking for personal use should be discouraged unless there is a known sibling with a condition that could benefit from cord blood transplantation. 1

Types of Cord Blood Banking

There are two main types of cord blood banking options available to parents:

1. Public Cord Blood Banking

   • Free for families
   • Cord blood is available for any matching recipient who needs it
   • Units undergo rigorous quality control and accreditation
   • Genetic and infectious disease testing is performed
   • Parents are notified if abnormalities are identified
   • Donated units may not be accessible for future private use

2. Private Cord Blood Banking

   • Significant cost to families (not covered by insurance)
   • Cord blood is stored exclusively for potential family use
   • Less regulated for quality control than public banks
   • Underutilized for actual treatment
   • Often marketed as "biological insurance"

Evidence-Based Recommendations

When to Consider Public Banking

• Public cord blood donation should be encouraged whenever possible 1, 2
• Public banking provides a valuable resource for patients needing hematopoietic stem cell transplantation
• Public banks are subject to stringent quality control measures

When to Consider Private Banking

• Private banking is recommended only when:

  • There is a full sibling with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation 1
  • Examples include leukemias, lymphomas, hemoglobinopathies, immunodeficiencies, and metabolic disorders

• Private banking is NOT recommended when:

  • It is intended solely for potential future personal use with no known family indication
  • It is marketed as "biological insurance" against future illnesses 1

Why Private Banking is Generally Discouraged

1. Most conditions that might benefit from cord blood stem cells already exist in the infant's cord blood (e.g., premalignant changes in stem cells) 1
2. No scientific data currently supports routine autologous cord blood banking 1, 3
3. The likelihood of a child needing their own stored cord blood is extremely low (estimates range from 1:1,000 to 1:200,000) 1
4. Evidence shows DNA mutations in cord blood from children who later develop leukemia, making autologous transplant potentially contraindicated 1
5. Transplant physicians rarely choose autologous cord blood over alternative stem cell sources for most conditions 4

Important Considerations for Collection and Storage

Collection Standards

• Written informed consent must be obtained before the onset of active labor 1
• Collection should not be performed during complicated deliveries 1
• Collection should not alter routine practice for umbilical cord clamping 1
• Cord blood should be collected in bags containing citrate-phosphate-dextrose anticoagulant 1

Storage Standards

• Processing and freezing should occur within 48 hours of collection 1
• Banks should follow standardized freezing and storage conditions 1
• Units should be stored under liquid nitrogen or at equivalent temperatures 1
• All cord blood units should be tested for infectious diseases and hereditary hematologic diseases 1

Common Pitfalls to Avoid

1. Marketing Vulnerability: Families may be vulnerable to emotional marketing at the time of childbirth. Be aware that private banking companies may make unsubstantiated claims about future benefits 1, 3

2. Conflicts of Interest: Physicians or professionals who recruit for private cord blood banking should disclose any financial interests or conflicts 1

3. Quality Control Issues: Private banks are generally less regulated for quality control than public banks 2

4. Unrealistic Expectations: Parents should understand that autologous cord blood would not be used if the child later develops leukemia, as the same genetic mutations may be present in the stored blood 1

5. Failure to Notify: If a child whose cord blood was collected later develops a genetic, immunologic, or malignant disorder, parents should notify the cord blood bank so the unit is not used for transplantation 1