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Cord blood banking

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Some decisions come fairly easy for most expectant parents -- whether to breastfeed, which pediatrician to go to or what to name the baby. But more parents today are considering whether to bank their baby's umbilical cord blood.

Advertisements in magazines and online promotions tell parents about this "once-in-a-lifetime" opportunity to save their baby's cord blood for possible use later in life. It is a phenomenon that has yet to gain much traction in Siouxland, where the absence of cord blood banks, one medical expert says, makes it impractical. For now.

Dr. Mike Kafka, pathologist and director of the pathology lab at St. Luke's Regional Medical Center, also pointed out that the likelihood that a donor would ever use their cord blood or get it back from a private cord blood bank is "very, very small." Not that cord blood banking doesn't have its growing uses, and some day the tri-state area may have a public cord blood bank to serve those uses, he said.

Cord blood is one of three sources for bone marrow transplants, The others, he noted, are bone marrow transplants and peripheral blood stem cells. "Cord blood banking is a way of getting stem cells like they use for transplanting into patients that may have things like leukemias. Because of the treatments they are undergoing, their cancerous cells are actually being wiped out by chemotherapy or radiation therapy," Kafka said.

Cord blood banking in a public bank is a fairly noncontroversial issue. After all, it doesn't hurt to take a baby's umbilical cord blood that would be discarded anyway and bank it for free in a public bank for use by any family in need. The advent of for-profit cord blood banks, however, has changed the nature of the game ... where it is available.

Nowhere to bank

The problem in the Midwest is there are no cord blood banks available, public or private, Kafka said.

"I don't think there are any hospitals in Iowa or Nebraska or South Dakota that actually do any collection of cord blood. They all tend to be out on the coasts or the Northeast region," he said.

Denver had a public cord blood bank until a few years ago. "But because of the expense and the fact that it really wasn't moving their inventory, they actually got out of it," he said.

Eventually a number of for-profit blood centers and blood banks got into the business of storing cord blood for parents to use later for their children as needed. This being a very expensive process, it has actually delayed people from donating, he added.

"The public blood banks are beginning to become more popular. There's probably about 20 in the United States that you can get things to if you need to," he said. "But in those cases you're making it as a donation to the bank with the intent that you will not get your own stuff back if you need it."

Until recently, Kafka said, pediatric academies and OB/GYN people have not been too supportive of cord blood banking because of the cost and the likelihood that the donors would never get to use the blood.

"But since then, they've decided that the public banking route is the way to go. And so they are supportive of that," he said.

Another issue, he noted, is the volumes you get out of the placenta are fairly small. So it is usually children or small adolescents who can benefit from the transplants. There are not enough stem cells for it to be effective for adults, based on body weight. But they are looking at having an adult potentially use two cord blood donations from different donors, as long as they match, Kafka said.

A family most likely to find value in a private cord blood bank donation is one in which a donor's older sibling has some sort of inherited disorder, such as anemia, and his life could be salvaged or saved through use of the cord blood, Kafka said, providing the tissue match is close enough -- which is most likely with a sibling.

Ethnic advantages

"It's a fascinating technology. They say that it's going to continue to take its place in supporting new therapies," he said, noting that the immature cells in cord blood appear to have less of a "tissue rejection phenomenon" than can happen with bone marrow transplants. "So they are potentially looking at these cells for other applications besides bone marrow transplants."

Experts predict that worldwide there will be about 10,000 cord blood transplants within the next four to five years.

And this may be of special interest to a number of ethic groups who are seriously underrepresented when it comes to bone marrow donations, Kafka said.

"With cord bloods, they have a higher likelihood of being able to get people of other ethnic backgrounds to actually donate, in which case then they're finding out that people that are benefiting from the cord blood donations are Hispanics, blacks and other where the normal donor pool would not be reflective of that particular ethnic group," he said. "With cord blood donations, they actually have a higher likelihood of being successful."


Hospitals affiliated with a public blood center will often collect cord blood at no cost, and medical personnel at unaffiliated hospitals who do the cord blood collection may charge up to $100; but donors who opt for private cord blood banks face some serious expenses, Dr. Mike Kafka said.

"If you go the private route, it can be $1,500 to $2,000 for the initial processing. Then there's an annual storage fee after that that's usually around $125 or $150. So it's an ongoing expense for something that in most cases people end up not using," he said.


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