We have prepared for you a list of the most frequently asked questions and answers about umbilical cord blood, umbilical cord tissue and tissue of placenta.
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FAQ
What are haematopoietic stem cells?
Haematopoietic stem cells are partially differentiated cells capable of transforming into red blood cells, white blood cells and platelets. In adults, these cells are found in bone marrow, but during prenatal development, they are located in the liver and spleen. Several weeks before delivery, the body starts to release haematopoietic stem cells in the blood, and they are progressively caught in the bone marrow, where they remain for life. That is why a baby’s blood contains a relatively large number of haematopoietic cells.
What are stem cells?
Stem cells are basic cells of an organism, capable of developing into various specialised types of cells (e.g. nerve, blood, muscle, bone, skin or organ cells, etc.) and of recovery, which means that they may differentiate into further identical blood cells.
Stem cells can recover diseased or damaged tissue and are an inevitable part of an organism during its lifetime.
What is cord blood?
Cord blood is a baby’s blood that remains in the placenta and the umbilical cord after the baby is born and the umbilical cord is cut. It is unique since it contains valuable haematopoietic stem cells which are young and do not carry a burden associated with acquired diseases, treatment or ageing.
In addition to the haematopoietic stem cells, cord blood also contains the so-called mesenchymal stem cells which are capable of differentiating into cells of many types of tissue. Umbilical and placental tissue is one of the sources of mesenchymal stem cells.
Cord blood is currently used for the treatment of certain haematologic disorders and cancer types, such as leukaemia, lymphoma, organ tumours, immunity or metabolic disorders. The majority of these diseases are associated with failure of haematopoiesis in bone marrow. Bone marrow recovery using haematopoietic stem cells involves the so-called haematopoietic cell transplantation.
Currently, there are several ongoing clinical trials, which are investigating the potential of cord blood in other diseases that are beyond the usual scope of oncology or haematology.
What is placental blood?
Placental blood is cord blood collected from superficial placental veins. It is collected after the delivery of the placenta. The blood is processed and stored separately. Just like cord blood obtained from the umbilical cord, this cord blood contains, in particular, haematopoietic stem cells and mesenchymal stem cells which are capable of differentiating into many types of tissue. Use of cord blood – here.
Placental blood is collected as part of the PREMIUM collection. This way, it is possible to obtain up to as many as 40% more stem cells compared to the Standard collection, which increases the chance of saving lives during potential transplantation.
What is umbilical tissue?
The umbilical cord connects the baby with the placenta and the mother. Three vessels pass through the umbilical cord, surrounded by Wharton’s jelly – a transparent, gelatinous matter. The vessels supply the foetus with oxygenated, nutrient-rich blood from the placenta.
The umbilical cord is a rich source of mesenchymal stem cells, which are capable of differentiating into cells of many types of tissue. Mesenchymal stem cells are probably the most promising type of cells for cell therapy, recovery treatment of damaged organs and treatment of various diseases.
What is placental tissue?
The placenta, also called the ‘tree of life’, is a complex organ that performs vital functions during pregnancy. It not only ensures a basic connection between a mother and her baby, but also plays an active role in harmonic growth and development of the foetus during pregnancy.
Recent studies have provided strong evidence of the quality value of the placenta not only during pregnancy but also in further use of the placenta after delivery. Placenta has proven to be a unique source of stem cells – mesenchymal stem cells, haematopoietic stem cells and endothelial progenitor cells which are increasingly used for therapy in recovery medicine.
The advantage of autologous mesenchymal stem cells obtained from placenta is that:
- they are better tolerated and therefore not perceived as foreign by the immune system;
- they have the potential to differentiate into a wide range of cells;
- they grow faster than adult mesenchymal stem cells from bone marrow or other sources.
What are the advantages of cord blood compared to other sources of stem cells?
The most important benefits of cord blood as a source of haematopoietic cells compared to other sources (bone marrow and peripheral blood) lie in the fact that its cells are not burdened by diseases acquired during lifetime, treatment of ageing and have a better ability to differentiate further. In addition to the haematopoietic stem cells, cord blood also contains the so-called mesenchymal stem cells, which are capable of differentiating into cells of many types of tissue.
It is frozen and ready for immediate use without the need to plan and carry out the collection. Moreover, own cord blood may be used in cases when it is not possible to obtain own cells after disease flare-up – for example, in the case of bone marrow failure.
Cord blood:
- is a standard treatment option for dozens of serious diseases;
- has potential in the treatment of several diseased beyond standard treatment – more than 600 clinical trials;
- may be used both in childhood and adulthood;
- may be used for the treatment of the child’s sibling as well;
- its unique characteristics are preserved also in the case of long-term storage;
- may be collected once in a lifetime only, at the time when the child is born;
- is owned by the parents and immediately available if necessary.
What is regenerative medicine?
Regenerative medicine is a field of medicine that deals with the restoration of damaged tissues and organs. Relatively new and promising in this area is the use of umbilical cord blood cells and cells of umbilical cord and placenta tissue. Research is successfully advancing in many cardiovascular or neurodegenerative diseases, such as cerebral palsy, autism, brain and spine trauma and others, is successfully ongoing. Regenerative medicine focuses not only on the improvement of the patient’s condition but also on their quality of life, which is extremely important.
Stem cells which may be obtained during the delivery from the umbilical cord blood, umbilical cord tissue and placenta tissue belong to ‘adult’ stem cells. They are not associated with any ethical issues in therapeutic use or for research purposes. Regenerative medicine should be one of the priority areas supported by the EU and individual member states.
What are clinical trials?
Long-term monitored clinical trials – which are subject to strict rules and inspections during the entire trial period – are conducted in order to verify the safety and efficacy of a new therapy. Each clinical trial has its own protocol: a document describing what will happen to the patient, what examinations he/she will undergo, and what are the objectives of the clinical trial. Physicians treat patients according to the protocol.
New treatment options emerge thanks to clinical trials. They may include expansion of existing treatment or initiation of a new therapy for previously incurable diseases. Clinical trials are, therefore, a great benefit for the patients since they provide them with access to innovative treatment.
Read about the potential of current use of stem cells in clinical trials conducted worldwide.
Is collection painful or dangerous?
No. Collection of cord blood or cord and placental tissue is completely painless and safe and is carried out when the mother and the baby have been taken care of. At the time of cord blood collection, the umbilical cord is already cut and clamped and the baby is in the care of a paediatrician. The collection is not unpleasant or painful for either the mother or the baby. In no case does it interfere with a standard course of labour and delivery.
How and by whom is the collection carried out?
Collection of cord blood is carried out by an obstetrician or qualified medical staff during the delivery of a baby, after the umbilical cord had been cut and clamped and before the delivery of the placenta. Cord blood is collected into a sterile kit: the umbilical vein is punctured with a needle and the blood is allowed to flow from the umbilical cord into a collection bag by gravity. In case of Premium collection, the blood is additionally collected directly from placental veins, but only after the delivery of the placenta.
What volume of blood or tissue is collected?
The amount of cord blood and/or placental blood collected is strictly individual and, among other things, depends on the length of the umbilical cord and on the blood supply to the umbilical cord and placenta. Neither we nor the obstetricians or mothers can influence the collection and its scope.
In the case of umbilical tissue collection, approximately 10-15 cm of the umbilical cord itself is collected as well.
The placental tissue is collected in its entirety.
Is it possible to collect cord blood or tissue even when delaying clamping of the cord?
Yes. Cutting the umbilical cord from the time of delivery until the 1st minute has only a negligible impact on the quality of the collection. However, cutting the umbilical cord after the 1st minute results in lower volume and reduced cellularity of cord blood. Therefore, when the umbilical cord continues pulsating for a longer period, we recommend considering the PREMIUM collection (collection of blood from superficial placental veins as well).
However, the time when the umbilical cord was cut after delivery has no impact on the collection and the quality of cells collected from the cord and placental tissue.
Can the collection fail?
Yes, it can happen. The primary obligation of physicians at the delivery is to take care of the baby and the mother; the collection of cord blood comes second.
Is it possible to collect cord blood during a C-section or a delivery into the water?
Yes. Experience with cord blood collection during a C-section or delivery in water is very good. Of course, the health of the baby and mother is more important than the cord blood collection. Therefore, in case of complications, the obstetrician will decide at his or her own discretion whether it is possible to carry out the collection.
Is it possible to collect cord blood or tissue when I am gestational diabetes?
Yes. Cord blood is also collected in case the mother suffers from diabetes, gestosis or other diseases during pregnancy. The only cases when cord blood is not collected are when the mother has a proven HIV, syphilis, hepatitis B or C infection during pregnancy.
Do drugs taken during pregnancy influence the quality of cord blood?
If you have been prescribed any therapy by your doctor, compliance with treatment is necessary in your own interest and that of your baby. None of the drugs prescribed to pregnant women influences the quality of stem cells in cord blood.
In case of twins, does it make sense to store cord blood from both babies?
Yes, it does. Twins may be dizygotic and thus not identical genetically, which is why their cord blood may differ. In the case of monozygotic twins, two collections are more beneficial as well since it may happen that both babies will need cord blood in the future.
What is the estimated likelihood of cord blood transplantation?
Cord blood is a source of haematopoietic stem cells which are used especially in the treatment of haematological and malignant diseases, such as leukaemia, lymphoma, cancer of various organs, acquired or hereditary haematopoietic disorders, immune or metabolic disorders and other conditions. The majority of these diseases are associated with failure of haematopoiesis in bone marrow. Bone marrow recovery using haematopoietic stem cells involves the so-called haematopoietic cell transplantation.
The likelihood of using your own cord blood is determined by the number of haematopoietic cell transplantations that are performed. Until 2019, cord blood had been used more than 40 000 times. The likelihood that a person will undergo transplantation of own (autologous) haematopoietic cells in their lifetime is 1:400. This calculation has been made by American scientists based on the incidence of individual diseases and frequency of transplantations.* Before the age of 20, the likelihood is 1:5000.
The advantage of own cord blood lies in the fact that its cells are not burdened with diseases acquired during lifetime, treatment or ageing and have a better ability to differentiate.
* Nietfeld et al., Biology of Blood and Marrow Transplantation, 14:316-322,2008; Lifetime Probability of Hematopoietic Stem Cells Transplantation in the US
What aspects are important in relation to the usage of cord blood as a transplant?
One of the important parameters of a transplant in the course of haematopoietic cell transplantation is the number of nucleated cells. The coefficient of the number of nucleated cells per kg of patient body weight has not been exactly defined, but in the case of cord blood, the limit of >2×107 of nucleated cells per kg of patient body weight is generally recommended. However, this coefficient may be higher or lower, depending on the specific disease.*
The number of nucleated cells of a suitable transplant for a particular patient is decided by a transplant specialist.
A higher patient weight than the specified ‘value’ does not automatically mean that the cord blood transplant may not be used.
Sources of haematopoietic stem cells may be combined. This means that in the case of one’s own cord blood or cord blood from a sibling, it is possible to combine the cord blood with bone marrow from the same individual.**
*http://www.scielo.org.mx/scielo.php?pid=s0034-83762005000200027&script=sci_arttext
When is the combination of cord blood and bone marrow used?
Sources of haematopoietic stem cells may be combined. In the case of one’s own cord blood or cord blood from a sibling, it is possible to combine the cord blood with bone marrow from the same individual (https://pubmed.ncbi.nlm.nih.gov/24803091).
Usage of cord blood, umbilical cord and placental tissue in regenerative medicine
When talking about recovery medicine which treats various types of tissue damage (e.g. following injury) or neurological diseases (such as cerebral palsy), the utilisation of cord blood or cord or placental tissue in this area is experimental in nature. Perinatal tissue contains several types of stem cells, the efficacy of which is being verified in clinical trials. The type and amount of stem cells in individual trials may differ significantly. Moreover, cord blood contains a large number of other components in addition to stem cells which may be important in the treatment of various diseases.
Which diseases may be treated using cord blood stored in a family bank?
Cord blood is a source of haematopoietic stem cells, which are currently used in particular for the treatment of certain haematologic disorders and oncological diseases, such as leukaemia, lymphoma, organ tumours, immunity or metabolic disorders. Haematopoietic stem cells are capable of restoration of damaged bone marrow and recovery of haematopoiesis after bone marrow failure. This condition may be caused by the disease itself or may develop after chemotherapy. In the case of bone marrow recovery using haematopoietic stem cells, we speak of the so-called haematopoietic cell transplantation, which is carried out in more than 80 different diseases.
Currently, there are hundreds of ongoing clinical trials, investigating the potential of cord blood in diseases beyond the usual scope of oncology or haematology. There are the following areas of disease: haematologic disorders and cancer, immunity disorders and neurological or vascular diseases.
Can stored umbilical cord blood be used more than once?
As a rule, all haematopoietic cells from the cord blood unit are utilised during a haematopoietic stem cell transplantation, which means that a single prepared transplant is usually used only once.
If stored in several bags, as in the case of the PREMIUM collection (depending on the volume of collected cord blood), it is possible to use only one of the bags. The decision is made by the attending physician.
The purpose of multiplication (expansion) of haematopoietic cells is to solve the issue of a limited number of cells that are collected, i.e. to increase the number of cells in the transplant and, in general, to allow wider use of a single cord blood unit or to provide an opportunity for its multiple use. This may significantly extend the use of stem cells in cord blood.
Cell expansion – how has the research progressed?
The purpose of multiplication (expansion) of haematopoietic stem cells is to solve the issue of the limited number of cells that are collected, i.e. to increase the number of cells in the transplant and to allow wider use of a single cord blood unit or provide an opportunity for its multiple use. This may significantly extend the use of stem cells in cord blood.
Currently, there are several ongoing clinical trials* which verify the efficacy and safety of administration of expanded haematopoietic stem cells to patients. Several trials are in their second and third phase, which indicates that in the future, the use of expanded cells could become part of clinical practice.
Is it possible to use haematopoietic stem cells from cord blood of my child to treat another family member?
Yes, in the case of transplantation of haematopoietic cells from another person, the compatibility of signs between the donor and recipient (HLA compatibility) is the primary criterion. The likelihood that siblings will be 100% identical is as high as 25%. The likelihood of a 50% match is 50%. In such a case, we are talking about haploidentical siblings. Parents and their child are also haploidentical since the child inherits half of its genetic material from each parent.
We store cord blood for one child. Does it make sense to store cord blood for the other?
When doctors treat the child using the child’s own cord blood, we speak of autologous transplantation. If blood has been used for the child’s sibling, it is allogeneic transplantation. In certain diseases, own cells may be used, and in others, doctors prefer cells from a healthy donor. In the case of cord blood from a sibling, the chance that the transplant will be suitable for the sibling is much higher. The likelihood that siblings will be 100% identical is as high as 25%. However, we do not know beforehand which of the children could need cord blood, whether their own or from their sibling. Therefore, it makes sense to keep cord blood for all children.
In which diseases is own umbilical cord blood used and when from a donor, such as a sibling?
For the most part, the difference lies in the type of disease. In certain diseases, own haematopoietic cells are used, while others require donor cells. The suitable type of stem cells depends on the decision of the attending physicians and recommendations. You can find the list of diseases here.
What is the difference between donation of cord blood and storing it in a family bank?
If you keep cord blood in a family bank, you are the exclusive owner of the blood and the blood is ready for use if necessary.
If you donate blood, it is an act of humanity, but you are waiving your right to such blood. Donated blood is the property of a donor registry and is intended for a diseased patient anywhere in the world. It may happen that your child will need cord blood which you had donated to a donor registry, but the blood will already have been used to treat another patient.
What are the advantages of storing cord blood in a family bank?
Storing cord blood in a family bank guarantees immediate access to stem cells. Stored cord blood is ready for use and it is not necessary to burden the patient with bone marrow collection. Moreover, stem cells from cord blood have a unique composition and quality and are collected at birth, which means that they are ‘pure’, i.e. not burdened with a disease, therapy or ageing of the organism.
Can I donate cord blood?
You can donate cord blood to the registry of cord blood donors. The following applies to cord blood donations:
- it is an act of humanity just like blood donation and, therefore, mothers donate cord blood for free (without entitlement to remuneration);
- the blood is owned by a registry of cord blood donors;
- the blood is intended for any patient anywhere in the world who might need it;
- once the child needs the cord blood that has been donated to the donor registry, there is no guarantee that the blood will still be available;
- there are some criteria for donor selection which are governed by applicable laws;
- collected blood that does not meet the required criteria is disposed of or used for scientific purposes.
Is there a risk of confusing an umbilical cord blood transplant during processing?
A state-of-the-art system for handling cord blood during processing prevents accidental swapping of transplants. Each collection of cord blood is labelled using a double labelling system. There are two unique identification numbers assigned to each transplant. Likewise, as a standard rule, the identity of cord blood stored by us and of the person for which it is to be used is verified prior to final use.
How is cord blood stored?
Processed cord blood is stored in special biologic containers in liquid nitrogen at temperatures below -150°C. The system is completely independent of electricity or other energy supplies. The amount of liquid nitrogen and the temperature in the container are monitored by a monitoring system. The storage areas are protected against vandalism by an alarm system connected to employees and the police, with the premises themselves being located on a site guarded round-the-clock by a security guard service.
How long can cord blood be stored?
Previous research of stored live cells (sperm, bone marrow, cord blood, etc.) demonstrates that cryoconservation in liquid nitrogen keeps cells viable for several decades or even for an unlimited time. Other studies related directly to cord blood have compared the samples after they had been stored for several months and several years and the quality of the observed samples did not differ even after 25 years later. Based on previous research, there is no expiry period defined for stored cord blood.
What do the data on the Certificate mean?
The Certificate that you received approximately a month after the cord blood collection shows the number of nucleated cells. The ability of stem cells from cord blood to settle and ensure haematopoietic recovery depends on the number (density) of nucleated cells in the transplant (cord blood unit).
The mother cannot influence the density or the number of these cells. Neither can it be estimated in advance (for example, if there are xxx ml of cord blood, there will be xxx nucleated cells).
The decisive parameter of the haematopoietic stem cell transplantation itself is the number of nucleated cells in the transplant in combination with the disease that is to be treated with cord blood.
What benefits do you offer?
The cord blood bank Cord Blood Center has more than 20 years of experience and is the 2nd largest cord blood bank in Europe. We offer our clients more than just the collection and storing of cord blood. Our own support programmes, that are unique for each branch, include:
- Support programme – we provide professional consultations, coverage of costs of transplantation in case of diagnoses that are traditionally curable with own cord blood (up to EUR 155,000) and coverage of personal expenses (up to EUR 30,000).
- Helping Hand programme – we actively offer help to families with stored cord blood which may be treated with stem cells from the cord blood, as part of the most modern use of stem cells in experimental medicine.
- Programme of free indicated collection – if you have a child with a disease that can be treated with cord blood and you are expecting another baby, the collection and storage of cord blood, cord and placental tissue will be provided by us free of charge.
More information here.
