An interesting article that caught my attention on the BBC recently was discussing the rise in individuals storing their umbilical cord blood in private blood banks as opposed to public stem cell banks. I thought that today I’d chat a bit about the issues surrounding this, and start a bit of a discussion about the pro and cons.
Normal hospital practice after childbirth is for the placenta and umbilical cord to be discarded. The only time that this practice changes is after a traumatic birth, where the placenta will be sent to histology and examined by a pathologist to look for any evidence of placental abnormalities. Pathologists may be looking for placental infection or meconium discolouration (dark green streaks in the otherwise red/pink placenta), which can be a sign of foetal distress and suggests that the baby’s oxygen supply was inadequate. These tests are performed to prove that the baby will not have any long-term problems caused by labour or delivery.
However, there is another practice that is being adopted following after-birth delivery of the placenta and umbilical cord; private umbilical cord blood storage.
Umbilical cord blood is rich in stem cells. Stem cells are cells that can turn into any cell type within the body. Use this analogy to think about them; you are making origami animals, and your flatmate accidentally steps on your swan, so you need another swan. Think of stem cells as a sheet of A4 paper, you can fold it into a swan, but you could also fold it into a monkey if you needed to. Stem cells can be found in many tissues including; the brain, bone marrow, skeletal muscles, skin and blood. Umbilical cords are rich in blood stem cells. They can be used to treat patients with blood cancers or immune disease as they can become any type of cell that is needed if the patient is deficient.
Parents can choose to donate their cord blood to the public stem-cell bank; the NHS Cord Blood Bank, or one run by a charity such as the Anthony Nolan Trust. Stem cell banks like these are available for public use, and any donations are not kept for specific individuals.
Possibly due to this, the numbers of parents storing their children’s umbilical cord blood in private banks has been rising quickly. These stem cells are stored by companies external to the NHS and can be stored for use in the future as treatments for the child of the donor, should they become ill with life-threatening diseases. This is becoming popular as in the case of blood cancers like leukaemia or immunodeficiency, there would already be a perfect match unit available for use and parents need not go through the additional stress of waiting on a stem cell register for a match when their child is so ill.
Figures published by the BBC show that the number of umbilical cord blood units kept in private storage has almost doubled in the last 4 years, rising from 6,289 to 11,950.
Umbilical cord is covered by many regulations, with the main regulatory body being the Human Tissue Authority (if you haven’t read my blog post about the Anatomy Act, that will explain this authority better – read it HERE). There are therefore only 7 private companies currently licensed to accept umbilical cord blood in the UK. Umbilical cord blood is stored in liquid nitrogen and can be kept for 25 years.
To store samples privately, there is a cost. This can vary from company to company but there is a ‘one off’ cost for the initial storage. This can range from approximately £1,500 to £2,500 and is then followed by yearly storage fees that are around £100. Obviously if a family are not able to supply these funds, it could mean that this is a service that only the rich can access, and I think that is where the problems start to arise with this potential treatment.
I personally think it would be great if this service was offered on the NHS, but I’m not naïve enough to believe it would happen without something else being sacrificed, as the costs to run such a programme for every single female giving birth in the UK would be incredibly high. There is also currently little benefit of saving the blood if the individual never becomes ill. Therefore, it may be more beneficial to look at saving the cord blood if the individual is classed as ‘higher-risk’, for example if they have known genetic mutations in their family lineage. A good way to assess this may be to perform routine genome screening upon birth, to assess if there is really any medical need to save the cord blood.
As always, let me know your thoughts. I think it’s a topic that could be widely debated and has many pros and cons. Exactly what the answer is and how we should proceed, I’m not really sure, but I’ll be interested to see if umbilical cord blood donations to private companies become even more popular in the future.
Until next time,