This page contains answers to frequently asked questions about umbilical cord blood banking, including information about what umbilical cord blood is, how it is collected and how it is used and stored.
Cord blood is the blood found in the umbilical cord and placenta.
Like bone marrow, umbilical cord blood is a rich source of blood forming (haematopoietic) stem cells. The blood-forming stem cells from cord blood are potentially useful for treating diseases that require stem cell transplants.
Some private tissue banks store umbilical cord tissue, dental pulp and adipose (fat) tissue to extract cells for potential future uses. There are currently no established medical uses for cells extracted from these types of tissue.
There are mandatory screening and testing requirements for anyone who donates any kind of tissue or cells. These requirements are set out in Annexes A and B of the HTA’s Guide to Quality and Safety Assurance for Human Tissues and Cells for Patient Treatment. As well as these, each cord blood bank may set its own eligibility criteria, and carry out its own additional tests.
If you are considering travelling abroad for a treatment, you should first talk to a trusted medical practitioner, such as your GP or specialist, about the safety of unlicensed stem cell treatments or treatments only available overseas. Use caution with online searches and clinics that promise cures based on patient testimonials.
The umbilical cord is clamped and cut in the same manner as it would be for normal delivery of the baby. Blood is then drawn from the umbilical cord into a cord blood collection bag. By law, anyone collecting cord blood must be appropriately trained and working under the authority of an HTA licence. The premises where the cord blood is collected must be risk assessed by a trained individual and be deemed suitable; this assessment must be documented.
For optimal viability it is recommend that the cord blood is stored as soon as possible following collection, and certainly within 72 hours (NetCord-FACT 2013). Minimising time between the birth and cryopreservation (storage) is important for maintaining the quality of the cord blood unit.
Since 5 July 2008, any person collecting cord blood must be acting under the authority of an HTA licence. The main responsibility for complying with HTA requirements lies with licensed establishments and organisations acting on their behalf. However, it is also important for parents to be familiar with this legal requirement so that they do not unknowingly allow collection by an unauthorised person. It would be unlawful for an unauthorised midwife or birthing partner to undertake the collection.
Licensed establishments are required to report all instances of unlawful cord blood collection to the HTA. Using an unauthorised person to collect cord blood may lead to contamination of the cord blood or inadequate collection. The HTA can require the disposal of any unlawfully collected cord blood.
Cord blood banks should ensure that critical transport conditions such as temperature and time limits are defined, validated and maintained to preserve the quality and safety of the cord blood. Only packaging and containers that have been validated as being fit for purpose should be used.
By law, donors of umbilical cord blood (i.e. the mother) must be screened and tested for evidence of infection with certain transmissible diseases.
The donor screening process typically involves the mother answering a series of health and lifestyle questions designed to determine which tests are needed. A sample of the mother’s blood is then taken after the birth. Usually, this is at an appropriate time on the same day as the birth, but if that is not possible then the mother’s blood sample must be taken for testing within seven days after she has given birth.
Certain tests are mandatory for all donors. Diseases that must be tested for include: Human Immunodeficiency Virus (HIV), Hepatitis viruses B and C (HBV, HCV) and Syphilis. In certain circumstances, other tests such as Human T-lymphotropic virus Type I (HTLV-I) testing may be required, depending on the information provided during the donor screening process.
After the cord blood is collected, it is sent to the cord blood bank for processing, quality control testing, and storage. Processing procedures, quality control tests and storage procedures can vary from bank to bank.
An unprocessed cord blood unit contains different components, including plasma, red blood cells, white blood cells and stem cells.
Cryopreservation of ‘whole blood’ refers to freezing and storing the cord blood unit without removing any red blood cells or plasma.
Red blood cells have been associated with harmful or fatal side effects if too many of them are used in a transplant (FACT Spring 2013). This means that some of the red blood cells need to be removed from the unit before it can be used in a transplant, and this can be done before or after cryopreservation. ‘Red cell depletion’ (also called ‘red cell reduction’) refers to the removal of most of the red blood cells before cryopreserving the cord blood unit. Units stored without red cell depletion must be washed after they are thawed and before use in a transplant (FACT-JACIE Cellular Therapy Standards).
Plasma does not contain any stem cells. To reduce the space required for the storage of cord blood, plasma is removed before cryopreserving the unit, and this process is referred to as ‘volume reduction’.
Yes. Both public and private cord blood banks may choose not to store the cord blood unit based on their acceptance criteria for cord blood quality. Acceptance criteria vary between private cord blood banks, but it is rare for a private cord blood bank to reject a cord blood unit if the family wishes to continue storage. Some banks will not store cord blood units if the mother’s blood tests positive for an infectious disease such as HIV.
Where a privately-banked cord blood unit has been identified as not meeting a bank’s acceptance criteria, the reasons for this and any implications on the clinical usefulness of the cord blood should be discussed with the family. This will help the family to make an informed decision about whether to store the cord blood. If a bank decides to discontinue storage based on their own policies, the family is normally entitled to a full or partial refund according to the terms of the storage agreement.
In addition to storage for established transplant treatments, private cord blood banks market cord blood banking services for potential future uses, including clinical trials and stem cell therapies that have not yet been developed. Private cord blood banks should provide families with sound scientific and medical information to assist them in making informed choices about whether to store their cord blood for potential future uses yet to be investigated or proven.
Cord blood rejected by a public or private cord blood bank can be used for research, but only if the mother has given her specific consent for this. Otherwise, cord blood that is unsuitable for banking will be disposed of using normal hospital disposal procedures.
Cryopreservation refers to freezing and storing at low temperatures.
The length of time cord blood can be stored for and then used successfully has not been determined. Under appropriate storage conditions, it may be possible to preserve the cells for many decades.
No. It can be used worldwide. Once the cord blood unit has been frozen, it will be stored until required. By consenting to bank your cord blood publicly, you are agreeing to its being registered on national and international databases such as the British Bone Marrow Registry, Bone Marrow Donors Worldwide and the European Marrow Donor Information System (EMDIS). Organisations worldwide can search these databases to find a suitable match for a patient who needs a stem cell transplant.
Yes. The quantity and characteristics of cells in the cord blood unit influence how the cord blood unit may be used. For example, a transplant containing too few stem cells may fail.
Some private cord blood banks provide statistics to illustrate the likelihood that an individual will need to use their banked cord blood. However, estimates of the probability of an individual needing a stem cell transplant tend to vary according to the source and are based on uncertain assumptions. The estimates cannot be directly translated into the likelihood of an individual using their own cord blood unit since this would also depend on other factors such as the number of stem cells within the unit, the quality of the cells and the availability of alternative sources of stem cells such as peripheral blood stem cells (Pasquini 2005).
Although cord blood storage is a unique opportunity to preserve the stem cells within cord blood, it is not an individual’s only opportunity to access their own stem cells since peripheral blood stem cells and bone marrow stem cells may also be available. Stem cell technologies are developing rapidly, and it is likely that there will be future developments that will find new uses for stem cells. It is, however, by no means certain that these uses will rely entirely on individuals having their own cord blood stored.
The HTA is not able to give advice about the effectiveness of treatments using cord blood.