Department: CLINICAL QUERIES
My patient, who is pregnant, wants to collect and bank her newborn's umbilical cord blood. She is considering using a private versus a public cord blood bank. I advised her to discuss the pros and cons of each type of cord blood bank with her obstetrician before making any decisions. What does she need to know to make an informed decision?—K.L., W.VA.
Roxanne A. Ferguson, EdD, MSN, RN, responds: Umbilical cord blood is the blood remaining in the umbilical cord and placenta following the birth of an infant. It has emerged as an alternative source of hematopoietic stem cells in allogeneic hematopoietic cell transplantation and can be used to treat specific hematologic diseases that benefit from stem cell transplantation.
Umbilical cord blood can be collected and stored through either a private or public cord blood bank. Public cord blood banks, which are supported by federal and private funding, make a large registry of cord blood available to anyone in need at no cost to families. In contrast, private banks are for-profit organizations that preserve cord blood for a family that has requested the banking for the child or another member of the family should the need arise.1,2 Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) stress that patients considering cord blood donation banking begin the informed-consent process as early in the pregnancy as possible so they understand the potential benefits, risks, and drawbacks of cord blood donation.1,3,4
ACOG has issued various recommendations regarding umbilical cord blood banking. For example, ACOG recommends informing patients that “routine collection and storage of umbilical cord blood with a private cord blood bank is not supported.”2 Patients and families should understand that umbilical cord blood banking cannot be used to treat a genetic disease or malignancy in the neonate because the stored cord blood contains the same genetic material. ACOG also stresses the importance of not compromising the care provided to the mother or neonate in order to collect cord blood.
The AAP agrees with ACOG's position that public banking is the preferred method of collection. AAP also identifies the need for recruiting underserved ethnic minorities for cord blood donations.3
When discussing private versus public blood banking with patients, inform them that banking blood privately is not covered by insurance and may be very costly. Also note that blood banked privately may never be used. In contrast, public cord blood banks make blood available free of charge to anyone in need. These organizations are also more tightly regulated and have rigorous safety and quality control systems. For more information, direct patients to the FDA's consumer-friendly website referenced below.5
3. Shearer WT, Lubin BH, Cairo MS, Notarangelo LDSection on Hematology/Oncology, Section on Allergy and Immunology. Cord blood banking for potential future transplantation. Pediatrics
4. Lubin BH. Collection and storage of umbilical cord blood for hematopoietic cell transplantation. UpToDate. 2018. http://www.uptodate.com