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Bleg for Advice Re Cord Blood Banking:

After some hesitation, we banked our daughter's cord blood at her birth 2.5 years ago. We are now expected daughter number two, and are wondering whether we should bank her cord blood as well. It's pretty hard to get objective information about this, and thoughts from others who have contemplated the same decision are welcome. We can afford to do it, but don't want to waste our money.

Ilya Somin:
Just as a matter of interest, what is cord blood banking, and what is its purpose?
4.21.2008 11:20pm
DavidBernstein (mail):
You extract the blood from the baby's umbilical cord just after birth. It's rich in stem cells, has a few medical uses right now, will hopefully have more in the future.
4.21.2008 11:24pm
Pin Head (mail):
Cord blood is a good source of totipotent stem cells that are genetically identical to the fetus. They could be used for life saving treatment for things like bone marrow transplants for leukemias. While they are ideal as a source for syngeneic stem cells, there are alternatives, like xenogenic transplants using donor bone marrow. Whether the cost is worth the potential benefit considering the risk is your decision.
4.21.2008 11:24pm
Cornellian (mail):
I have no information at all on the subject, but I have in the past wondered if it's realistically possible to store blood for years at a time without having something go wrong with it.
4.21.2008 11:24pm
Joe Kowalski (mail):
When our middle daughter was going to be born, we inquired about it with a company (ViaCord I think?), and were given a pretty hard sell. Several large mailings, several phone calls, etc. It was enough to convince us that a substantial portion of the fees we would have paid would have ended up going to pay for the marketing &sales efforts. We felt that if a company has to go to that extent to sell something, there would be a decent chance that said company might not be around in the future, and we could end up throwing the money away (a couple thousand if I remember right).
4.21.2008 11:34pm
Nathan_M (mail):

I have no information at all on the subject, but I have in the past wondered if it's realistically possible to store blood for years at a time without having something go wrong with it.

Apparently the blood can be stored for 10-15 years. (That figure is from a non-profit bank that takes donations without payment, so I doubt it's the marketing BS that seems somewhat prevalent in this industry.)
4.21.2008 11:43pm
Uthaw:
We banked with CDR last year. Unfortunately, 2.5 years is too soon to tell whether or not you "needed" it. I expect when we have kid #2 we'll do it again.
4.22.2008 1:00am
Uthaw:
(CBR not CDR, sorry.)
4.22.2008 1:01am
SocratesAbroad (mail):
For a balanced explanation, have a look here for both pros and cons.
The first question to ask, though, is why you'd need to bank the blood in the first place.

The primary reason that parents consider banking their newborn's cord blood is because they have a child or close relative with or a family medical history of diseases that can be treated with bone marrow transplants. Some diseases that more commonly involve bone marrow transplants include certain kinds of leukemia or lymphoma, aplastic anemia, severe sickle cell anemia, and severe combined immune deficiency.

The odds that the average baby without risk factors will ever use his or her own banked cord blood is considered low; however, no accurate estimates exist at this time.
4.22.2008 1:22am
guest (mail):
We tried donating our kids' cords to research and failed--three times. Apparently protocols need to be in-place at each hospital and the paperwork is massive. We got close with #2 and then the University Hospital lost its certification and so last second they couldn't. Seems insane when there's so much demand for sound-ethic stem cell lines. But we batted 0 for 3.
4.22.2008 2:10am
guest (mail):
Following up to my own comment:
Cord Blood Donation
4.22.2008 2:12am
Bruce:
I don't have any data, but the cost seemed out of whack as an insurance product to insure against a very low risk. It struck me as similar to an extended warranty.

We thought about donating cord blood, but for a donation, we would have had to collect the blood ourselves. Given that we didn't even know how to change a diaper that seemed like a non-starter.
4.22.2008 2:14am
Inda Know (mail):
I am acquainted with several very accomplished transplant docs. I asked them specifically about this question. To their knowledge, only a handful of kids have received transplants of their own cord blood out of the 200,00+ units banked by for-profit companies. The Red Cross does bank cord bloods on a non-profit basis, and these have been used extensively. The fact is that as cord blood donation becomes more and more frequent, the likelihood that a match will be found rises while the need for a child's own cord blood falls. Bottom line: it's just not worth the money.
4.22.2008 2:50am
theobromophile (www):
The primary reason that parents consider banking their newborn's cord blood is because they have a child or close relative with or a family medical history of diseases that can be treated with bone marrow transplants.

To questions from a non-biologist:
1. Can you determine, pre-delivery, that the baby will be a good match for donation with your first child?
2. If you can so determine, and your kids are a good match for each other, why not bank only one cord? Obviously, there is value to not having to take immuno-suppressant drugs, but if the concern is that your kid have any donor, the cord from a sibling might suffice.
4.22.2008 3:18am
Patrick McKenzie (mail):
Seems like something with dubious medical value to sell to overwrought high-income parents. Snake oil in the age of genetics.
4.22.2008 4:07am
Jocelyn (mail):
theobromophile said:

if the concern is that your kid have any donor, the cord from a sibling might suffice.

But it might not. The only sure match is your own blood. Every now and then you read about a so-called "savior sibling" who has been conceived in hopes of being a perfect match for an older, much beloved child who is in need of a transplant. The ethics of that decision always come under scrutiny, among other things because of the concern about family dynamics and long-term psychological effects in the case where the younger child proves not to be an appropriate donor for the sick child.

A few thousand dollars, if you can afford it, seems like a small price to pay for peace of mind. I'm just not convinced your peace of mind would be founded on anything rational, but you might not care about that. And just remember that finding a perfect match does not mean that a sick person is out of the woods - my friend's daughter had an appropriate match and received bone marrow from her brother. She was on her way to recovery when she died as the result of a blood clot. You cannot insure against everything.

Upon re-reading my own comments, I am just glad that this was not an option when my children were born. Good luck and I hope your children never need their cord blood.
4.22.2008 8:13am
Anonymous Comment:
Cord blood companies may be scamming people. When we asked about donating our cord blood, our OB said that when previous patients tried to donate, the company frequently said that there wasn't enough to be useful. That happened so frequently that donations are no longer accepted.

By contrast, no company has ever told a paying patient that there wasn't enough to be useful. Although she admitted she wasn't sure, our OB was clearly implying that the companies were knowingly accepting payment for useless samples.
4.22.2008 8:31am
Jay:
My wife and I did it for both of our children, but my wife has a genetic disease for which stem cells might someday be useful, so it made sense for us. I think the actual number of people who have been treated from cells from umbilical cord blood is very small. In addition to the initital cost, there is also a yearly storage fee, so the expenses add up.
4.22.2008 10:18am
merevaudevillian:
Speaking purely anecdotally, my wife and I decided to donate blood using Cryobanks. We had a last-minute substitution for our doctor in the delivery room, but he quickly did the blood collection for us, and we promptly mailed it out without any problem. The company notified us that they received it without difficulty. Our doctor noted that this was by far the easiest collection kit he'd used, and he'd used several from other companies as previous times.

But I entirely agree that donation is the way to go.
4.22.2008 10:43am
DavidBernsteni (mail):
It's too late (past 34 weeks) for us to donate. I don't think we're going to do it this time. The reason we did it last time is that we got a very big discount and confirmed that our MSA would also cover it, reducing the real initial cost from $1,800 to something like $700, and that seemed cheap enough for "insurance."
4.22.2008 1:25pm
guy in the veal calf office (mail) (www):
When I researched it, it became pretty clear that all the benefits are potential benefits. Ask the cord blood salesmen if cord blood has ever been used to treat one of the conditions they go on about, and if so, which one(s). It seemed about as viable as freezing your head when you die for future restoration, except with the added punch of preying on a parent's concern for their children.
4.22.2008 1:26pm
LawClerk:
This issue is near and dear to my heart, so let me apologize in advance for the soapbox I'm climbing onto. My niece is alive today because parents whose names we will never know donated their baby's cord blood to a public bank. She was diagnosed with leukemia when she was five, went through the standard (but not at all easy) treatment for two years, and all was well for the next two years, when she relapsed. After about a year and half of the much more difficult relapse treatment protocol, we learned that the chemo and radiation had caused a bone marrow disorder that could quickly turn into a different kind of leukemia that would be even more difficult to treat. Her only hope for survival was a bone marrow transplant. No one in the family (including her sister) was a match for her, and no suitable match was found in the National Marrow Donor Program's database. There was, however, a suitable cord blood match, and she had the transplant done at Duke, one of the pioneering cord blood transplant centers. The survival rate after transplants is not very good, and making it one year post-transplant is a huge milestone. I happy to say that my niece is now 18 months post-transplant and is largely indistinguishable from any other middle-school girl.

Like bone marrow, cord blood is a source of stem cells. Stem cells can also be collected from the peripheral (circulating) blood. Any of these sources can be used for what is generally referred to as a bone marrow transplant. (The more proper medical term is probably stem cell transplant. And for what it's worth, cord blood and stem cells transplants like this have nothing to do with embryonic stem cells.) There are some medical pluses and minuses that factor into the decision to use one source of stem cells over another, but many patients like my niece don't have the luxury of a choice. One of the great values of cord blood is that the cells are so naive (in that they haven't been exposed to invaders like bacteria and viruses) that a greater mis-match between the donor and patient can be tolerated.

I don't know much about banking cord blood for personal use. The odds of a child actually needing a transplant are very small, and as Professor Bernstein knows, private storage is pretty expensive. Peace of mind is very valuable thing, though, so some parents may view private banking as a real bargain. For those who aren't interested in private banking, I urge you to consider donating your baby's cord blood. Unfortunately, this isn't as easy as it should be. There aren't that many public cord blood banks, and not all hospitals collect cord blood. But the list of hospitals is growing all the time. Information is available from marrow.org, the National Marrow Donor Program's site, and what seems to be more current information is available at the Parent's Guide to Cord Blood Foundation's website [parentsguidecordblood.org]. (In case Professor Bernstein is thinking about donating, the Parents Guide site lists a couple of hospitals in the DC area that collect cord blood--Inova Hospital in Fairfax and Washington Hospital Center.) According to the Parents Guide site, Cryobanks International now has a public bank and can accept donations by mail from any hospital. There may be a small charge for the initial collection, but I don't think Cryobanks charges storage fees for donated cord blood.

OK, I'm off my soapbox now. I sincerely thank Professor Bernstein for raising this issue, and I apologize for inflicting my family's story on the Conspiracy readership.
4.22.2008 2:05pm
DavidBernstein (mail):
The hospital we're delivering at doesn't collect cord blood donations, and Cyrobanks, which collects everywhere, requires notification by 34 weeks. We're beyond that. Donation sounds like a very good idea, and if we had our act together in time, we'd have done it.
4.22.2008 2:36pm
Jeff S. (mail):
All 3 of my kids' cordblood is banked with Cryo-cell.
4.24.2008 2:40pm