Umbilical Cord Blood Donation: Implications for the Obstetrician
Umbilical Cord Blood (UCB) Stem Cell - Banking€¦ · Menstrual Blood Stem cells. Umbilical cord...
Transcript of Umbilical Cord Blood (UCB) Stem Cell - Banking€¦ · Menstrual Blood Stem cells. Umbilical cord...
Umbilical Cord Blood (UCB) Stem Cell - Banking
• Our Role?
• Indications?
• After story?
• Which Bank?
• Cost?
• Hype/Hope?
1886: First use of term - Stem cellsWilliam Sedgwick
Sources of stem cells
Menstrual Blood
Stem cells
Umbilical cord blood
Blood, discarded at birth
with cord & placenta,
can be collected without physical risk to
mother or baby donor
Fantabulous repository of
hematopoitic & mesenchymal
stem cells
Umbilical cord blood
Graft-versus-host disease (GVHD) is
10-folds lower than that seen after
transplantation with HLA-matched bone
marrow
Umbilical cord blood
Cord blood contains sufficient numbers of stem cells capable of reconstituting
the entire hematopoitic system of a child
If you want to store…
Can be used for…
Thalassemia
Sickle cell disorders
Hematological malignancies
Other hematological disorders
Immunodeficiency syndromes
Inborn errors of metabolism
Obstet Gynecol 2005;106:1393–1407
Cord Blood Stem Cells are: Multi-potent stem cells
What happens afterwards…
UCB Banking
PrivatePublic
Private Bank
• Private UCB banks which actually conceptualized after public banks, have gained much popularity!
• First Private Bank: 1992 in USA
• Here the service provider is making money (taken as a fee) in real time and does not have to wait years to break even when units are released for therapy
• Not surprisingly, this business model has enabled family banks to propagate much faster than public banks
Private Bank
• 2001: 17 such banks (11 in the USA, 2 in Canada, one each in
Germany, Hong Kong, Korea and Japan)
• 2015: 215 private UCB banks in 54 countries, plus at least 200
marketing affiliates serving over 70 countries
Ballen KK. Umbilical cord blood donation: public or private? Bone marrow transplantation. 2015 Oct
Cost?
•Probability of being used -1 in 2,700 to 1 in 250,000
Many professional organisations and experts have expressed concerns that
potential donors have insufficient understanding of current accepted indications
for, and the likelihood of, UCB use in a private bank setting.
Furthermore, these banks wrongly advertise and overemphasise unproven possible future indications of these banked stem cells.
Given the substantial cost and low
probability of using the product,
currently private banking of UCB is not
recommended for unidentified possible future use.
Public Bank
• In 1991, Dr Pablo Rubinstein - first unrelated
UCB bank at the New York Blood Centre
• Now > 160 public UCB banks worldwide
• With ∼730,000 UCB units available for public use
Exactly like Blood- Banks
Changing Trend of Cell-Transplant
In 40% cases of UCB transplants - donors and recipients
are living in a different country
Eurocord Report (1998-2007)
• 3327 UCB transplants at 373 transplant centers,
in 43 countries
Transplant Number Percentage
Unrelated 2,965 89.10 %
Related 359 10.81 %
Autologous 3 0.09 %
Private Banks advertise, they don’t publish
Quality
CONCLUSION: Quality parameters of privately banked CBUs are inferior
to those stored in public banks.
The quality of autologous units should be held to the same standards as
those stored in public banks.
Public Bank (INDIA)2008
Private versus Public Banks (Reality check)
• Private Bank
• Expensive
• >99.9% chance that you wont need it
• 50% are not usable
• No therapeutic advantage over autologous PBSC
• Regenerative/stem cell therapy is – Experimental
• Enough – only for a 11 year old/36 kg
• UNETHICAL
Our Role ?• Only 26.5% knew UCB
• More awareness of private cord blood banking compared to public banking.
• One-third of the women in our population had undue expectations from banking of the UCB
• More than half of the pregnant women expected their obstetrician to inform them regarding UCB
In a multicentre study involving five European nations (France, Germany, Italy,
Spain, and the UK) - strong preference for public banking (76.5%) among the
pregnant women. (Katz G.2011Transfusion)
Our Role ?
• Obstetricians should play a more active role in explaining the patients regarding pros and cons of UCB banking.
Obstetricians and others health care professionals delivering antenatal care
should take it as a primary responsibility to increase awareness of umbilical
cord blood donation to develop and expand public banking activities.
Herlihy MM, Delpapa EH. Obstetricians and their role in cord blood banking: promoting a public
model. Obstet Gynecol. 2013
When we deliver one life here; don’t forget we can save ‘one more’
somewhere…
A is a centre where blood gathered as a result of blood donation, stored and preserved for later use in blood transfusion.
1492: First Historical Transfusion AttemptThe blood of three 10-year-old boys was infused by mouth into Pope Innocent VIII as he sank into a coma. The Pope and the boys died.
1667: First Recorded Human Transfusion1st fully documented human blood transfusion was administered in France. Blood of a sheep into a 15-year-old boy, who survived.
1818: First Recorded Human-to-Human TransfusionBritish Obstetrician Blundell performs the first recorded human-to-human blood transfusion. He injected a patient suffering from internal bleeding with 12 to 14 ounces of blood from several donors. The patient died after initially showing improvement.
Learning from examples….
Impact of World Wars1914: First Non-Direct Transfusion
1917: First Blood DepotArmy doctor collected/stored type O blood, in advance of the Battle of Cambrai in World War I.
1937: Term "Blood Bank" CoinedDr. Bernard Fantus at Chicago's Cook Co. Hospital coins the term "blood bank."
1922: Blood Donor Service Established Volunteers agree to be on 24-hour call and to travel to local hospitals to give blood as the need arises.
Do we have to wait for another World War to start believing in the power and possibilities of
Public UCB Banks across the nation?
I hope not !!!