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Volume 6, No. 3, March 2008
Abstract of the Month
Minorities underrepresented in both public and private umbilical cord blood banking
ABSTRACT:
Two types of banks have emerged for the collection and storage of umbilical cord blood—public banks and private banks. Public banks promote allogenic (related or unrelated) donation, analogous to the current collection of whole blood units in the United States. Private banks were initially developed to store stem cells from umbilical cord blood for autologous use (taken from an individual for subsequent use by the same individual) by a child if the child develops disease later in life. If a patient requests information on umbilical cord blood banking, balanced and accurate information regarding the advantages and disadvantages of public versus private banking should be provided. The remote chance of an autologous unit of umbilical cord blood being used for a child or a family member (approximately 1 in 2,700 individuals) should be disclosed. The collection should not alter routine practice for the timing of umbilical cord clamping. Physicians or other professionals who recruit pregnant women and their families for for-profit umbilical cord blood banking should disclose any financial interests or other potential conflicts of interest.
Umbilical Cord Blood Banking. ACOG Committee Opinion No. 399. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;111:475–7.
http://www.ncbi.nlm.nih.gov/pubmed/18238991
OB/GYN CCC Editorial comment:
Providers should give balanced information when discussing cord blood banking
Minorities are a particularly underrepresented in both modalities of banking, especially American Indians and Alaska Natives. This deficiency could have significant implications for our (now) young patients later in their lives. The Indian Health system should cooperate fully with both groups of banking methods.
The MCH Frequently Asked Questions page has long had a discussion of the advantages and disadvantages of AI/AN cord blood banking which includes a template Disclaimer Form.
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/CordStem4206.doc
ACOG recommends providers give balanced information to their pregnant patients who are considering cord blood banking, presenting both the advantages and disadvantages of public vs. private cord blood banks.
ACOG also advises physicians who recruit patients for for-profit cord blood banking to disclose their financial interests or other potential conflicts of interest to pregnant women and their families.
Blood from a newborn's umbilical cord, once considered a waste product that was routinely discarded along with the placenta, is now considered to contain potentially life-saving stem cells. Private banks were initially developed to store cord blood stem cells from newborns, for a fee, for potential future use by the same child or a family member if he/she developed disease later in life. Today, there are public banks that store, for free, stem cells that can be used by anyone needing them similar to how public blood banks work.
"Patients need to be aware that the chances are remote that the stem cells from their baby's banked cord blood will be used to treat that same child—or another family member—in the future," said Anthony R. Gregg, MD, chair of ACOG's Committee on Genetics. ACOG's Committee Opinion is a joint document produced by the Committee on Obstetric Practice and the Committee on Genetics.
Although ACOG takes no position for or against cord blood banking, it recommends that physicians disclose that there is no reliable estimate of a child's likelihood of actually using his or her own saved cord blood later. Some experts estimate this likelihood at 1 in 2,700, while others argue the rate is even lower. Physicians should also disclose to their patients that it is unknown how long cord blood can successfully be stored.
Pregnant women should be aware that stem cells from cord blood cannot currently be used to treat inborn errors of metabolism or other genetic diseases in the same individual from which they were collected because the cord blood would have the same genetic mutation. "Cord blood collected from a newborn that later develops childhood leukemia cannot be used to treat that leukemia for much the same reason," said Dr. Gregg.
Federal legislation was passed in 2005 that provides funding for continued growth of a national cord blood registry in the US. Several states have laws requiring physicians to inform patients about cord blood banking options. Physicians should consult with their state medical association for more information about their individual state laws.
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
