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Umbilical Cord Blood: Counselling, Collection, and Banking

      Abstract

      Objective

      To review current evidence regarding umbilical cord blood counselling, collection, and banking and to provide guidelines for Canadian health care professionals regarding patient education, informed consent, procedural aspects, and options for cord blood banking in Canada

      Options

      Selective or routine collection and banking of umbilical cord blood for future stem cell transplantation for autologous (self) or allogeneic (related or unrelated) treatment of malignant and nonmalignant disorders in children and adults Cord blood can be collected using in utero or ex utero techniques.

      Outcomes

      Umbilical cord blood counselling, collection, and banking, education of health care professionals, indications for cord blood collection, shortand long-term risk and benefits, maternal and perinatal morbidity, parental satisfaction, and health care costs

      Evidence

      Published literature was retrieved through searches of Medline and PubMed beginning in September 2013 using appropriate controlled MeSH vocabulary (fetal blood, pregnancy, transplantation, ethics) and key words (umbilical cord blood, banking, collection, pregnancy, transplantation, ethics, public, private). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials Searches were updated on a regular basis and incorporated in the guideline to September 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies.

      Values

      The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).

      Benefits, Harms, and Costs

      Umbilical cord blood is a readily available source of hematopoetic stem cells used with increasing frequency as an alternative to bone marrow or peripheral stem cell transplantation to treat malignant and non-malignant conditions in children and adults There is minimal harm to the mother or newborn provided that priority is given to maternal/newborn safety during childbirth management. Recipients of umbilical cord stem cells may experience graft-versus-host disease, transfer of infection or genetic abnormalities, or therapeutic failure The financial burden on the health system for public cord blood banking and on families for private cord blood banking is considerable.

      Key Words

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      REFERENCES

        • Gluckman E.
        • Broxmeyer H.A.
        • Auerbach A.D.
        • Friedman H.S.
        • Douglas G.W.
        • Devergie A.
        • et al.
        Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilical-cord blood from an HLA-identical sibling.
        N Engl J Med. 1989; 321: 1174-1178
      1. Bone Marrow Donors Worldwide. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.bmdw.org. Accessed on January 20, 2015.

        • Gratwohl A.
        • Baldomero H.
        • Passweg J.
        Hematopoietic stem cell transplantation activity in Europe.
        Curr Opin Hematol. 2013; 20: 485-493
        • Cohen Y.
        • Nagler A.
        Umbilical cord blood transplantation—how, when and for whom?.
        Blood Rev. 2004; 18: 167-179
        • Martin P.L.
        • Carter S.L.
        • Kernan N.A.
        Results of the Cord Blood Transplantation Study (COBLT): outcomes of unrelated donor umbilical cord blood transplantation in pediatric patients with lysosomal and peroxisomal storage diseases.
        Biol Blood Marrow Transplant. 2006; 12: 184-194
        • Rocha V.
        • Labopin M.
        • Sanz G.
        • Arcese W.
        • Schwerdtfeger R.
        • Bosi A.
        • et al.
        Acute Leukemia Working Party of European Blood and Marrow Transplant Group; Eurocord-Netcord Registry. Transplants of umbilical cord blood or bone marrow from unrelated donors in adults with acute leukemia.
        N Engl J Med. 2004; 351: 2276-2285
        • Allan D.S.
        • Takach S.
        • Smith S.
        • Goldman M.
        Impact of declining fertility rates on donor options in blood and marrow transplantation.
        Biol Blood Marrow Transplant:. 2009; 15: 1634-1637
      2. World Marrow Donor Association. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.wmda.info. Accessed on May 27, 2015.

      3. Canadian Blood Services. One Match Stem Cell and Marrow Network. Ottawa (ON): Canadian Blood Services; 2015. Available at: https://wwwblood.ca/en/stem-cells?utm_source=onematch&utm_medium=redirect&utm_campaign=onematch. Accessed on September 14, 2014.

      4. Héma-Québec. Saint-Laurent (QC): Héma-Quebec; 2015. Available at: http://www.hema-quebec.qc.ca. Accessed on May 27, 2015.

        • Barker J.N.
        • Scaradavou A.
        • Stevens C.E.
        Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies.
        Blood. 2010; 115: 1843-1849
        • Wagner J.E.
        • Barker J.N.
        • DeFor T.E.
        • Baker K.S.
        • Blazar B.R.
        • Eide C.
        • et al.
        Transplantation of unrelated donor umbilical cord blood in 102 patients with malignant and nonmalignant diseases: influence of CD34 cell dose and HLA disparity on treatment-related mortality and survival.
        Blood. 2002; 100: 1611-1618
        • Caillat-Zucman S.
        • Le Deist F.
        • Haddad E.
        • Gannagé M.
        • Dal Cortivo L.
        • Jabado N.
        • et al.
        Impact of HLA matching on outcome of hematopoietic stem cell transplantation in children with inherited diseases: a single-center comparative analysis of genoidentical, haploidentical or unrelated donors.
        Bone Marrow Transplant. 2004; 33: 1089-1095
        • Jaime-Perez J.C.
        • Monreal-Robles
        • Rodriguez-Romo L.N.
        • Herrera-Garza J.L.
        Evaluation of volume and total nucleated cell count as cord blood selection parameters.
        Am J Clin Path. 2011; 136: 721-726
        • Gluckman E.
        • Rocha V.
        • Arcese W.
        • Michel G.
        • Sanz G.
        • Chan K.W.
        • et al.
        Factors associated with outcomes of unrelated cord blood transplant: guidelines for donor choice.
        Exp Hematol. 2004; 32: 397-407
        • Brunstein C.G.
        • Fuchs E.J.
        • Carter S.L.
        • Karanes C.
        • Costa L.J.
        • Wu J.
        • et al.
        Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts.
        Blood. 2011; 118: 282-288
        • Ballen K.K.
        • Spitzer T.R.
        • Yeap B.Y.
        • McAfee S.
        • Dey B.R.
        • Attar E.
        • et al.
        Double unrelated reduced-intensity umbilical cord blood transplantation in adults.
        Biol Blood Marrow Transplant. 2007; 13: 82-89
        • Bart T.
        • Boo M.
        • Balabanova S.
        • Fischer Y.
        • Nicoloso G.
        • Foeken L.
        • et al.
        Impact of selection of cord blood units from the United States and Swiss registries on the cost of banking operations.
        Transf Med Hemother. 2013; 40: 14-20
        • Broxmeyer H.E.
        • Farag S.
        Background and future considerations for human cord blood hematopoietic cell transplantation, including economic concerns.
        Stem Cells Dev. 2013; 22: 103-110
        • Brown N.
        • Machin L.
        • McLeod D.
        Immunitary bioeconomy: the economisation of life in the international cord blood market.
        Soc Sci Med. 2011; 72: 1115-1122
        • Gluckman E.
        • Ruggeri A.
        • Rocha V.
        • Baudoux E.
        • Boo M.
        • Kurtzberg J.
        • et al.
        Family-directed umbilical cord blood banking.
        Haematologica. 2011; 96: 1700-1707
        • Hyun I.
        Therapeutic hope, spiritual distress, and the problem of stem cell tourism.
        Cell Stem Cell. 2013; 12: 505-507
      5. Health Canada. Guidance document for cell, tissue, and organ establishments safety of human cells, tissues and organs for transplantation. Adopted with minor revisions 08/26/2013. Ottawa (ON): Health Canada; 2013. Available at: http://www.hc-sc.gc.ca/dhp-mps/brgtherap/reg-init/cell/cto_gd_ld-eng.php. Accessed on September 14, 2014.

      6. American Association of Blood Banks. Standards for hematopoietic progenitor cell services. Bethesda (MD): AABB; 2015. Available at: http://wwwaabb.org/Search/Pages/results.aspx?k=Standards%20for%20hematopoietic%20progenitor%20cell%20services. Accessed on September 14, 2015.

      7. Foundation for the Accreditation of Cellular Therapy (FACT). Omaha (NE): FACT; 2015. Available at: http://www.factwebsite.org. Accessed on May 27, 2015.

        • Eapen M.
        Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukemia: a comparison study.
        Lancet. 2007; 369: 1947-1954
        • Gluckman E.
        • Rocha V.
        • Boyer-Chammard A.
        • Locatelli F.
        • Arcese W.
        • Pasquini R.
        • et al.
        Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and Marrow Transplantation Group.
        N Engl J Med. 1997; 337: 373-381
        • Bizzetto R.
        • Bonfim C.
        • Rocha V.
        Outcomes after related and unrelated umbilical cord blood transplantation for heredity bone marrow failure syndromes other than Fanconi anemia.
        Haematologica. 2011; 96: 134-141
        • Iafolla M.A.J.
        • Tay J.
        • Allan D.S.
        Transplantation of umbilical cord blood-derived cells for novel indications in regenerative or immunomodulatory therapy: a scoping review of clinical studies.
        Biol Blood Marrow Transplant. 2014; 20: 20-25
        • Nietfeld J.J.
        • Harris D.T.
        Cost-effectiveness of private umbilical cord blood banking.
        Obstet Gynecol. 2010; 115: 1090
        • Sun J.
        • Allison J.
        • McLaughlin C.
        • Sledge L.
        • Waters-Pick B.
        • Wease S.
        • et al.
        Differences in quality between privately and publicly banked umbilical cord blood units: a pilot study of autologous cord blood infusion in children with acquired neurologic disorders.
        Transfusion. 2010; 50: 1980-1987
        • Fernandez C.V.
        • Gordon K.
        • Van den Hof M.
        • Taweel S.
        • Baylis F.
        Knowledge and attitudes of pregnant women with regard to collection, testing and banking of cord blood stem cells.
        CMAJ. 2003; 168: 695-698
        • Perlow J.H.
        Patients’ knowledge of umbilical cord blood banking.
        J Reprod Med. 2006; 51: 642-648
        • Kharaboyan L.
        • Knoppers B.M.
        • Avard D.
        • Nisker J.
        Understanding umbilical cord blood banking: what women need to know before deciding.
        Womens Health Issues. 2007; 17: 277-280
        • Fox N.S.
        • Stevens C.
        • Ciubotariu R.
        • Rubinstein P.
        • McCullough L.B.
        • Chervenak F.A.
        Umbilical cord blood collection: do patients really understand?.
        J Perinat Med. 2007; 35: 314-321
        • Katz G.
        • Mills A.
        • Garcia J.
        • Hooper K.
        • McGuckm C.
        • Platz A.
        • et al.
        Banking cord blood stem cells: attitude and knowledge of pregnant women in five European countries.
        Transfusion. 2011; 51: 578-586
        • Dinç H.
        • Sahin N.H.
        Pregnant women’s knowledge and attitudes about stem cells and cord blood banking.
        Int Nurs Rev. 2009; 56: 250-256
        • Walker T.
        • Steckler D.
        • Spellman S.
        • Haven D.
        • Welte K.
        • Boo M.
        Awareness and acceptance of public cord blood banking among practicing obstetricians in the United States.
        Transfusion. 2012; 52: 787-793
        • Porter M.
        • Kerridge I.H.
        • Jordens C.F.
        “Good mothering” or “good citizenship”?.
        J Bioeth Inq. 2012; 9: 41-47
        • Herlihy M.M.
        • Delpapa E.H.
        Obstetricians and their role in cord blood banking: promoting a public model.
        Obstet Gynecol. 2013; 121: 851-855
        • Smith F.O.
        • Thomson B.G.
        Umbilical cord blood collection, banking, and transplantation: current status and issues relevant to perinatal caregivers.
        Birth. 2000; 27: 127-135
        • American College of Obstetricians and Gynecologists, Committee on Obstetric Practice
        Committee on Genetics. ACOG Committee Opinion No. 399. Umbilical cord blood banking.
        Obstet Gynecol. 2008; 111: 475-477
        • Lubin B.H.
        • Shearer W.T.
        American Academy of Pediatrics Section on Hematology/Oncology; American Academy of Pediatrics Section on Allergy/Immunology. Cord blood banking for potential future transplantation.
        Pediatrics. 2007; 119: 165-170
      8. Royal College of Obstetricians & Gynaecologists. Umbilical Cord Blood Banking Scientific Impact Paper No. 2. Revised June 2006. London (GB): RCOG; 2006. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_2.pdf. Accessed on May 27, 2015.

        • New Zealand College of Midwives
        Christchurch (NZ): New Zealand College of Midwives; 2013.
        Available at: http://www.midwife.org.nz/quality-practice/nzcom-consensus-statements. 2013; (Consensus statement: umbilical cord blood banking. Ratified at the NZCOM Annual General Meeting on August 14)
        • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
        Victoria (AU): The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2015.
        Available at: https://www.ranzcog.edu.au/college-statements-guidelines.html#obstetrics. March 2016; (College Statement C-Obs 18. Umbilical cord blood banking. Endorsed: February 2003, Current: May 2013, Review)
        • Perlow J.H.
        Umbilical cord blood banking options and the prenatal patient: an obstetrician’s perspective.
        Stem Cell Rev. 2006; 2: 127-132
        • Moise Jr., K.J.
        Umbilical cord stem cells.
        Obstet Gynecol. 2005; 106: 1393-1407
        • Sugarman J.
        • Kurtzberg J.
        • Box T.L.
        • Horner R.D.
        Optimization of informed consent for umbilical cord blood banking.
        Am J Obstet Gynecol. 2002; 187: 1642-1646
        • Broder S.M.
        • Ponsaran R.S.
        • Goldenberg A.J.
        US public cord blood banking practices: recruitment, donation, and the timing of consent.
        Transfusion. 2013; 53: 679-687
        • Vawter D.E.
        • Rogers-Chrysler G.
        • Clay M.
        • Pittelko L.
        • Therkelsen D.
        • Kim D.
        • et al.
        A phased consent policy for cord blood donation.
        Transfusion. 2002; 42: 1268-1274
        • Petrini C.
        • Farisco M.
        Informed consent for cord blood donation. A theoretical and empirical study.
        Blood Transfus. 2011; 9: 292-300
        • Solves P.
        • Moraga R.
        • Saucedo E.
        • Perales A.
        • Soler M.A.
        • Larrea L.
        • et al.
        Comparison between two strategies for umbilical cord blood collection.
        Bone Marrow Transplant. 2003; 31: 269-273
        • Skoric D.
        • Balint B.
        • Petakov M.
        • Sindjic M.
        • Rodic P.
        Collection strategies and cryopreservation of umbilical cord blood.
        Transfus Med. 2007; 17: 107-113
        • Omori A.
        • Manabe M.
        • Kudo K.
        • Tanaka K.
        • Takahashi K.
        • Kashiwakura I.
        Influence of obstetric factors on the yield of mononuclear cells, CD34+ cell count and volume of placental/umbilical cord blood.
        J Obstet Gynaecol Res. 2010; 36: 52-57
        • Mancinelli F.
        • Tamburini A.
        • Spagnoli A.
        • Malerba C.
        • Suppo G.
        • Lasorella R.
        • et al.
        Optimizing umbilical cord blood collection: impact of obstetric factors versus quality of cord blood units.
        Transplant Proc. 2006; 38: 1174-1176
        • Surbek D.V.
        • Schonfeld B.
        • Tichelli A.
        • Gratwohl A.
        • Holzgreve W.
        Optimizing cord blood mononuclear cell yield: a randomized comparison of collection before vs after placenta delivery.
        Bone Marrow Transplant. 1998; 22: 311-312
        • Wong A.
        • Yuen P.M.
        • Li K.
        • Yu A.L.
        • Tsoi W.C.
        Cord blood collection before and after placental delivery: levels of nucleated cells, haematopoietic progenitor cells, leukocyte subpopulations and macroscopic clots.
        Bone Marrow Transplant. 2001; 27: 133-138
        • Armson B.A.
        Society of Obstetricians and Gynaecologists of Canada Maternal/Fetal Medicine Committee. Umbilical cord blood banking: implications for perinatal care providers. SOGCV Clinical Practice Guidelines, No 156, March 2005.
        J Obstet Gynaecol Can. 2005; 27: 263-290
        • Jones J.
        • Stevens C.E.
        • Rubinstein P.
        • Robertazzi R.R.
        • Kerr A.
        • Cabbad M.F.
        Obstetric predictors of placental/umbilical cord blood volume for transplantation.
        Am J Obstet Gynecol. 2003; 188: 503-509
        • Surbek D.V.
        • Visca E.
        • Steinmann C.
        • Tichelli A.
        • Schatt S.
        • Hahn S.
        • et al.
        Umbilical cord blood collection before placental delivery during cesarean delivery increases cord blood volume and nucleated cell number available for transplantation.
        Am J Obstet Gynecol. 2000; 183: 218-221
        • Sparrow R.L.
        • Cauchi J.A.
        • Ramadi L.T.
        • Waugh C.M.
        • Kirkland M.A.
        Influence of mode of birth and collection on WBC yields of umbilical cord blood units.
        Transfusion. 2002; 42: 210-215
        • Manegold G.
        • Meyer-Monard S.
        • Tichelli A.
        • Pauli D.
        • Holzgreve W.
        • Troeger C.
        Cesarean section due to fetal distress increases the number of stem cells in umbilical cord blood.
        Transfusion. 2008; 48: 871-876
        • Picardi A.
        • Tamburini A.
        • Caravita T.
        • De Angelis C.
        • Ballatore G.
        • Spagnoli A.
        • et al.
        Diagnosis of acute foetal distress does not preclude banking of umbilical cord blood units.
        Transfus Med. 2006; 16: 349-354
        • Harris D.T.
        Collection, processing, and banking of umbilical cord blood stem cells for clinical use in transplantation and regenerative medicine.
        Lab Med. 2008; 39: 173-178
        • Lasky L.C.
        • Lane T.A.
        • Miller J.P.
        • Lindgren B.
        • Patterson H.A.
        • Haley N.R.
        • et al.
        In utero or ex utero cord blood collection: which is better?.
        Transfusion. 2002; 42: 1261-1267
        • Ballen K.K.
        • Gluckman E.
        • Broxmeyer H.E.
        Umbilical cord blood transplantation: the first 25 years and beyond.
        Blood. 2013; 122: 491-498
        • Rabe H.
        • Diaz-Rossello J.L.
        • Duley L.
        • Dowswell T.
        Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.
        Cochrane Database Syst Rev. 2012; 8: CD003248
        • Mercer J.S.
        • Vohr B.R.
        • Erickson-Owens D.A.
        • Padbury J.F.
        • Oh W.
        Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping.
        J Perinatol. 2010; 30 (22): 11-16
        • McDonald S.J.
        • Middleton P.
        • Dowswell T.
        • Morris P.S.
        Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.
        Cochrane Database Syst Rev. 2013; 7: CD004074
        • Garofalo M.
        • Abenhaim H.A.
        Early versus delayed cord clamping in term and preterm births: a review.
        J Obstet Gynaecol Can. 2012; 34: 525-531
        • American College of Obstetricians and Gynecologists, Committee on Obstetric Practice
        Committee Opinion No. 543. Timing of umbilical cord clamping after birth.
        Obstet Gynecol. 2012; 12: 1522-1526
        • Grisaru D.
        • Deutsch V.
        • Pick M.
        • Fait G.
        • Lessing J.B.
        • Dollberg S.
        • et al.
        Placing the newborn on the maternal abdomen after delivery increases the volume and CD34 cell content in the umbilical cord blood collected: an old maneuver with new applications.
        Am J Obstet Gynecol. 1999; 180: 1240-1243
        • Hutton E.K.
        • Hassan E.S.
        Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.
        JAMA. 2007; 297: 1241-1252
        • Andersson O.
        • Domellof M.
        • Andersson D.
        • Hellstrom-Westas L.
        Effects of delayed cord clamping on iron status and neurodevelopment at age 12 months: a randomised trial.
        JAMA Pediatr. 2014; 168: 547-554
      9. World Health Organization. Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants. Geneva (CH): WHO; 2015. Available at: http://www.who.int/elena/titles/cord_clamping/en. Accessed on May 27, 2015.

      10. U.S. National Institutes of Health. ClinicalTrials.gov. NCT00593242, NCT01072370, NCT01147653, NCT01193660, NCT01506258, NCT01528436, NCT01601158, NCT01649648. Bethesda (MD): U.S. National Library of Medicine; 2015. Available at: http://www.clinicaltrials.gov. Accessed on May 27, 2015.

        • Woolf S.H.
        • Battista R.N.
        • Angerson G.M.
        • Logan A.G.
        • Eel W.
        • Canadian Task Force on Preventive Health Care
        New grades for recommendations from the Canad ian Task Force on Preventive Health Care.
        CMAJ. 2003; 169: 207-208