Abstract
Objective
Options
Outcomes
Evidence
Values
Benefits, Harms, and Costs
Key Words
Abbreviations
AABBRecommendations
- 1.Health care professionals should be well-informed about cord blood collection and storage and about factors that influence the volume, quality, and ability to collect a cord blood unit. (III-A)
- 2.Health care professionals caring for women and families who choose private umbilical cord blood banking must disclose any financial interests or potential conflicts of interest. (III-A)
- 3.Pregnant women should be provided with unbiased information about umbilical cord blood banking options, including the benefits and limitations of public and private banks. (III-A)
- 4.Health care professionals should obtain consent from mothers for the collection of umbilical cord blood prior to the onset of active labour, ideally during the third trimester, with ample time to address any questions. (III-A)Table 1.Key to evidence statements and grading of recommendations, using the ranking of the Canadian Task Force on Preventive Health Care
Quality of evidence assessment Classification of recommendations I: Evidence obtained from at least one properly randomized controlled trial
II-1: Evidence from well-designed controlled trials without randomization
II-2: Evidence from well-designed cohort (prospective or retrospective) or case–control studies, preferably from more than one centre or research group
II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committeesA. There is good evidence to recommend the clinical preventive action
B. There is fair evidence to recommend the clinical preventive action
C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making
D. There is fair evidence to recommend against the clinical preventive action
E. There is good evidence to recommend against the clinical preventive action
L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making*The quality of evidence reported in these guidelines has been adapted from The Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.78.†Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.78. - 5.Health care professionals must be trained in standardized procedures (ex utero and in utero techniques) for cord blood collection to ensure the sterility and quality of the collected unit. (II-2A)
- 6.Umbilical cord blood should be collected with the goal of maximizing the content of hematopoietic progenitors through the volume collected The decision to bank the unit will depend upon specific measures of graft potency. (II-2A)
- 7.Umbilical cord blood collection must not adversely affect the health of the mother or newborn Cord blood collection should not interfere with delayed cord clamping. (III-E)
- 8.Health care professionals should inform pregnant women and their partners of the benefits of delayed cord clamping and of its impact on cord blood collection and banking. (II-2A)
- 9.Cord blood units collected for public or private banking can be used for biomedical research, provided consent is obtained, when units cannot be banked or when consent for banking is withdrawn. (II-3B)
- 10.Mothers may be approached to donate cells for biomedical research Informed consent for research using cord blood should ideally be obtained prior to the onset of active labour or elective Caesarean section following established research ethics guidelines. (II-2A)
INTRODUCTION
Bone Marrow Donors Worldwide. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.bmdw.org. Accessed on January 20, 2015.
Hematopoietic Stem Cell Transplantation
- Rocha V.
- Labopin M.
- Sanz G.
- Arcese W.
- Schwerdtfeger R.
- Bosi A.
- et al.
Bone Marrow Donors Worldwide. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.bmdw.org. Accessed on January 20, 2015.
World Marrow Donor Association. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.wmda.info. Accessed on May 27, 2015.
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.
Héma-Québec. Saint-Laurent (QC): Héma-Quebec; 2015. Available at: http://www.hema-quebec.qc.ca. Accessed on May 27, 2015.
Bone Marrow Donors Worldwide. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.bmdw.org. Accessed on January 20, 2015.
Role of Umbilical Cord Blood
World Marrow Donor Association. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.wmda.info. Accessed on May 27, 2015.
- Wagner J.E.
- Barker J.N.
- DeFor T.E.
- Baker K.S.
- Blazar B.R.
- Eide C.
- et al.
- Caillat-Zucman S.
- Le Deist F.
- Haddad E.
- Gannagé M.
- Dal Cortivo L.
- Jabado N.
- et al.
- Brunstein C.G.
- Fuchs E.J.
- Carter S.L.
- Karanes C.
- Costa L.J.
- Wu J.
- et al.
Indications for Use of Cord Blood from a Family Member
PUBLIC CORD BLOOD BANKING
Considerations Regarding Public Banking
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.
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.
Foundation for the Accreditation of Cellular Therapy (FACT). Omaha (NE): FACT; 2015. Available at: http://www.factwebsite.org. Accessed on May 27, 2015.
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.
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.
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.
PRIVATE CORD BLOOD BANKING
Considerations Regarding Private Banking
COORDINATION OF PRIVATE AND PUBLIC BANKS
World Marrow Donor Association. Leiden (NL): Bone Marrow Donors Worldwide, 2015. Available at: http://www.wmda.info. Accessed on May 27, 2015.
EDUCATION OF PARENTS AND HEALTH CARE PROFESSIONALS
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.
- The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
INFORMED CONSENT
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.
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.
Foundation for the Accreditation of Cellular Therapy (FACT). Omaha (NE): FACT; 2015. Available at: http://www.factwebsite.org. Accessed on May 27, 2015.
UMBILICAL CORD BLOOD COLLECTION
Regulatory Issues and Practice Standards for Collecting and Processing Umbilical Cord Blood
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.
Recommendations
- 5.Health care professionals must be trained in standardized procedures (ex utero and in utero techniques) for cord blood collection to ensure the sterility and quality of the collected unit. (II-2A)
- 6.Umbilical cord blood should be collected with the goal of maximizing the content of hematopoietic progenitors through the volume collected. The decision to bank the unit will depend upon specific measures of graft potency. (II-2A)
- 7.Umbilical cord blood collection must not adversely affect the health of the mother or newborn. Cord blood collection should not interfere with delayed cord clamping. (III-A)
- 8.Health care professionals should inform pregnant women and their partners of the benefits of delayed cord clamping and of its impact on cord blood collection and banking. (II-2A)
Timing of Umbilical Cord Clamping
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.
RESEARCH AND POTENTIAL FUTURE USE OF UMBILICAL CORD BLOOD
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.
Recommendations
- 9.Cord blood units collected for public or private banking can be used for biomedical research, provided consent is obtained, when units cannot be banked or when consent for banking is withdrawn. (II-3B)
- 10.Mothers may be approached to donate cells for biomedical research. Informed consent for research using cord blood should ideally be obtained prior to the onset of active labour or elective Caesarean section following established research ethics guidelines. (II-2A)
CORD BLOOD BANKING IN CANADA
Public Cord Blood Collection in Canada as of 2015
SUMMARY
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Article info
Publication history
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC.
This clinical practice guideline has been prepared by the Cord Blood Banking Working Group, reviewed by the Clinical Practice – Obstetrics, Maternal Fetal Medicine, Family Physician Advisory, and Aboriginal Health Initiative Committees, and approved by the Executive and Board of the Society of Obstetricians and Gynaecologists of Canada.
Disclosure statements have been received from all contributors.