Delayed cord clamping, cord blood banking and cord tissue banking



Cord Blood Banking vs Delayed umbilical cord clamping


Delayed umbilical cord clamping

The advantages of delayed umbilical cord clamping (at least 30-60 seconds after birth) in term babies include:

1. increase the haemoglobin level at birth

2. improve iron stores in the first several months of life, which may have a favourable effect on developmental outcomes


Additional advantages of delayed umbilical cord clamping in preterm babies include:

1. lower rates of necrotizing enterocolitis

2. lower rates of intraventricular haemorrhage

3. lower need for blood transfusion


The main disadvantage is a small increase in the rates of jaundice that requires phototherapy in infants. There is no increase in the risk of postpartum haemorrhage.


Public and private cord blood banking

The blood in the umbilical cord is a rich source of blood stem cells which have been successfully used in the treatment of blood-related cancers (e.g. leukaemia, lymphoma), immune and genetic diseases (e.g. metabolic diseases). Blood stem cells are primitive cells that can differentiate into white and red blood cells, and platelets. An alternative source of these blood stem cells are those obtained from the bone marrow or mobilized peripheral blood.


There are advantages to using umbilical cord blood stem cells as opposed to those from the bone marrow or mobilized peripheral blood: 1. lower risk of graft-vs-host disease 2. tissue typing at banking allows easier search for a match 3. immediate availability when required 4. safe and painless with minimal risk to the mother and baby


Public cord blood banking

1. This is more cost-effective than private cord blood banking. Donation to the public cord blood bank is free.

2. There is, however, a high rate of rejection (up to 70-80%) chiefly due to inadequate cell count. Where the cell count is inadequate for public cord blood banking but adequate for community cord blood banking, parents would be given an option to pay a fee to bank in for potential use by the family.

3. Patients who require the cord blood banking have to pay for the cord blood.


Private cord blood banking

1. This is not as cost-effective as public cord blood banking as the chance of using it is low.

2. The rate of rejection is very low.

3. For many of the established indications for treatment (e.g. leukaemia, lymphoma, genetic diseases), the affected individual would not be able to use his / her own stored cord blood. If there is a relative's blood that matches the individual, the cord blood may be used (if there is adequate cell count).

4. An individual's cord blood can be used for the treatment of autism and cerebral palsy. This is currently performed on an experimental basis.


Private cord tissue banking


There is also stem cells present in the Wharton's jelly of the cord tissue. These mesenchymal stem cells can differentiate into cells of a person's nervous system, sensory organs, circulatory tissues, skin, bone, cartilage and more tissues. Research is expanding very quickly which may allow such cells to be used to treat many other diseases e.g. heart and kidney disease, autoimmune diseases, multiple sclerosis, Alzheimer's disease, Parkinson's disease, wound healing and sport injuries. Treatments with cord tissues are currently still performed on an experimental basis.

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