Newborn Umbilical Cord and Placental Blood

General | September 27, 2017 | Author: Naturopath

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Newborn Umbilical Cord and Placental Blood

Blood is essential to the very survival and overall health of humans as its function is to deliver vital substances like nutrients and oxygen to the cells of the body. Blood also carries metabolic waste products away from those same bodily cells. Without adequate, healthy blood in the body, people may develop diseases and disorders such as blood cancers and various forms of anemia.

Sometimes, to treat these diseases, umbilical cord and placental blood (or simply, cord blood) is used similarly to the way in which hematopoietic stem cell transplantation (HSCT) is used to re-form bone marrow after radiation treatment for different types of blood cancers and treatment of some forms of anemia.

What is Cord Blood?

What is Cord Blood?The placenta is the tissue structure that attaches a fetus to the uterine wall to allow for nutrient absorption, temperature-regulation, waste elimination, and gas exchange through the mother's blood supply. 

This makes it possible for the fetus to fight against infections in the womb and also to produce the hormones which are vital for pregnancy.  

The umbilical cord serves as the channel between the fetus and the placenta. It has two arteries and one vein hidden within a substance known as Wharton's jelly. The umbilical vein transports oxygenated, nutrient-rich blood directly from the placenta to the fetus.

Umbilical cord blood is the blood that remains in the placenta and the attached umbilical cord after birth.

What Is Cord Blood Used For?

Cord blood is collected and stored because it is rich in stem cells, which are used to treat hematopoietic and genetic disorders. To date, it has been used to treat over 80 different diseases.What Is Cord Blood Used For?

The most commonly treated disease category has been leukemia. Inherited diseases of red blood cells, the immune system and certain metabolic abnormalities are the next largest group of diseases treated with cord blood. There have also been successful cord blood transplantation treatments of patients with lymphoma, myelodysplasia and severe aplastic anemia.

How are candidates for Cord Blood transplantation chosen and who qualifies?

Bone Marrow (BM) that is surgically harvested from the posterior iliac crests had been used as the source of HSC for transplantation. It was only in the 1990s that the two alternative HSC options became available; G-CSF-mobilized PBSCs and Cord Blood. Although there are numerous differences between the three HSC sources, clinical results after HSCT seem to be quite similar.

 Ultimately, the choice of the different stem cell sources depends on factors including:

  • age of the donor and the recipient
  • clinical co-morbidities
  • disease stage
  • preferences of different centers and donors

What are the advantages of cord blood?

Cord blood has numerous advantages to donors and transplant recipients in comparison with other stem cell source alternatives.

What are the advantages of cord blood?Easy collection and no medical risk to newborn infant or the mother
The procedures for cord blood collection are as safe as they are simple.

Cord blood is collected only from a delivered placenta and not in-utero, which means that collection of cord blood does not interfere with the medical care or needs of the mother or newborn infant.

 

Cord blood collected is easily accessible
The donation of cord blood is done in advance for and prepared for future use.  Required standard testing is completed and the approved units are stored frozen and ready for clinical use. Should a match be indentified, these units may be reserved immediately. HLA typing and all other required special testing is completed typically within 5 days.

Cord blood is a far easier and more accessible option compared to bone marrow, for example, wherein there is the need for the time-consuming task of locating a possible donor, and only then to determine whether they are willing and able to donate.

Cord blood transplants matching is flexible
Over the years, studies have proven that cord blood transplantation can be performed even if the donor and the recipient are only partially matched,  unlike bone marrow grafts which, in most cases,  strictly require 8/8 matching. Partial matching increases patients’ chances of finding suitable donors.

Cord blood transplants are associated with lower incidence of GvHD.
The immune cells contained in cord blood seem, according to studies, to decrease the potential for developing Graft vs. Host Disease (the attack of the patient's own tissues from donor’s cells). This is in comparison to the alternative of bone marrow from unrelated donors.

Cord Blood Transplants are associated with lower risk of viral infections.
The probability of transmitting common viruses such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), which are potentially lethal infections, is also significantly reduced with cord blood transplant.

Collection and Storage of Umbilical Cord blood

Cord blood, as with whole blood, contains red blood cells, white blood cells, plasma, platelets and is very rich in hematopoietic stem cells.

There are currently various methods for collecting cord blood, of which the most commonly used in clinical practice, is the "closed technique".  The closed technique is comparable to normal blood collection techniques.

In the closed technique method, the technician uses a needle that is connected to a blood bag and cannulates the umbilical vein of the severed umbilical cord.  This will cause the cord blood to flow through the needle into the attached bag. The closed technique allows for collection of an average of 75 ml of cord blood.

The cord blood that is collected is cryopreserved (frozen).  It is then further stored in a cord blood bank until it is used in transplantation. Cord blood collection is normally depleted of the red blood cells before freezing to facilitate the highest possible rate of stem cell recovery.

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References

  1. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med (2006) 354:1813–26.10.1056/NEJMra052638 [PubMed] [Cross Ref]
  2. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood (2013) 122:491–8.10.1182/blood-2013-02-453175 [PMC free article] [PubMed][Cross Ref]
  3. Gluckman E, Broxmeyer HA, Auerbach AD, Friedman HS, Douglas GW, 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) 321:1174–8.10.1056/NEJM198910263211707 [PubMed][Cross Ref]
  4. Laughlin MJ, Barker J, Bambach B, Koc ON, Rizzieri DA, Wagner JE, et al. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. N Engl J Med(2001) 344:1815–22.10.1056/NEJM200106143442402 [PubMed] [Cross Ref]
  5. Milano F, Boelens JJ. Stem cell comparison: what can we learn clinically from unrelated cord blood transplantation as an alternative stem cell source? Cytotherapy (2015) 17:695–701.10.1016/j.jcyt.2015.03.003 [PubMed] [Cross Ref]
  6. JOHN E. WAGNER, HAL E. BROXMEYER, and SCOTT COOPER. Journal of Hematotherapy. May 2009, 1(2): 167-173.https://doi.org/10.1089/scd.1.1992.1.167
  7. Avery S, Shi W, Lubin M, Gonzales AM, Heller G, Castro-Malaspina H, et al. Influence of infused cell dose and HLA match on engraftment after double-unit cord blood allografts. Blood (2011) 117:3277–85.10.1182/blood-2010-08-300491 [PMC free article] [PubMed] [Cross Ref]
  8. Rocha V, Gluckman E. Improving outcomes of cord blood transplantation: HLA matching, cell dose and other graft- and transplantation-related factors. Br J Haematol (2009) 147:262–74.10.1111/j.1365-2141.2009.07883.x [PubMed] [Cross Ref]
  9. Laughlin MJ, Eapen M, Rubinstein P, Wagner JE, Zhang MJ, Champlin RE, et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med(2004) 351:2265–75.10.1056/NEJMoa041276 [PubMed] [Cross Ref]
  10. Rocha V, Labopin M, Sanz G, Arcese W, Schwerdtfeger R, Bosi A, et al. Transplants of umbilical-cord blood or bone marrow from unrelated donors in adults with acute leukemia. N Engl J Med (2004) 351:2276–85.10.1056/NEJMoa041469 [PubMed] [Cross Ref]

 

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