This might be something u guys wanna read.. appeared on Sat's ST by senior writer Andy Ho.
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Go public when banking cord blood
AT A recent wedding reception, I met some women who spoke favourably of banking umbilical cord blood.
Why throw away the blood-making stem cells in cord blood which could save one's own kid if he ever developed blood malignancies or other diseases?
Hopefully, private banks don't target expectant mothers at what is an emotionally vulnerable time. The worry is not cost alone. Instead, mothers may also be disinformed that cord blood collection is totally harmless.
Unfortunately, this is a misconception. Stem cells in cord blood can transform into blood and immune cells. But, unlike embryonic stem cells, they cannot become other types of cells.
The women were unanimous that private banks to keep cord blood were preferable to public ones. If donated to Singapore's only public cord blood bank, it could be made available to anyone who needs it.
Last year, both private banks for cord blood here registered their first 10,000th customer. However, most associations of obstetricians and paediatricians in the United States, Canada and Australia, as well as the European Union's Group on Ethics and New Technologies, urge expectant mothers to donate cord blood to public banks.
Public banks promote the use of cord blood from unrelated people. Counter-intuitively, this is better than relying on private banks because most of the conditions that cord blood stem cells may cure a baby of later in life would already be present in its cord blood too.
For example, if a child develops leukaemia and receives his own cord blood, there might be pre-leukaemic cells in the cord blood. Since his own immune system is unable to suppress leukaemia in the first place, the immune cells in his cord blood would be unlikely to do so as well. However, the immune cells in someone else's cord blood might.
The likelihood that a child can use his own cord blood in the future is extremely remote. A 2008 review suggests that, in the first 20 years of life, that chance ranges from 0.0005 per cent (or 1 in 200,000) to 0.04 per cent (or 1 in 2,500). At any rate, this is much less than the 1 in 400 chance some private banks claim.
Any patient who can be helped by cord blood is likely to find succour in some unit stored away in a public bank somewhere in the world. And anyone anywhere in the world can have access to all public cord blood banks globally. Your transplant physician will look for a suitable unit locally and globally through the Singapore Bone Marrow Programme, which also deals with cord blood banks.
Hopefully, private banks don't target expectant mothers at what is an emotionally vulnerable time. The worry is not cost alone, which is currently about $250 annually for 21 years (plus GST). Instead, mothers may also be disinformed that cord blood collection is totally harmless.
Here's why it may not be so. The success of cord blood usage depends on the number of cells available in it. On average, each unit has about 750 million to 900 million cells. To treat leukaemia, say, these would be sufficient for only a 30kg patient. Personal cord blood just won't have enough cells for a child's condition the older he gets. Thus, for 'security' and so that mothers feel they get value for money, some private banks may be tempted to harvest as much cord blood as they can.
The volume of cord blood harvested depends on when the cord is clamped. Clamped too early, the baby can be deprived of a significant amount of blood and might develop anaemia later on. In premature babies, immediate clamping may also cause bleeding in the brain.
Moreover, delivery personnel should be focusing on the mother's safety, not the needs of some private bank. Cord blood is not squeezed out of some discarded placenta, as is popularly imagined. In fact, if harvesting is done after the placenta is delivered, the volume of cord blood that can be extracted is much less.
In practice, therefore, to maximise the volume collected, cord blood tends to be extracted after the baby is delivered but while the placenta is still within the womb. However, this period is the most dangerous part of labour. Fatal bleeding can happen at this time if the placenta is not delivered properly.
In fact, in 2006, the Royal College of Obstetricians and Gynaecologists in Britain advised that cord blood collection, if undertaken, should proceed only after the placenta is delivered (so it is outside the mother's womb). At that point, bank staff - rather than labour room staff with duty of care to mother and baby - should do the extraction itself.
Labour rooms should heed this piece of advice and not prioritise cord blood collection over maternal safety during this risky period. And labour room staff with financial interests in private banks should disclose such information to pregnant mothers who sign up.
By contrast, cord blood collection by public banks does not face the volume constraint. Since cord blood of the same ABO group can be pooled together, public banks tend to harvest only as much as they can do so safely - and no more.
Another piece of misinformation concerns how long cord blood can be successfully stored. In February, the American College of Obstetricians and Gynaecologists recommended that doctors tell mothers that no one knows the answer to this question. Private banks tend to assert that it can be banked in liquid nitrogen indefinitely. Even so, can it be used successfully decades hence?
Public banks serve not only therapy but also research. In contrast, private banking leads to inferior service for everyone worldwide: A privately banked unit of cord blood is a unit taken out of the global pool of cord blood.
France's National Consultative Committee on Ethics has denounced for-profit cord blood banking. Italy banned it in 2003 while the American Academy of Paediatrics also opposes it.
There is one situation where private banking may be worthwhile. This is where the family has an older child or a parent with a condition that could potentially benefit from a child's cord blood.
This exception apart, expectant mothers should support the public Singapore Cord Blood Bank.