Umbilical cord blood for a baby. Saving umbilical cord blood Blood from the umbilical cord

I work in the field of bone marrow transplantation and am often asked about the advisability of cord blood banking. In response, I suggest counting your money and thinking about how to spend it more profitably.

But first, a little about the clinical use of cord blood. Stem cell transplantation is used to restore hematopoiesis after high-dose chemotherapy for blood cancer. However, cord blood has a number of disadvantages that significantly reduce the likelihood of its use.

Firstly, transplantation of one's own cord blood stem cells may not be appropriate for leukemia, since the transplant may already contain cells with mutations that provoke the disease.

Secondly, the number of stem cells that a cord blood sample contains is sufficient for transplantation into a child weighing no more than 10 kg. Thus, if you decide to pay for umbilical cord storage, keep in mind that after 3 years of age, in case of illness, these cells are no longer enough for the child.

It is also necessary to take into account the fact that the incidence of blood cancer in children is 8 per 100,000 children. Considering the low risks of developing this disease and the small number of stem cells in cord blood, the demand for samples from commercial banks is very low.

Thus, according to a report from the European Society for Stem Cell Transplantation, since 2012, the number of stem cell transplants obtained from umbilical cord blood has been decreasing. Umbilical cord blood as a source of stem cells for transplantation has given way to transplantation from an adult donor.


This trend is due to the fact thatIt is quite simple to obtain the required number of stem cells from an adult donor - I talked about this procedure in my blog.

However, cord blood banks continue to increase the volume of cord blood procurement on a commercial basis. The cost of services from these banks is 70,000 - 120,000 rubles for cell procurement and another 5,000 - 7,000 for each year of storage. So, if you really want to insure your child against a serious illness, then for the same money the insurance company will offer you insurance against any critical illness for many years, and not for the first three years of life. In this case, insurance will be able to cover the entire treatment, while umbilical cord blood cell transplantation is only the restoration of hematopoiesis after high-dose chemotherapy, which itself costs several times more than the transplant itself and is applicable only for several rare blood diseases.

Today, if not everyone, then very many have heard about stem cells. The topic is of particular interest to future parents who are on the path to making a decision about saving blood from the umbilical cord of their newborn baby. The health of the child may directly depend on the correctness of their choice.

Let's talk about why cord blood is stored in special banks. In addition, we will consider its characteristics and methods of application.

What is cord blood?

This name is given to the blood that is taken from the baby’s umbilical cord and placenta immediately after birth. Its value lies in the large concentration of stem cells, which have many positive characteristics.

What are stem cells

Cord blood cells are called stem cells. They are the main “building blocks” in the structure of the body’s immune system. In addition, stem cells have such interesting feature, as the possibility of division throughout the entire life cycle. This helps restore any tissue in the body. And stem cells are capable of differentiating into absolutely any other of which there are more than two hundred.

How is cord blood collected?

So how should cord blood be collected? It is immediately worth noting that this procedure is completely painless for both the mother and her newborn baby. Besides this, it does not pose any danger.

Immediately after birth, a needle is inserted into the umbilical vein, through which the blood flows by gravity into a special bag. It already contains liquid that prevents clotting. In total, from 50 to 250 ml of blood comes out, which contains from 3 to 5 percent stem cells.

After the placenta has passed, the obstetrician cuts off approximately 10-20 centimeters of the umbilical cord and places it in a special package.

All biomaterials must be delivered to the laboratory within 4-6 hours. There they are processed, frozen and stored.

Shelf life of stem cells and their use

Saving cord blood is a process that must occur in compliance with all necessary rules and regulations. After all, the “lifetime” of stem cells depends on it.

If stored properly, this period can be tens of years, which is confirmed by the fact that the first blood bank was opened back in 1993. It was from that moment until our time that the first stem cells taken from umbilical cord blood were stored.

There can be no doubt that this biomaterial will be 100% suitable for the child himself in the future. In addition, studies have shown that parents, brothers and sisters can also use the valuable liquid. At the same time, the probability that the blood will be an ideal match is within 25%.

Stem cells in an adult

After reading the information described above, a question may arise: why is it necessary to collect stem cells from a newborn child? Are they really not present in the body of an adult? Of course there is. But!

The main difference is the concentration of stem cells in the blood. With age, their number constantly decreases. The results of the research will help confirm this: in newborns there is 1 stem cell per 10 thousand cells of the body, in adolescence - per 100 thousand, and after 50 years - per 500 thousand. At the same time, not only their quantity decreases, but also their quality. Umbilical cord stem cells are much more active than those obtained from bone marrow. The main reason This is due to their youth.

Why is it necessary to save blood from the umbilical cord?

Modern medicine has advanced far and can do a lot. But there are still some diseases for which a cure has not yet been invented. It is in such cases that the way out of the situation may be the use of umbilical cord blood, or, more precisely, the stem cells contained in it. For example, these could be diseases of the immune system. This also includes cases when restoration or blood is needed, and biomaterial is used for rapid tissue regeneration after extensive burns or wounds.

Even if the baby was born completely healthy, this does not guarantee that he will not need stem cells throughout his life. In addition, they can also be used to treat close relatives. Therefore, even before giving birth, it is worth thinking about the issue of collecting umbilical cord blood to ensure that, if something happens, it is possible to restore the health of not only the child, but also the rest.

Treatment with cord blood

It was mentioned above that umbilical cord blood and the stem cells it contains are a real panacea for getting rid of many serious diseases. But without concrete examples, such words will remain just empty sounds. Therefore, let’s remember some of the most common diseases (although there are more than 80 of them in total), which can be gotten rid of thanks to the use of such biomaterial. For convenience, they will all be divided into interrelated groups.

Blood diseases:

• lymphoma;
• hemoglobinuria;
• refractory and aplastic anemia;
• sickle cell anemia;
• Waldenström;
• paroxysmal nocturnal hemoglobinuria;
• spicy and ;
• Fanconi anemia;
• macroglobulinemia;
• myelodysplasia.

Autoimmune diseases:

• rheumatoid arthritis;
• cerebral palsy;
• spinal cord injury;
• stroke;
• Alzheimer's disease;
• systemic scleroderma;
• diseases of the nervous system;
• Parkinson's disease.

Oncological diseases:

• neuroblastoma;
• cancer (breast, kidney, ovarian, testicular);
• Ewing's sarcoma;
• rhabdomyosarcoma;
• a brain tumor;
• thymoma.

Other congenital and acquired diseases:

• metabolic disorders;
• immunodeficiency;
• diabetes;
• muscular dystrophy;
• cirrhosis of the liver;
• AIDS;
• histiocytosis;
• amyloidosis.

Special indications and contraindications for storing blood from the umbilical cord

There are situations when special attention must be paid to the issue of preserving cord blood. This applies to cases when:

• family members are representatives of different nationalities;
• anyone in the family has been diagnosed with blood diseases or malignant diseases;
• there are many children in the family;
• the family already has sick children;
• pregnancy occurred after IVF;
• There are suspicions that in the future there may be a need to use stem cells.

But it also happens that saving stem cells is prohibited. This occurs in cases of a positive result for the presence of diseases such as hepatitis B and C, syphilis, HIV-1 and HIV-2, T-cell leukemia.

How effective is stem cell treatment?

Scientists have long known about useful functions that umbilical cord blood possesses. And today, active research is being conducted on the use of stem cells to treat various diseases. It is worth noting that they are quite successful, and in the near future, thanks to umbilical cord blood, it will be possible to get rid of many diseases. Besides, in laboratory conditions You can grow a new full-fledged organ from stem cells! This discovery advanced medicine far forward and put it, so to speak, at a new stage of evolution.

stem cells and what does he do?

Once the decision has been made to preserve cord blood, there is only one question left to deal with: where will it be stored? Are there special places for such purposes? The answer, of course, is yes.

The cord blood stem cell bank is a place where such valuable biological material will be stored in compliance with all necessary standards. There are two registers: nominal and public.

In the first case, the blood from the child’s umbilical cord belongs to his parents, and only they can dispose of it. But in such a situation, they will have to pay for all services themselves, from collection and processing to storage.

Stem cells from the public registry can be used by anyone if the need arises.

Selecting a stem cell bank

When choosing a stem cell storage bank, you need to focus on several important points. Let's look at each of them in more detail.

1. Lifetime of the bank. In this regard, everything is logical, because the more time an organization operates, the more clients trust it, mainly due to confidence in its stability. In addition, the employees of such a bank usually have extensive experience working with cord blood.
2. Availability of a license. This is a mandatory item. The bank must have permission to collect, transport and store stem cells, which was issued by the health committee.
3. Institution base. It is best to choose a bank that is located on the basis of a research institute or medical institution. This will guarantee that they will meet all the conditions for working with biological material and storing it.
4. Availability of necessary equipment. The bank must be equipped with a double centrifuge, as well as Sepax and Macopress devices.
5. Availability of an automatic control system for cryogenic storage facilities. This will help control the temperature in the room with cord blood samples, as well as receive reports on their storage for placement in a special archive.
6. Availability of courier service. This is necessary so that bank employees can quickly come to the maternity ward, collect cord blood and deliver it to the laboratory. The preservation of the viability of stem cells directly depends on the efficiency of their work.
7. Conducted by the bank scientific research in the field of cell technologies. This point is no less important than all the others. In addition, the bank must cooperate with medical institutions and leading research institutes of the city.
8. Availability of 24-hour security. This point does not require further explanation.

Among other things, you can further clarify whether the bank has experience in using stem cells for treatment purposes. Having a positive answer will only be another plus.

So we got acquainted with the question “what is umbilical cord blood”. Its use, as we see, is indicated for the treatment of serious diseases when medications are no longer effective. But in any case, the decision about whether to collect the cord blood of their newborn child or not is made only by his parents.

Among the many activities offered to pregnant women, the collection and storage of umbilical cord blood stands out. The essence of the procedure is as follows: immediately after birth, blood that belonged to the fetus is obtained from the umbilical cord. The cells isolated from it are frozen and stored in a special jar until they are needed.

The value of umbilical cord blood lies in the fact that it contains biologically active stem cells, and is therefore well suited for the needs of cell therapy and transplantology.

Cord blood banks are divided into registered ones - they store the blood of those children whose parents have entered into a corresponding contract, and registry banks created on the basis of gratuitous donation. Any person who requires cord blood for treatment can contact the registry bank. However, the problem is that it can be very difficult to select suitable blood: a match in the main antigenic systems is necessary, otherwise foreign cells will cause a rejection reaction in the patient. Unfortunately, in Russia the collection of register banks is quite meager, so you often have to look for blood abroad, which takes time (from 6 months to a year) and a lot of money (from 15,000 Euros). A possible way out of this situation is to store your own blood at birth: it will always be available and, if necessary, ideal for transplantation.

The procedure for preserving umbilical cord blood is well established and is available to any parents on a contract basis - but few have heard of it. We decided to find out more about this possibility and turned for information to the leading registered cord blood bank, the Stem Cell Bank “CryoCenter”, created on the basis of the Scientific Center of Obstetrics, Gynecology and Perinatology.

Why is cord blood valuable?

Umbilical cord blood is rich in hematopoietic stem cells, i.e. the progenitor cells of blood elements. They are used for transplantation when one’s own hematopoiesis is impaired: in case of leukemia, severe disorders of the immune system and other diseases. Opponents of cord blood storage reasonably note that such pathologies, although life-threatening, are rare. However, on the other hand, in the future it is expected that stem cells will be used for wider indications. In any case, thousands of cord blood transplants have already been successfully performed, saving the lives of patients with previously considered incurable diseases.

Umbilical cord blood is not the only source of hematopoietic cells, but it has a number of advantages: easy and safe collection, youth, and therefore high functional activity of stem cells and immunological compatibility. To use pre-prepared blood, it takes from several days to several weeks.

A newborn's umbilical cord blood can be used to treat other family members. Successful cases of transplantation have been documented for parents, grandparents, and even cousins. However, children of the same parents with many children have the greatest chance of being compatible.

Every parent decides whether or not to save cord blood depending on their financial situation and how necessary they consider this procedure. It should be borne in mind that cord blood collection is especially indicated for those children whose families have had severe diseases of the hematopoietic system or already have sick children who can be cured with the cord blood of a brother or sister, as well as for ethnic minorities who find it difficult to find a compatible donor in international banks - registers.

How is cord blood collected?

After the baby is born, the midwife ties and cuts the umbilical cord. Then the maternal end of the umbilical cord is treated with a sterile solution and blood is taken from the umbilical vein using a needle into a special sterile container with an anticoagulant. Umbilical cord blood is usually small, about 80 ml, so it is advisable to additionally extract all the blood present in the placenta.

The procedure is absolutely painless and takes a few minutes. It can be performed both during normal childbirth and during caesarean section. Moreover, during multiple pregnancies, it is technologically possible to collect cord blood from each child.

How are stem cells isolated?

No later than 24 hours after collection, the sample goes to the bank. Before sending blood for storage, it must be thoroughly processed. First, the sample is checked for infections, the blood type and Rh factor are determined, then it is “processed,” that is, a stem cell concentrate is obtained. Using a special device, excess plasma and almost all red blood cells are removed. The resulting concentrate is analyzed under a microscope to determine cell viability. The next stage is freezing the cells, which should not lead to their death. For this purpose, a cryoprotectant is added to prevent the formation of “sharp, cell-tearing” ice crystals. Then the concentrate is smoothly frozen to -90°C and placed in quarantine storage (liquid nitrogen vapor, -150°C), where they remain until the results of all analyzes are ready. Finally, after approximately 20 days, the samples are transferred to permanent storage (liquid nitrogen, -196°C).

The output is from 5 to 7 tubes of concentrate. In addition to the main tubes, several satellite tubes are prepared - they contain a minimum volume of plasma and cells sufficient for analysis. For example, if the owner of the blood wants to use it for his relative and needs to check for compatibility, there will be no need to thaw the main sample - it will be enough to remove the satellite tube.

How are stem cells stored?

Cord blood cells are stored in special containers with liquid nitrogen in a separate room located deep underground. The low temperature is maintained by a special automated system that continuously monitors the level of liquid nitrogen. It will work even if the central power supply is turned off. The cord blood bank is guarded 24 hours a day.

Research shows that in this state the cells remain virtually intact for many years. There is already no doubt that they do not lose their properties in 15-17 years. In theory, frozen cells can be stored indefinitely.

Who owns stem cells?

Until the child reaches adulthood, the supply of umbilical cord blood cells belongs to his parent or to the person indicated in the storage agreement. After reaching adulthood, the child himself becomes the owner.

How much does the contract cost?

To collect, isolate and freeze umbilical cord blood cells, you will have to pay a one-time fee of about 2000 Euros. In the future, storing the sample will cost 3,000 rubles per year (the amount is specified in the contract and does not change subsequently).

What should you do if you want to save cord blood?

At any stage of pregnancy, you need to come to the cord blood bank, get tested for infections and sign an agreement. Then bank employees will deliver a personalized kit with a unique barcode to the maternity hospital in advance, negotiate with the doctor and midwife, and ensure the collection and delivery of blood to the bank, where stem cells will be isolated from it.

It does not matter whether paid or free childbirth or a caesarean section is expected. If a woman is taken by ambulance with contractions to the nearest maternity hospital, you should call a 24-hour phone number and report your location - bank employees will negotiate with the doctors.

Our compatriots first heard the terms “stem cells”, “cord blood”, “cryobank” relatively recently - five years ago. While in the USA, the first cryobank of umbilical cord blood stem cells, “Cryo-Cell,” was opened in 1992. Nevertheless, the first assumption about the existence of stem cells was made by a Russian scientist. In 1909, A. A. Maksimov, a professor at the Military Medical-Surgical Academy of St. Petersburg, made a sensational statement that the human body contains so-called “stem” cells that, under certain conditions, can transform into mature, differentiated cells of the body. Somewhat later, a professor at the Moscow Research Institute of Epidemiology and Microbiology. N. F. Gamaleya A. Ya. Friedenstein confirmed his colleague’s assumption and, studying the capabilities of these special cells, began to develop the scope of their application.

Now, according to Professor B.V. Afanasyev, director of the bone marrow transplantation clinic of the St. Petersburg State Medical University. I. P. Pavlova, in Russia, scientists and practicing doctors from Moscow, St. Petersburg and Novosibirsk are working on stem cell issues.

Why are stem cells needed?

A single term for the name of these universal cells has not yet been invented. They are called “stem”, “progenitor”, and “reserve” cells. In the adult body, especially in the bone marrow, there are cells that have the ability to transform into almost all types of adult tissue cells, for example, muscle cells, liver cells, and others. Unlike differentiated ones, stem cells have the property of unlimited reproduction, while differentiated cells perform only certain functions (muscle cells - contract, red blood cells - carry oxygen, etc.), and are not able to divide unlimitedly. The transformation of stem cells into differentiated cells occurs under the influence of cells and substrates surrounding stem cell, caught in one or another tissue. We know that normally there are extremely few stem cells in the body, but they are universal “spare” parts that are used by the body to restore various tissues. “Repairing” the body with the help of stem cells occurs as follows: when damage occurs in a tissue, its dying cells send an alarm signal to the blood, releasing special substances. This signal enters the bone marrow, which begins to actively release certain precursor cells into the blood. These, in turn, travel through the bloodstream to the affected area. Here, hundreds of stem cells that come to the rescue are divided into millions, copying the dead ones and thus restoring their balance.

Currently, these capabilities of stem cells are used in practical medicine in the treatment of more than 60 dangerous diseases. Among them, the main place is occupied by diseases of the blood system, various oncological diseases, hereditary and autoimmune diseases. This is due to the fact that the method of transplanting hematopoietic stem cells, i.e., the progenitor cells of the hematopoietic system, is becoming a routine method of treating this severe group of diseases. As sad as the statistics are, 1 in 600 children under the age of 14 may develop this disease.

At the same time, research recent years showed that stem cells can be successfully used in treatment, for example, cardiovascular diseases. Thus, during a myocardial infarction (a condition in which the blood supply to an area of ​​the heart muscle is disrupted), the patient’s bone marrow immediately begins to release stem cells into the blood, but their quantity is usually not enough to effectively restore heart muscle tissue. Research is currently underway on implanting stem cells into the area of ​​the heart muscle damaged by myocardial infarction. Such operations were carried out, for example, in Belgium and Germany. In this case, the patient was successfully implanted with stem cells obtained from his own bone marrow into the area of ​​the damaged heart muscle. It should be noted that in in this case stem cells stimulate the formation of muscle tissue - the myocardium itself, as well as blood vessels in the damaged area.

Methods for obtaining stem cells

Currently, stem cells for transplantation are obtained in clinical settings:

1. From bone marrow. This surgical intervention is performed through multiple punctures of the pelvic bones and sternum. In this case, about 1000 ml of bone marrow is harvested. This method has been used for over 30 years. Its disadvantages are the need for anesthesia and the possibility of developing postoperative complications, although they are quite rare.
2. From peripheral blood. Devices - blood cell fractionators - are connected to the veins of the patient or donor, and in one or two operations 10-20 liters of blood are passed through them. These procedures are carried out against the background of the introduction of special drugs (growth factors) to the person, which increase the content of stem cells in the blood. The second method does not have the disadvantages of the first, but is more expensive, because it requires the use of expensive equipment and growth factors.
3. From umbilical cord blood. Stem cells are harvested at the time of birth of a child, subjected to a thorough examination, frozen and, in cases of their compatibility with any patient based on the antigens of the major compatibility complex - the HLA system, transplanted.

The number of stem cells, which are recognized by the detection of certain antigenic structures on their surface, obtained when preparing material for transplantation from bone marrow, collected from a donor or patient, usually does not exceed 1 * 10 6 / kg, for a concentrate of hematopoietic stem cells from peripheral blood - 1-10*10 6 /kg, for a cord blood sample - 1-4*10 6 /kg.

The third method is worth talking about in more detail. In the umbilical vein of a newborn, the concentration of stem cells is relatively high. This is due to the fact that newborns retain elements of embryonic hematopoiesis, and the placenta itself secretes powerful stimulants of this process. Blood cells responsible for immune reactions in newborns are less mature than in adults, which leads to a reduced risk of graft-versus-host disease and makes it possible to successfully transplant hematopoietic cells in the presence of certain differences in the HLA system of the recipient and the donor. In addition, the process of collecting such blood is quick and simple; it does not require any contact with mother and child and is therefore painless. Research in recent years has proven that the blood that remains in the umbilical cord can be collected and frozen for future use.

Stem cell transplantation. Theory and life

Modern world medicine has accumulated sufficient experience real cure of patients using stem cells. An example of this is the story of six-year-old Kinsey Morrison, who suffers from an acute form of leukemia 1 . Without knowing it, her newborn sister gave her a chance to recover. The baby's stem cells, taken from the umbilical cord after her birth, turned out to be completely immunologically compatible with Kinsey's cells, while none of the possible 9 million potential stem cell donors in the world, data collected in the global Hematopoietic Cell Donor Registry (including her mother) , was not suitable for the sick girl.

The first operation in Europe using umbilical cord blood stem cells from a matched related donor was performed in 1988 in Paris on a child with Fanconi anemia 2 . Today the child is alive and well. This example was one of many facts about the successful use of umbilical cord blood stem cells in the treatment of blood diseases. In total, umbilical cord blood stem cells have been used in more than 2 thousand transplantations.

In our country, the existence of a register of unrelated donors is declared on the basis of the Hematology Center; there are also databases in Russian Institute Hematology and Transfusiology, St. Petersburg Medical University - these are data banks for donors, typed according to the HLA system and who have signed a consent to donate stem cells if necessary (from bone marrow or blood). There are more than 50 such registries abroad in 30 countries, many of which also have banks of samples of collected and frozen umbilical cord blood. If doctors and relatives of patients can access national databases, international ones are usually accessed through doctors (there is a certain procedure for this, which is not always possible for Russians).

What is a cryobank?

Cryobanks are specially equipped storage facilities for stem cells. In Europe and America, cord blood stem cell banks began to appear more than 10 years ago. Today there are a total of 45 of them. These banks store umbilical cord blood samples collected from newborn donors, the data of which is included in the National Registries of Hematopoietic Cell Donors. By concluding an agreement with such a bank, parents can also save stem cells “for future use” for their child. The cells are thoroughly examined and frozen at special program and are stored in liquid nitrogen at a temperature of - 196°C in a state of complete anabiosis and can be used to treat the child himself or his immediate family. In other words, storing your own autologous stem cells is a biological insurance for the child in the future, thanks to which he has his own healthy “spare” cells in case of a serious illness. After all, it is known that today more than 30% of people who need a stem cell transplant never find a suitable transplant.

Cord blood sampling technology

The manipulation is carried out after the baby is born and the umbilical cord is clamped: the umbilical cord is cut and the blood is collected in a sterile container containing an anticoagulant - a solution that prevents blood clotting. Typically, the volume of blood collected ranges from 60 to 120 ml. This procedure does not pose any risk to either the mother or the child and can be performed both during the normal course of labor and during childbirth by birth. The collected cord blood is packaged and placed in a special container for transportation, which is pre-printed with all the necessary information.

Stem cell storage is designed specifically for long-term storage. It is a tank with liquid nitrogen with a volume of 500 liters, equipped with an internal system for placing cryoboxes with test tubes. It is equipped with an alarm and a computer system that allows you to monitor the level of liquid nitrogen and the temperature in the storage facility around the clock. To date, there has been 15 years of experience in storing stem cells, and after thawing, the cells retain all their properties. Defrost samples in a water bath at a temperature of 40-41°C for 3-5 minutes. Thawed cells should be immediately transfused to the recipient.

The “life” of cord blood samples is limited not so much by the duration of storage, but by the fact that the number of stem cells contained in cord blood is usually only sufficient for transplantation into children under 10-14 years of age. Therefore, the storage period for umbilical cord blood taken from a particular newborn for possible transplantation is limited to the specified framework. (By the way, cord blood can be used not only for the children themselves, but also for their relatives who are immunologically compatible with them and have indications for transplantation and for whom the amount of this blood will be sufficient).

Scientists involved in stem cell research are confident that in the near future the scope of their possible use will increase significantly, because Scientific research in this area is developing extremely dynamically, and work on creating special cord blood banks in Russia is proceeding intensively. Services for storing umbilical cord blood stem cells can, to some extent, protect the life of the child, and, possibly, other family members. Time will tell how quickly they will take root in our country, with the only caveat that the chance to preserve “healing cells” is given to parents only once - at the time of the birth of the child.

1 Leukemia (leukemia) is a disease known to most people as “blood cancer”.
2 Fanconi anemia is a hereditary disease that affects stem cells. Manifested by bleeding, growth retardation, hormonal imbalances and a tendency to develop leukemia.

Lyubov Fregatova.
Doctor of Medical Sciences, Professor of the Department of Hematology, Transfusiology and Transplantology of St. Petersburg State Medical University named after. I.P. Pavlova

Article from the October issue of the magazine.

A radical method of treating many severe hematological diseases is, which is isolated from bone marrow or blood tissue. This can be accomplished by searching for a suitable donor, which is not easy. The probability of the existence of an unrelated donor who is HLA-matched is 1:100,000. This requires entire registers of typed donors, numbering several hundred thousand people. Harvesting umbilical cord blood helps to partially solve this problem.

Clinical use

Cord blood contains a large number of stem cells, which could be used in the future to treat a number of serious diseases.

Blood obtained from the placenta is a rich source of hematopoietic cells. The concentration of colony-forming units in it significantly exceeds their amount in the blood of an adult, even after stimulation with growth factors. Its composition is similar to bone marrow tissue. Therefore, stem cells contained in umbilical cord blood can be successfully used in hematology to treat the following diseases:

• myelodysplastic syndromes;
• some congenital diseases (hereditary hemoglobinopathies, Barr syndrome, etc.).

Transplantation of hematopoietic cells obtained from placental blood is a promising direction in medicine, which is already used in neurology (consequences of injuries, degenerative diseases of the nervous system), rheumatology (diffuse), oncology and other industries.

The effectiveness of such treatment is determined by:

• timely diagnosis and treatment of the disease;
• degree of histocompatibility (according to the HLA system) of the donor and recipient;
• age of the patient (gives good results in children under 5 years old);
• the number of transplanted stem cells (if there are few of them, the risk of relapse of the pathological process or graft failure increases).

Blank

Umbilical cord blood is obtained during childbirth either vaginally or by caesarean section. At the stage of planning the procedure, the pregnant woman is thoroughly examined and diseases of an infectious nature are excluded (, etc.).

In preparation for childbirth, a blood collection system is prepared under aseptic conditions. It consists of a special container with a hemopreservative and a device for drawing blood.

During normal childbirth through the vaginal birth canal, blood sampling can be carried out in two ways:

• If the placenta is in the uterine cavity and has not yet separated, then blood exfusion is performed after applying a clamp to the umbilical cord and separating the newborn from the fetal site. To do this, the umbilical cord is thoroughly treated with antiseptic solutions, after which the umbilical vein is punctured, placing the container for collecting material 50-70 cm below the mother’s abdomen so that the blood flows into it spontaneously.
• If the placenta has already been separated from the uterine cavity, then it is placed on a special frame with the fetal part downwards, then the umbilical cord vein is also processed and punctured, after which blood is obtained into a container.

An additional 10 ml of blood is taken from the umbilical cord artery for the initial stage of examination for blood type and hidden infections.

After the procedure is completed, the container is disconnected and transported to the cord blood bank in a special refrigerator or an additional container protected from temperature extremes. In this case, the duration of storage of blood with a hemopreservative before its fractionation should not exceed 24 hours. Otherwise, the stem cells die.

Stem cell storage

Stem cells are stored in a container with liquid nitrogen for up to 25 years.

Isolation of hematopoietic cells from umbilical cord blood is carried out under aseptic conditions.

• To do this, the blood is centrifuged at high speeds, as a result of which the plasma is separated from it.
• After this, sedimentation of erythrocytes begins by adding a sedimentation substance (gelatin, hydroxyethyl starch).
• The resulting cell suspension is mixed with saline solution and centrifuge twice.
• Then, using a syringe, the cell sediment is separated and prepared for freezing and long-term storage.

Stem cells obtained from umbilical cord blood are stored at low temperatures in a frozen state:

• in refrigerators with a temperature of -80 degrees (up to 6 months);
• in liquid nitrogen vapor at a temperature of -150 degrees (several years);
• in containers with liquid nitrogen and a temperature of -196 degrees (more than 20 years).

To freeze the cell suspension, it is pre-cooled to +4 degrees in an ice bath or in a refrigerator. Then this suspension is taken up with a syringe and transferred to a canning bag, adding a fencing solution drop by drop, after which the bag is sealed and placed in a special apparatus for program freezing. Moreover, the process itself is carried out according to a four-stage program, which allows maintaining cell viability for a long time.

To use frozen stem cell samples, immediately before transfusion, the cell suspension is slowly defrosted in a water bath at +40 degrees. After thorough mixing, a test is performed to determine the safety of the cells and their viability.

Laboratory testing

The use of blood obtained from the umbilical cord in clinical practice requires special testing in a laboratory. This allows you to determine the HLA system, assess the quality of the drug and identify the potential for infection with infectious diseases.

The list of necessary laboratory tests includes:

• determination of the volume of umbilical cord blood and the content of cellular elements in it (stem cells, leukocytes, erythrocytes);
• blood test for markers of viral hepatitis;
• biochemical blood test ();
• detection of antibodies to HIV, Treponema pallidum,;
• blood culture for sterility;
• determination of HLA genotype, blood group according to the AB0 system and Rh factor.

To conduct all studies in full, about 10 ml of blood is required. Of these, 4 ml are immediately taken for testing, and the remaining 6 ml are centrifuged and frozen, after which they are tested again. This makes it possible to assess the quality of the transplant and predict the time of engraftment of hematopoietic cells in the patient’s body.

Umbilical cord blood is used very sparingly for research in order to minimize the loss of hematopoietic cells.

• Determination of group affiliation, HLA phenotype, and biochemical parameters is carried out in a portion of blood taken from the umbilical cord artery.
• Bacteriological research is carried out in the red blood cell mass remaining after centrifugation.
• Serological tests of blood serum to detect infections are carried out using plasma obtained through the fractionation process.
• The concentration of hematopoietic precursor cells is assessed in a cell sediment obtained by dividing blood into fractions.

Advantages and disadvantages of using cord blood

Currently, many parents are thinking about whether it is worth harvesting their child’s umbilical cord blood, is it important or not? In order to answer these questions, let's consider the benefits of this treatment method.

1. The procedure is absolutely safe (does not harm the health of the mother and child).
2. Does not require additional pain relief.
3. Has a low risk of contracting infectious diseases.
4. Provides the possibility of long-term storage of hematopoietic cells.
5. Provides biological life insurance for a child in the event of the development of serious diseases (especially the hematopoietic system).

However, there are also disadvantages to using umbilical cord blood as a source of stem cells.

1. The main one is the relatively small volume of material obtained and its loss during procurement and laboratory testing.
2. Another disadvantage of this procedure is its high cost with a low probability of use in a child. However, it is hardly comparable to the cost of a bone marrow transplant, which amounts to tens of thousands of dollars.

Currently, in Russia and other countries there are special cord blood banks. These can be private and government entities. The latter pursue the goal of creating a certain supply of biological material that can be used for scientific research and treatment of patients.

Private banks store personalized samples that can be used in case of illness. They offer their clients different tariffs:

• The average cost of collecting and storing umbilical cord blood at Gemabank is 65,000 rubles, each year of storage is paid separately (7,000 rubles).
• At the Cryocenter stem cell bank, a stem cell storage package (25 years) has a total cost of about 230,000 rubles.