FAQ
Banking cord blood
Collection of cord blood
Processing and storage of cord blood
Registration with Progenics
Transportation of cord blood to Progenics
29. What should I do after the cord blood is collected?
30. Can I make payments and change my information online?
Banking cord blood
1. Why is an AABB-accredited bank important to you?
AABB (American Association of Blood Banks) accreditation is essential for a cord blood bank since an accredited cord blood bank has to meet standards set out by this international organization. However, if a cord blood sample is stored in an AABB accredited bank it does not necessarily mean that the sample can be used for transplant when needed. Suitability of a cord blood sample for transplant is determined by the number of cells stored. Therefore, a good bank should get accredited by the AABB and in addition, should save more cells. Progenics has been an AABB accredited bank since 2005 and guarantees that more cells will be saved.
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2. What is cord blood?
After a baby is delivered, the umbilical cord
is clamped and cut, close to the baby's "belly-button". In the remaining umbilical cord that is still attached to the placenta, there is about 100mL of fetal blood, known as "cord blood". This "left-over" blood is traditionally discarded with the placenta as biological waste. However, scientists have discovered that cord blood is very rich in a special kind of cells called Hematopoietic (Blood-forming) Stem Cells(HSCs).
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3. What are Hematopoietic Stem Cells (HSCs)?
HSCs are pluripotent cells with an unlimited capacity for self-renewal. They continuously replicate and differentiate into all the components of the blood and immune systems. Every day, HSCs produce billions of red blood cells, white blood cells, and platelets that are essential for our health. The three sources of hematopoietic (blood-forming) stem cells which are routinely used for medical treatments are:
- Bone marrow
- Peripheral (circulating) blood
- Cord blood
4. Why transplant stem cells?
Sometimes, the HSCs in the bone marrow may become diseased (malignant or non-malignant), or may be destroyed by cancer chemotherapy and/or radiotherapy. When this occurs, stem cell therapy is essential.
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Traditionally, the source of HSCs is the bone marrow, hence the term "bone marrow transplant". However, umbilical cord blood is another very important source of these precious life saving stem cells. In fact, researchers have discovered that cord blood-derived stem cells have many advantages over bone marrow-derived stem cells and are preferred in transplants.
The concept of the stem cell transplant is very simple. Stem cells from one person are transplanted to another whose bone marrow has been damaged from disease or cancer treatment, like chemotherapy and/or radiation. Patients can also store their own stem cells for use after chemotherapy.
Hematopoietic (blood-forming) Stem Cells are capable of developing into all the specific types of cells in the blood and immune systems. For some diseases stem cell transplants are a standard treatment. For some diseases they are the only therapy, and in some other diseases they are only employed when front-line therapies have failed or when the disease is very aggressive.
When a patient requires a stem cell transplant, the attending physician will decide which source of stem cells to use. This will depend on several factors, including but not limited to: the degree of HLA match between donor and patient (sometimes the donor and patient are the same person), the expected speed of engraftment (number of available cells), and the amount of time available to search for a perfectly matching donor. Over 20,000 cord blood transplants have been performed worldwide. |
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5. What is the difference between cord blood and bone marrow transplants?
Transplantation using stem cells derived from cord blood rather than bone marrow has many advantages. These include immediate availability, a painless and non-invasive collection process, a lower risk of infectious complications, a superior capacity for proliferation and self-renewal, a greater tolerance for tissue mismatch and most importantly, a significantly reduced risk of fatal post-transplantation "graft-versus-host" disease. This is because cord blood stem cells are more immunologically immature and thus more tolerant than bone marrow stem cells.
6. What kinds of diseases can be treated with cord blood stem cells?
More than 70 diseases have been successfully treated with stem cells. These include cancers (leukemias, lymphomas, myelomas), blood disorders (thalassemias, sickle cell anemia, Fanconi's anemia), and immune deficiency diseases.
List of Stem Cell Treatable Diseases
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7. Why save cord blood?
Cord blood transplantation has saved the lives of thousands of patients worldwide since 1988, when a patient with Fanconi anemia received his sister's cord blood at age 5. Now the patient is currently healthy with a complete long-term hematologic and immunologic donor reconstitution.
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8. What is the chance of using cord blood?
The chance of a child using his or her own stem cells over the course of his or her lifetime is 1/400 (0.25%) (Nietfeld J.J. and Verter F., 2008). The chance of transplanting cord blood stem cells to siblings has been 17 out of 506 donors (3.4%) (Reed W. et al. Transfusion 2003; 101: 351-357). The opportunities for using cord blood are expected to increase with advances in research and improvements in transplantation.
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9. Who else can use my baby's cord blood?
Your baby's cord blood is stored for the use of your family only. A sibling has the best chance of being a perfect match (about 1/4) and the chance of a transplantable match is much higher. Parents and other family members have a chance of matching a cord blood unit as well.
10. Should I bank cord blood for each of my children?
There is a 1/4 chance for a child to match a sibling perfectly. Therefore, it makes sense to save cord blood stem cells from each child to increase the probability of matching a family member who might develop a disease requiring stem cell therapy.
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11. How much cord blood is needed for a transplant?
A successful transplant is closely related to the number of cells in the cord blood being transplanted, not the volume of cord blood. The optimal amount of cord blood for a transplant is defined as 2 x 107 (Tse and Laughlin, Hematology (Am Soc Hematol Educ Program) 2005; 377-383) nucleated cells per kilogram of the recipient's body weight. Transplanting a nucleated cell dose lower than 1 x 107 / kg delays engraftment and increases the probability of failure.
12. Can a successful transplant of cord blood be guaranteed?
Not really, because a successful transplant is determined not only by the quality of the cord blood cells but by the condition of the recipient as well.
However, a successful transplant DOES correlate with the cell dose of total nucleated cells (TNC) administered to the patient. Because a small volume and low cell count of cord blood limit its application, obtaining a high yield (recovery rate) of TNC from processing (saving more cells) plays a role in determining the success of a transplant. When comparing results from different cord blood banks (Moroff G et al. Transplantation and Cellular Engineering (46) 507-515, 2006) the cell count of nucleated cells is the most reliable indicator because it is the least variable. Therefore, a successful transplant should be guaranteed by extracting a higher cell dose from processing if conditions of patients are similar.
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Collection of cord blood
13. How is cord blood collected?
You will be provided with our special collection kit that makes the procedure safe and simple. After your baby is delivered and the umbilical cord is clamped and cut, your doctor or midwife will collect the cord blood from the umbilical cord in a collection bag. After collection, the cord blood will be couriered to our laboratory for processing. It is a painless process for both mother and child.
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What is the average collection volume without anticoagulant(mL)?
For a public bank, about 50% of collected cord blood samples are discarded and the average volume is dependent on a cut off volume. Normally the average volume is about 75 mL without anticoagulant. However there is no report about collection volume available for a private bank. It is very important to have enough cells for a successful transplant. An investigation on banking sibling cord blood for transplantation shows an average collection volume of 68 mL with a transplantation rate of 3.4% (Reed W. et al. Transfusion 101: 351-357 (2003)).
Average volume received by Progenics is 75 mL without anticoagulant.
• What is the minimum cord blood volume accepted for storage?
There should not be a minimum volume for storage because any volume might be useful if cord blood could be expanded a few hundred fold in the future. However, a recommended minimum volume should be set since it is costly to store the cord blood, while chances of usage are low based on current standards. From a study of sibling cord blood banking, 20 mL or 300 x 106 nucleated cells should be an acceptable minimum for banking (Reed W. et al. Transfusion 101: 351-357 (2003)).
Minimum volume eligible for processing at Progenics is 40 mL without anticoagulant and the number of nucleated cells is 300 x 106 before processing. Over 93% of samples received at Progenics have been over 40 mL. If the volume is below 40 mL AND the number of nucleated cells is less than 300x106 before processing, then according to the parents request in the consent and agreement, Progenics will provide information on the sample and the final decision to process the cord blood will be made by the parents.
• What is the discard rate if there is an acceptable minimum volume?
Nearly 50% of collected cord blood samples are discarded from public cord blood banks but no information is available from private banks. From a sibling cord blood banking study, 34/540 cord blood samples were discarded (Reed W. et al. Transfusion 101: 351-357 (2003)).
At Progenics less than 1% of samples below 40 mL and with a nucleated cell count less than 300 x 106 have been discarded. |
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14. What should I do after the cord blood is collected?
Follow the instructions given to you at the time of registration for transporting the collected cord blood to Progenics:
- Call courier to pick up cord blood
For all hospitals (except for North York General Hospital) please call Air Logistics at 1-866-882-8865 to arrange for courier service.
- Call Progenics at 416-221-1666 or 1-866-921-1666 to inform us of the following:
- The Progenics Client ID #
- The mother's name
- The delivery date/time
- The delivery hospital and city
- A phone number that we can reach you at all times
15. How do I know if the cord blood has been received by Progenics?
You will be notified by our office as soon as the cord blood is received and/or processed.
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Processing and storage of cord blood
16. How is cord blood processed?
Cord blood is processed to make it usable for future transplantation. Most cord blood banks perform volume reduction in the processing procedure. Volume reduction is essentially the removal of most of the red blood cells and some plasma, leaving behind nucleated cells, which includes stem cells (approximately 0.39% of nucleated cells are stem cells). Since the number of nucleated cells in cord blood is the most predictive factor of a successful transplant, a good processing technique to save more stem cells is critical to contribute to that success. With Progenics' processing procedure, over 94% of the red blood cells are removed and the average yield of total nucleated cells from processing is 97.6%. The average time between collection and processing is 15 hours.
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What is an acceptable time frame between collection and processing?
Acceptable time frames between collection and processing are defined differently depending on the bank. Usually, 48 hours after collection is the limit for most cord blood banks but the shorter the storage time before processing, the better.
At Progenics the average time between collection and processing is 15 hours. If a sample of cord blood is received after 48 hours from collection the viability will be assessed to determine whether the cord blood is still eligible for processing and storage.
Is there a risk that the cord blood will become contaminated during the processing procedure?
Progenics uses a closed system during the processing procedure. A processing system is said to be closed when there is no chance for the cord blood to be exposed to air during processing. Closed system processing is the most efficient and effective procedure to prevent microbial contamination.
Progenics uses a closed system to process all cord blood samples.
What is the yield of nucleated cells after processing?
The number of total nucleated cells is the most important indicator of a successful transplant. The disadvantage of cord blood is a lower number of cells compared to bone marrow due to the smaller volume. The more cells that are lost during processing, the less chance there is for the transplant to be as successful in larger patients. During processing, 20-60% of total nucleated cells can be lost. The yield, in terms of percentage, is the number of nucleated cells left after processing, divided by the number of cells before processing, and then multiplied by 100.
With the superior double processing technique developed by Dr. H. Yang et al, the average yield of total nucleated cells at Progenics is over 97.6%.
What percentage of red blood cells is removed during processing?
The concentration of red blood cells left in the final product after processing is overlooked by less experienced cord blood banks. A study demonstrated that a high concentration of red blood cells (Hematocrit =0.36) can damage up to 1/3 of cord blood stem cells during cryopreservation (freezing). During optimal cryopreservation, ice only forms EXTRACELLULARLY and not intracellularly. Intracellular ice formation directly damages cord blood stem cells but extracellular ice only damages cells when the concentration of red blood cells is very high, causing what is known as "the packed effect."
With Progenics' processing procedure, 94% of the red blood cells are removed, and the average hematocrit is 0.077.
What is the average number of total nucleated cells after processing?
The yield is a critical factor for good processing of cord blood but it has to be verified by the number of total nucleated cells per unit.
Average total nucleated cells after processing at Progenics was 1,055 x 106/sample.
Is the processing method published in a scientific journal?
If published, the processing procedure of a bank has already been systematically investigated; therefore, it should be safe and efficient to be used for processing cord blood.
The processing protocol was developed by Dr. H. Yang et al and is published in Bone Marrow Transplantation (2001) 27:457-461.
Does double processing injure more stem cells than the conventional processing technique?
No, the viability of stem cells after double processing was 99.9%. |
If you would like to know the differences between the processing methods that other banks use (Optipress and AXP) and double processing (the method used at Progenics), please contact our office. We will provide you with the most recently published information from scientific journals.
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17. When should cord blood be processed after collection?
Within 48 hours. However, the shorter the period before processing begins, the higher the quality of the cord blood
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What is an acceptable time frame between collection and processing?
Acceptable time frames between collection and processing are defined differently depending on the bank. Usually, 48 hours after collection is the limit for most cord blood banks but the shorter the storage time before processing, the better (≤24 hours).
At Progenics the average time between collection and processing is 15 hours. If a sample of cord blood is received after 48 hours from collection the viability will be assessed to determine whether the cord blood is still eligible for processing and storage.
Is there a risk that the cord blood will become contaminated during the processing procedure?
Progenics uses a closed system during the processing procedure. A processing system is said to be closed when there is no chance for the cord blood to be exposed to air during processing. Closed system processing is the most efficient and effective procedure to prevent microbial contamination.
Progenics uses a closed system to process all cord blood samples.
What is the yield of nucleated cells after processing?
The number of total nucleated cells is the most important indicator of a successful transplant. The disadvantage of cord blood is a lower number of cells compared to bone marrow due to the smaller volume. The more cells that are lost during processing, the less chance there is for the transplant to be as successful in larger patients. During processing, 20-60% of total nucleated cells can be lost. The yield, in terms of percentage, is the number of nucleated cells left after processing, divided by the number of cells before processing, and then multiplied by 100.
With the superior double processing technique developed by Dr. H. Yang et al, the average yield of total nucleated cells at Progenics is over 97.6%.
What percentage of red blood cells is removed during processing?
The concentration of red blood cells left in the final product after processing is overlooked by less experienced cord blood banks. A study demonstrated that a high concentration of red blood cells (Hematocrit =0.36) can damage up to 1/3 of cord blood stem cells during cryopreservation (freezing). During optimal cryopreservation, ice only forms EXTRACELLULARLY and not intracellularly. Intracellular ice formation directly damages cord blood stem cells but extracellular ice only damages cells when the concentration of red blood cells is very high, causing what is known as "the packed effect."
With Progenics' processing procedure, 94% of the red blood cells are removed, and the average hematocrit is 0.078(8%).
What is the average number of total nucleated cells after processing?
The yield is a critical factor for good processing of cord blood but it has to be verified by the number of total nucleated cells per unit.
Average total nucleated cells after processing at Progenics was 1,055 x 106/sample.
Is the processing method published in a scientific journal?
If published, the processing procedure of a bank has already been systematically investigated; therefore, it should be safe and efficient to be used for processing cord blood.
The processing protocol was developed by Dr. H. Yang et al and is published in Bone Marrow Transplantation (2001) 27:457-461.
Does double processing injure more stem cells than the conventional processing technique?
No, the viability of stem cells after double processing was 99.9%. |
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18. How do I know if the cord blood has been successfully processed?
Progenics will send you a “Certificate of Cryopreservation” which reports the processed date, volume collected, yield (recovery rate) of total nucleated cells (%) and percentage of contaminating red blood cells (hematocrit).
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| If the cord blood volume is ≥ 40 mL, you will receive a certificate of cryopreservation after Progenics has obtained all of the results for both the maternal viral marker blood tests and the cord blood microbiological tests.We will contact you as per your request in the consent and agreement you completed at registration, and provide you with information about the cord blood if the volume is below 40 mL AND the cell count is below 300 x 106 total nucleated cells per cord blood sample (before processing). If you decide to bank your baby's cord blood, you will receive 50% off the storage fee for 18 years. The certificate with processing results and the quality guarantee confirms the successful processing and storage of your child's cord blood. You should expect to receive this certificate about 4-6 weeks after the birth of your child. |
19. How is cord blood cryopreserved?
Basically, the cryopreservation procedure includes the addition of a 5-10% Dimethyl Sulfoxide (DMSO) solution with freezing at a rate of around 1?C/min using a controlled rate freezer.
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| Almost no cells can survive freezing without an optimal cryopreservation process. The cryopreservation of cord blood started out as a purely empirical approach that was initially successful in the cryopreservation of bone marrow. It was gradually adapted for the cryopreservation of cord blood. Basically, the cryopreservation procedure includes the addition of a 5-10% dimethyl sulfoxide (DMSO) solution with freezing at a rate of around 1?C/min using a controlled-rate freezer. The controlled-rate freezer is a proven and commonly used piece of equipment for cryopreserving cord blood. Most, if not all, transplanted cord blood samples are cryopreserved using this cryopreservation technique. |
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20. How is cord blood stored?
At Progenics processed cord blood is stored in the vapor phase in a liquid nitrogen freezer, where the temperature is <=-180?C.
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| Normally cord blood stem cells are cooled down slowly from above 0?C to -60?C, and then transferred to a liquid nitrogen freezer for long term storage. When cord blood is stored in a liquid nitrogen freezer, it is very stable in either the vapor (gas) phase or liquid phase. The critical temperature for storing cord blood is -130?C. If a sample reaches a temperature higher than -130?C during storage, the cord blood can be damaged by intracellular recrystallization. Therefore, it is critical that the temperature of the storage freezers be monitored 24 hours a day and the contents of malfunctioning storage freezers be easily transferable to a back-up freezer immediately. At Progenics, processed cord blood is cryopreserved using a controlled-rate freezer and then stored in a liquid nitrogen freezer, where the temperature is -180?C or lower. A backup liquid nitrogen freezer is available at all times in case of an emergency. |
21. How long can cord blood be stored?
Cord blood stem cells have demonstrated the ability to be stored for at least 15 years in liquid nitrogen without significant damage (Broxmeyer He et al. Proc Natl Acad Sci USA 2003; 100: 645-650). Theoretically the cells can be stored in liquid nitrogen for up to 2000-4000 years.
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| The dose of ionizing radiation that kills 63% of representative cultured mammalian cells at room temperature is 200-400 rads (Elkind M and G. Whitmore: The radiobiology of cultured mammalian cells. New York : Gordon and Breach, 1967). Because terrestrial background radiation is approximately 0.1 rad/yr, it should require 2000-4000 years to kill that fraction of a population of typical mammalian cells at -196?C. Stability for centuries or millennia requires a temperature below -130?C. The temperature in the storage freezers is maintained simply by liquid nitrogen and not by electricity, so samples are reliably kept below the critical temperature. |
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22. Does Progenics use my baby's cord blood for research?
No, your baby's cord blood is stored for your family's use only. Any research is carried out with cord blood donated from voluntary donors with informed consent. All research is directly related to the improvement of banking cord blood.
23. Should I transfer my baby's stored cord blood if I move?
No, it is best to keep your stored cord blood in the bank since transferring it from one location to another does hold a risk of losing the sample to a variety of potential accidents during transportation. Therefore it is better to keep the sample at the processing laboratory and it is transferred when the stored cord blood is needed for treatment of a disease. The transportation will be arranged by Progenics and the transplant facility. The stored cord blood can be shipped to nearly anywhere in the world.
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24. How do I retrieve the cord blood when I need it for treatment?
If a member in your family becomes ill with a disease that can be treated with stem cell transplantation, the attending transplant physician, with your authorization, will contact us for information about the stored cord blood. If the physician decides to proceed with a transplant using that cord blood unit, he or she will send us a request along with your consent for the shipment of the unit to the transplant center.
Registration with Progenics
25. How do I register with Progenics?
You have four options for registering with Progenics.
Please obtain shipping information before you begin your registration.
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26. What is the cost of cord blood banking?
Please see Schedule of fees
27. How soon should I register with Progenics?
We highly recommend our clients to register at least TWO months before their expected due date. In certain circumstances you still can register with Progenics as long as there is enough time to deliver a collection kit to you before you give birth to your baby. Simply call the Progenics office for further details regarding the registration process.
28. What should I do after registering with Progenics?
Keep the cord blood collection kit at room temperature. Remember to bring the cord blood collection kit to your delivery hospital and give it to your attending labour nurse when you are admitted to the Labour and Delivery Ward (or Birthing Unit). See the "INSTRUCTIONS FOR PARENTS" for details when you receive your collection kit.
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| You will be provided with a cord blood collection kit once you register with us and the registration is approved. If you register online or by fax or mail we will send the collection kit to you via courier within 1-2 business days. Keep the cord blood collection kit at room temperature. Do not leave it in your car for an extended period of time. Remember to bring the cord blood collection kit to your delivery hospital and give it to your attending labour nurse when you are admitted to the Labour and Delivery Ward (or Birthing Unit). |
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Transportation of Cord Blood to Progenics
29. What should I do after the cord blood is collected?
29. What should I do after the cord blood is collected?
Follow the instructions given to you at the time of registration for transporting the collected cord blood to Progenics:
- Call courier to pick up cord blood
For all hospitals (except for North York General Hospital) please call Air Logistics at 1-866-882-8865 to arrange for courier service.
- Call Progenics at 416-221-1666 or 1-866-921-1666 to inform us of the following:
- The Progenics Client ID #
- The mother's name
- The delivery date/time
- The delivery hospital
- A phone number that we can reach you at all times
30. Can I make payments and change my information online?
Yes. Simply click on “My Account” and follow the instructions to make your payments or update your information.
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