Cord blood storage – Indications and

Safeguards
Dr Jo Howard
Guy’s and St Thomas’ NHS Trust
• Are cord blood transplants in the
haemoglobinopathies effective?
• Are cord blood transplants in the
haemoglobinopathies feasible?
• Who should have cord blood banked?
 Are cord blood transplants in the
haemoglobinopathies feasible?

• YES
• UK experience
– 44 units collected from families with
haemoglobinopathies (36 thalassaemia)
– 7 of units for thalassaemia had been used (20%)
– All patients alive and well (1 had secondary
graft rejection
– No units for sickle had been used

Smythe et al. Stem Cells 2007;25:2087-2093

 Are cord blood transplants in the
haemoglobinopathies feasible?
• US experience
– 1600 samples over 6 years, 96 (6%) for
thalassaemia, 450 (28%) for sickle cell
– In thalassaemia, 32 (33%) were HLA
compatible and 14 (44%) received CBT
– In sickle, by 2003, 163 CB units, 4 (2%) used
for CBT. All engrafted, ¾ have long term
survival.
– By 2005, 8 CBT (2% of units)
 Reasons for low use of CBT
• Low uptake of cord blood banking
– Cost
– Lack of awareness
– Social/family reasons
– Negative views of CBT by patients or
physicians
• Low use of banked cords
– HLA incompatibility
 Dilemma 1
• We need to ‘investigate the reasons both for low
banking rate and low usage rate before
formulating policies… about systematic collection
of CB’
• We are being asked by patients to provide this
service, and if we do not provide on NHS they not
get service, or have to use private providers
• PCTs will not fund individual patients without
hospital protocols
Draft Protocol
 Eligibility Criteria
• Only applies for directed sibling donations
of cord blood for banking for potential CBT
in future
A) An existing sibling could be treated by
allogeneic transplant
B) An earlier birth from the same parents
indicated an inherited condition that could
result in a future infant needing an
allogeneic transplant
 Dilemma 2
• Should we include
C) prenatal screening has revealed the
presence of a genetic condition that may be
treated by allogeneic transplantation in a
future infant
 Eligible conditions
• Inherited anaemias
– B thalassaemia, Sickle Cell Disease
• Haematological malignancies
• Immunodeficiency
• Enzyme deficiency
• Others eg aplastic anaemia
 Referral process
• Patient may present to
– Obstetricians
– Midwives
– Paediatricians
– Haematologists
– Community haemoglobinopathy nurses
 Referral process
• Initial referral goes to ‘Home from Home
Birth Centre Midwife’
• They will co-ordinate process and referral
to SCI-NBS
• <30/40 weeks gestation
• If concerns about eligibility refer to ‘Trust
Working Party on Cord Blood Donation’
 Referral process
• All referrals agreed by

A) Consultant Obstetrician – responsible for

medical review of the patient
B) Consultant Paediatrician or Haematologist
or Clinical Geneticist – has responsibility
for affected sibling or can advise about
liklihood of transplantation in a future sib
Trust Working Party on Cord Blood
Donation
• Home to Home Birth Centre Consultant
Midwife
• Consultant Obstetrician
• Consultant Paediatrician
• Consultant Haematologist
• Manage
Trust Working Party on Cord Blood
Donation
• Will decide on eligibility for directed cord
blood donation
• Will review initial results from NBS on
cord blood collected and deciding on
storage
• Yearly review of stored cords
• Will keep directed cord blood protocol up
to date
 Other issues
• Numbers
– 2-3 women who already have affected children
– 6 -10 presenting via prenatal screening
• Funding
– PCT
• How can couples be informed
– Community team as part of prenatal screening
• New UK guidelines