CBB NOTES

ABRIEF HISTORY OF BLOOD BANKING

1628 - William Harvey - circulation of blood.
1665 - First recorded successful blood transfusion - Richard Lower.
1818 - James Blundell - first successful transfusion of human blood to a patient.
1900 Karl Landsteiner - discovers the first three human blood groups.

UMBILICAL CORD
-The part of placenta that delivers nutrients to a fetus. In placental mammals, the
umbilical cord (also called the navel string, birth cord or funiculus umbilicalis)
is a conduit between the developing embryo or fetus and the placenta.
-It help fetus to survive during intrauterine period. The umbilical cord fluid is
loaded with stem cells. They can treat cancer, blood diseases like anemia, and some
immune system disorders, which disrupt your body's ability to defend itself.
The fluid is easy to collect and has 10 times more stem cells than those collected
from bone marrow.
Stem cells from cord blood rarely carry any infectious diseases and are half as
likely to be rejected as adult stem cells.

2.INTRODUCTION
-Cord blood banking involves collecting blood left in newborn’s umbilical cord and
placenta and storing it for future medical use . Cord blood (short for umbilical
cord blood) is the blood that remains in the umbilical cord and placenta post-
delivery. At or near term, there is a maternal–fetal transfer of cells to boost the
immune systems of both the mother and baby in preparation for labor. This makes
cord blood at the time of delivery a rich source of stem cells and other cells of
the immune system. Cord blood banking is the process of collecting the cord blood
and extracting and cryogenically freezing its stem cells and other cells of the
immune system for potential future medical use.
As cord blood is inter-related to cord blood banking, it is often a catch-all term
used for the various cells that are stored. It may be surprising for some parents
to learn that stored cord blood contains little of what people think of as "blood,"
as the red blood cells (RBCs) can actually be detrimental to a cord blood
treatment. (As we'll discuss later, one of the chief goals of cord blood processing
is to greatly reduce the volume of red blood cells in any cord blood collection.)

-Cord blood contains potentially lifesaving cells called STEM CELL. In Europe and
other parts of the world, cord blood banking is more often referred to as stem cell
banking. As banking cord blood is designed more to collect the blood-forming stem
cells and not the actual blood cells themselves, this term may be more appropriate.
There was a time before the 1990s when the umbilical cord and its blood were
considered medical waste. Today, parents bank or store their baby's umbilical cord
blood because the stem cells it contains are currently utilized or show promise in
the treatment of life-threatening and debilitating diseases.
Luckily for expectant parents, cord blood can be easily collected at the baby’s
birth via the umbilical cord with no harm to the mother or baby. This is why
pregnancy is a great time to plan to collect and bank a baby's cord blood.

https://www.cryo-cell.com/cord-blood-banking

3.Picture of (what is a stem cell)

4.Stem cell
-Stem cell are essentially the building blocks of the human body .
-Stem cell is capable of dividing for long periods of time , are unspecialized ,
but can develop into specialized cells . Stem cells are cells with the potential to
develop into many different types of cells in the body. They serve as a repair
system for the body. There are two main types of stem cells: embryonic stem cells
and adult stem cells.
-The earliest stem cell inside an embryo will eventually give rise to every cell ,
tissue and organ in the fetus’s body . When it divides , it can make any one of the
different cells in human body . Doctors and scientists are excited about stem
cells because they could help in many different areas of health and medical
research. Studying stem cells may help explain how serious conditions such as birth
defects and cancer come about. Stem cells may one day be used to make cells and
tissues for therapy of many diseases. Examples include Parkinson's disease,
Alzheimer's disease, spinal cord injury, heart disease, diabetes, and arthritis.

https://medlineplus.gov/stemcells.html

5.Stem cell picture

6.There are several types of stem cells

-Embryonic stem cells
-Adult stem cells
-Induced pluripotent stem cells (IPSC)
-Umbilical cord blood stem cell

7.Pictures of
Embryonic stem cell
-Embryonic stem cells (ESCs) are stem cells derived from the undifferentiated inner
mass cells of a human embryo.
Embryonic stem cells are pluripotent, meaning they are able to grow (i.e.
differentiate) into all derivatives of the three primary germ layers: ectoderm,
endoderm and mesoderm.
In other words, they can develop into each of the more than 200 cell types of the
adult body as long as they are specified to do so.
Embryonic stem cells are distinguished by two distinctive properties: their
pluripotency, and their ability to replicate indefinitely.
ES cells are pluripotent, that is, they are able to differentiate into all
derivatives of the three primary germ layers: ectoderm, endoderm, and mesoderm.
These include each of the more than 220 cell types in the adult body.
Pluripotency distinguishes embryonic stem cells from adult stem cells found in
adults; while embryonic stem cells can generate all cell types in the body, adult
stem cells are multipotent and can produce only a limited number of cell types.
Additionally, under defined conditions, embryonic stem cells are capable of
propagating themselves indefinitely.
This allows embryonic stem cells to be employed as useful tools for both research
and regenerative medicine, because they can produce limitless numbers of themselves
for continued research or clinical use.

https://www.sciencedaily.com/terms/embryonic_stem_cell.htm

Adult stem cell

-Adult stem cells are undifferentiated cells found throughout the body that divide
to replenish dying cells and regenerate damaged tissues.
Also known as somatic  stem cells, they can be found in children, as well as
adults.
Research into adult stem cells has been fueled by their abilities to divide or
self-renew indefinitely and generate all the cell types of the organ from which
they originate — potentially regenerating the entire organ from a few cells.
Unlike embryonic stem cells, the use of adult stem cells in research and therapy is
not controversial because the production of adult stem cells does not require the
destruction of an embryo.
Adult stem cells can be isolated from a tissue sample obtained from an adult.
They have mainly been studied in humans and model organisms such as mice and rats.
The rigorous definition of a stem cell requires that it possesses two properties:
Self-renewal - the ability to go through numerous cycles of cell division while
maintaining the undifferentiated state.

https://www.sciencedaily.com/terms/adult_stem_cell.htm

Induced pluripotent stem cells

iPSC are derived from skin or blood cells that have been reprogrammed back into an
embryonic-like pluripotent state that enables the development of an unlimited
source of any type of human cell needed for therapeutic purposes. For example, iPSC
can be prodded into becoming beta islet cells to treat diabetes, blood cells to
create new blood free of cancer cells for a leukemia patient, or neurons to treat
neurological disorders.

https://stemcell.ucla.edu/induced-pluripotent-stem-cells

Umbilical cord stem cell

The umbilical cord contains millions of stem cells, cells which can be collected
and stored at birth, and can be used to treat over 85 diseases and conditions. Stem
cells in the umbilical cord are shared between mother and baby during pregnancy,
making them a 100% match to the baby and a 25% match to any siblings. If collected
and stored at birth, cord stem cells have the potential to be used for numerous
future treatments for your children

https://futurehealthbiobank.com/stem-cell-banking/what-are-umbilical-cord-stem-
cells/

8.Purposes:
Two main purpose for cord blood storage :
-Donate baby’s cord blood to a public cord blood banking for anyone who needs its .
Donated to a public cord blood bank. Cord blood donated to a public cord blood bank
is available to patients who need a transplant. The donation process doesn’t cost
anything to the parents donating the umbilical cord blood. Today, however, only
certain hospitals can collect umbilical cord blood for storage in public cord blood
banks. Learn about Donating Umbilical Cord Blood to a Public Bank.

-To store for baby’s cord blood bank for family’s use . Stored in a family
(private) cord blood bank. Cord blood stored in a family cord blood bank is saved
for that family. Family cord blood banks are available throughout the country for
anyone who wants to pay for the collection and storage of the umbilical cord blood.
If you are thinking about family banking, call a family cord blood bank as soon as
possible. And Saved for a family member who has a medical need.

https://bloodstemcell.hrsa.gov/donor-information/donate-cord-blood/options-
umbilical-cord-blood-banking-donation

9.METHODS
There are two types and they are ;
-Syringe method: a syringe is used to draw blood from the umbilical cord shortly
after the umbilical cord has been cut. The process is similar to drawing blood for
a regular blood test . Once the umbilical cord is clamped, it is wiped with
antiseptic and a needle is inserted into the vein in the umbilical cord to withdraw
a few ounces of blood.

10.Picture of Syringe method

11.Bag method: The umbilical cord is elevated to drain the blood into a bag.
( Anti-coagulate already kept in the bag )

-Blood bags are designed for the collection, processing and storage of whole blood
and blood components.
-They help in providing aseptic conditions for the separation of blood components.
-It acts as a closed system reducing the chances of contamination.

12.Picture of Bag method

13.another pic of bag method

-Most common method of cord blood is bag method

14.COLLECTION
-Cord blood is collected right after birth. The umbilical cord is clamped and cut.
If cord blood is to be drawn, another clamp is placed 8 to 10 inches (20 to 25
centimeters) away from the first. The section between the clamps is cut and a blood
sample is collected into a specimen tube.
-The collection process is painless and safe for both mother and baby . The process
of collecting your baby’s cord blood is painless, safe and poses no risk to the
mother and baby. It does not interfere with your birth experience or your birth
plan. When the mother goes into labour in the Delivery Room, the mother’s blood is
collected to test for infectious diseases and other related tests. After the baby
is delivered, the umbilical cord is clamped and cut, the cord blood is collected
from the umbilicus vein before the placenta is delivered. The collection can only
take place at the time of delivery. The procedure takes a few minutes in the
Delivery Room, after the baby had been delivered, and before the placenta and
umbilical cord are discarded.
-In fact , it’s so quick and painless that parents caught up in holding and bonding
with their baby are often unaware it has even happened .

15.PROCESS
Clamping and cutting the cord : After the delivery of the baby whether vaginally or
by C-section , the cord is clamped and then cut in usual way . After you've
delivered your baby, whether vaginally or by C-section, the cord is clamped and
then cut in the usual fashion. You can delay cord clamping, as long as the delay is
brief – no more than a minute or two. (If cord clamping is delayed too long, the
blood in the cord will clot. And once the blood clots, it's of no benefit – it
doesn't go to your baby and can't be collected for storage.) Delayed cord clamping
is possible whether you have a cesarean or vaginal delivery. According to the World
Health Organization (WHO), Delayed umbilical cord clamping (not earlier than 1 min
after birth) is recommended for improved maternal and infant health and nutrition
outcomes.

16.Extracting the cord blood : The medical provider then inserts a needle into the
umbilical vein on the part of the cord that’s still attached to the placenta . The
needle doesn’t go anywhere near the baby . The blood drains into a collection bag .
Typically , entire umbilical blood are collected . The entire process takes less
than 5 minutes . The blood is shipped to a cord blood bank, where it's tested,
processed, and cryopreserved (preserved by controlled freezing) for long-term
storage if deemed acceptable according to quality standards.

17.Off to the bank : The blood is transfer to a cord blood bank , where it is
tested , processed , and cryopreserved (preserved by controlled freezing) for long-
term storage. Some family cord blood banks now offer to collect a segment of
umbilical cord tissue contains stem cells , and researchers are studying their
possible .
18.VALUABLE OF CORD BLOOD
-Cord blood is a rich source of blood stem cells .
-Stem cells are the building blocks of the blood and immune system .
-They have the ability to develop into other types of cells , so they can help to
repair tissue , organs , and blood vessels and can be used to treat a host of
diseases .

19.(cotnd)Stem cells are also found in bone marrow, human embryos , fetal tissue ,
hair follicles , baby teeth , fat , circulating blood , and muscle .
Every part of the human body contains some stem cells , but most are not a rich
enough source to have be harvest for therapeutic applications.

20.(contd)In 2012 , 38 % of Haspanic (spanish people in ancient time )patient and

44% of African American patients undergoing stem cell transplants received cord
blood .
More and more adults are receiving cord blood transplants , too , sometimes
involving two cord blood donations if a single one doesnot contains enough cells.
As the end of 2012 , more than 33,900 cord blood units had been transfer for
transplants worldwise .

Cord blood stem cells have been used successfully to treat more than 70 different
diseases, including some cancers, blood disorders, and immune deficiencies. Among
these are leukemia, aplastic anemia, thalassemia, Hodgkin's disease, and non-
Hodgkin's lymphoma. (Cord blood stem cells have been used successfully to treat
more than 70 different diseases, including some cancers, blood disorders, and
immune deficiencies. Among these are leukemia, aplastic anemia, thalassemia,
Hodgkin's disease, and non-Hodgkin's lymphoma. (Cord blood stem cells have also
been used to treat sickle cell anemia, but that procedure is not yet on the FDA-
approved list.)
Cord blood transplants are also used to treat rare metabolic disorders that would
otherwise be fatal for infants (Krabbe disease and Sanfilippo syndrome, for
example).
Studies are under way around the world to explore new ways of using cord blood.
Children in clinical trials are being treated with their own cord blood for
cerebral palsy and autism. Babies and young children in the United States are also
being reinfused with their own cord blood stem cells in clinical trials to develop
therapies for hydrocephalus (fluid in the brain), oxygen deprivation at birth,
traumatic brain injury, type 1 (juvenile) diabetes, and congenital heart defects
that require surgery. If the clinical trials are successful, these therapies may
become commonly available within a few years.
A full list of the current clinical trials with cord blood is available on the
“Diseases Treated” page of the Parent's Guide to Cord Blood Foundation website. The
odds that a child will ever use his or her own stored cord blood are small.
According to a 2005 editorial in the journal Obstetrics and Gynecology, the chances
are about one in 2,700. Other estimates range widely. Advertising from one private
cord blood bank puts the odds at 1 in 27. The American Academy of Pediatrics
suggests it's more like 1 in 200,000.

https://completewomenscarecenter.com/pregnancy-info/cord-blood-banking.dot

23.pic of potential uses of stem cells

24.Cord transplants are also used to treat rare metabolic disorder that would
otherwise be fatal for infants .

25.POSSIBLE FUTURE USES

Studies are under way around the world to explore new ways of using cord blood ;
-Cerebral palsy and autism
The connection between autism and cerebral palsy is not exactly direct – however,
because of the similarities within developmental disorders, it is common for autism
and cerebral palsy to co-occur.
Cerebral palsy is the result of brain damage that occurs before, during or shortly
after birth. Autism is also a brain development disorder, but it tends to progress
after age two or three when a child’s language and communication skills begin to
show an obvious delay.

Cord blood has the ability to cross the blood–brain barrier and differentiate into
neurons and other brain cells. There are a few schools of thought on how cord blood
can repair brain trauma or neurodegenerative disorders:
• The transplanted stem cells directly replace dead or dying cells.
• The transplanted stem cells secret growth factors that indirectly
rescue the injured tissue.
• The transplanted stem cells build a “biobridge” that connects the
healthy section of the brain and the damaged section of the brain to facilitate the
transport of new neural stem cells to the area in need of repair.
Current Clinical Trials
Duke University Medical Center received permission to expand access to cord blood
therapies for brain disorders including autism and cerebral palsy, attracting the
attention of many parents with stored cord blood. The clinical trial is open to
children who have their own cord blood stored or access to partially or fully
matching cord blood from a sibling.
The expanded access protocol is in addition to a phase II trial currently underway
but no longer recruiting

https://www.cerebralpalsyguide.com/cerebral-palsy/coexisting-conditions/autism/

-Hydrocephalus

Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the
brain. The excess fluid increases the size of the ventricles and puts pressure on
the brain.

Hydrocephalus can happen at any age, but it occurs more frequently among infants
and adults 60 and over. Surgical treatment for hydrocephalus can restore and
maintain normal cerebrospinal fluid levels in the brain. Many different therapies
are often required to manage symptoms or functional impairments resulting from
hydrocephalus.

Babies with congenital hydrocephalus often experience developmental disabilities

due to brain injury associated with prolonged increased pressure on the developing
brain parenchyma. Umbilical cord blood (CB) infusion has favorable effects in
animal models of brain hypoxia and stroke and is being investigated in clinical
trials of brain injury in both children and adults. We sought to establish the
safety and feasibility of repeated intravenous infusions of autologous CB in young
babies with congenital hydrocephalus.

Infants with severe congenital hydrocephalus and an available qualified autologous

CB unit traveled to Duke for evaluation and CB infusion. When possible, the CB unit
was utilized for multiple infusions. Patient and CB data were obtained at the time
of infusion and analyzed retrospectively.

Cryopreserved CB products may be effectively manipulated to provide multiple CB

doses. Repeated intravenous infusion of autologous CB is safe and feasible in young
babies with congenital hydrocephalus.

-Treatment for adults

Umbilical cord blood transplants are already successful in treating children with
leukemia, but until now the safety and effectiveness of the treatment in adults
with leukemia has not been examined.
A common treatment for adult leukemia is a stem cell bone marrow transplant. During
this procedure diseased bone marrow cells are replaced with healthy, immature cells
known as stem cells. These stem cells are taken from a strictly matched blood
marrow donor. Once transplanted into the leukemia patient, these cells can grow
into normal blood cells.
However, only about 30% of eligible adults with leukemia have a family member that
matches or is a compatible bone marrow donor. Of the remainder, nearly 20% receive
transplants from unrelated donors, but the risk of the recipient rejecting the bone
marrow transplant, because of incompatibility, is higher when an unrelated donor is
used.
Stem cells that can be used in such a transplant are also found in umbilical cord
blood. But cord blood transplants have been used only as a last resort in adults
with leukemia because cord blood contains only a small fraction of stem cells
needed to treat an adult.

https://www.webmd.com/cancer/lymphoma/news/20041124/cord-blood-transplant-ok-for-
adult-leukemia#1

-Animal studies

Cord blood has been used successfully as an alternative stem cell source to marrow,
particularly in pediatric patients with hematopoietic malignancies, bone marrow
failure, or inborn errors of metabolism, and currently expanding to adults. Cord
blood was known since the 1930s to be useful as a substitute for peripheral blood
in transfusions.

26.PARENTS NEED TO KNOW

The fields of medical research with stem cells is exploding .
The most important thing for parents to understand about the stem cells in cord
blood , by Frances Verter (founder and executive director of the nonprofit parent’s
guide to Cord Blood Foundation );
1. Donate the baby’s cord blood to help patients seeking transplants now or
2. Save the baby’s cord blood for the family in case the need it later , most
likely for a therapy that’s still being studied .

27.STORAGE
After the collection (entire placenta and cord’s blood collection should be done) ,
lab process start through cryopreserved.
There are many ways to process a cord blood until , and there are differing
opinions on what is the best ways .
Some processing methods separate out the red blood cells and remove them , while
others keeps the red blood cells . 7/29/2014 33

28.Cont.……
However the unit is processed , a cryopreservant is added to the cord blood to
allow the cells to survive the cryogenic process.
After the unit is slowly cooled to -90oC , it can then be added to a liquid
nitrogen tank which will keep the cord blood unit frozen at -196oC .
The slow freezing process is important to keep the cells alive during the freezing
process.

29.Contd……
More than 1 million units of cord blood are stored in family banks in the United
States .
And the national Be the match Registry provides nearly 1,85,000 donated cord blood
units in the United States , with additional access to more than 4,25,000 cord
blood units through partnerships with international registries .

30.Contd……
Verter estimates that about 5% of parents now bank their bank’s cord blood . 90% of
that cord blood goes to family and 10% goes to public banks .

31.ADVANTAGES
-Cord blood stem cells are currently used. Cord blood contains blood-forming stem
cells that can be used in the treatment of patients with blood cancers such as
leukemias and lymphomas, as well as certain disorders of the blood and immune
systems, such as sickle cell disease and Wiskott-Aldrich syndrome.
“Cord blood is useful because it is a source of stem cells that form into blood
cells. Cord blood can be used for transplantation in people who need regeneration,
that is, ‘regrowth,’ of these blood-forming cells,” Wonnacott says.
For instance, in many cancer patients, the disease is found in the blood cells.
Chemotherapy treatment of these patients kills both cancer cells and the healthy
blood-forming stem cells. Transplanted stem cells from cord blood can help regrow
the healthy blood cells after the chemotherapy.
However, cord blood is not a cure-all.
“Because cord blood contains stem cells, there have been stem cell fraud cases
related to cord blood,” says Wonnacott. “Consumers may think that stem cells can
cure any disease, but science doesn’t show this to be the case. Patients should be
skeptical if cord blood is being promoted for uses other than blood stem cell
regeneration.”

-several life-threatening diseases. Umbilical cord blood collected at birth is a

rich source of stem cells that can be used to treat diseases of the blood and
immune system. Cord blood stem cells which have infinite medical potential are
currently used in the treatment of several life-threatening diseases, and play an
important role in the treatment of blood and immune system related genetic
diseases, cancers, and blood disorders. Transplant recipients are less likely to
reject a cord blood stem cell and do not require a perfect match as bone marrow
transplants do. Transplantation of umbilical cord blood stem cells represents a
major advantage in providing a new source of stem cells to patients in need.
Private storage of cord blood stem cells clearly has value, in that it provides
future patients and families with potential therapeutic options for transplant.
Many recent studies showed that human umbilical cord blood stem cells have the
potential to generate cells with neuronal characteristics. Therefore, the umbilical
cord blood stem cells can be viewed as the stem cells source of choice for clinical
and non-clinical research applications.

-blood and immune system related genetic diseases , cancer and blood disorder .
-Cord blood stem cells can also be used for siblings and other members of the
family who have a matching tissue type .
-Siblings (75% )chance of compatibility , and the cord blood may even be a match
for parents (50%) and grandfather .

32.PUBLIC BANKS
-A primary concern with public banking is how to ensure the safety of the cord
blood .
-Because of privacy concerns , it is agreed by most ethical reviews boards that
blood donated to a public bank cannot be permanently linked to the donor.

In public banking, the baby's cord blood is donated to a cord blood bank, where
it's stored for use by anyone who may need it for a transplant. It may also be used
for medical research.
Remember, cord blood contains stem cells that can treat a host of diseases — and
the stem cells from your baby’s cord blood could be used to save someone else’s
life. That’s why most major medical organizations (including the AAP and ACOG)
encourage public donation.
Donating cord blood is free, and public cord blood banks pay for collection and
storage. But when parents donate their baby's cord blood, they sign away all rights
to it. The cord blood bank owns the blood.
There may be less legwork involved in finding a public bank compared to finding a
private one. The easiest way to donate publicly is to deliver in a hospital that
works directly with the National Marrow Donor Program network of public cord blood
banks. (To check if your delivery is scheduled at one of the NMDP-affiliated
hospitals, go to bethematch.org.
If your hospital doesn’t participate, you’ll need to find another public banking
option. To find out if there’s a public bank nearby that will accept your donation,
take a look at parentsguidecordblood.org, which lists public banks that participate
in the cord blood registry maintained by the NMDP, and other public banks that
aren’t affiliated with the organization. If there are no local public banks in your
area, there is one public bank that allows mail-in donations: Cord for Life.
Public donors have to meet certain eligibility requirements. If you’re healthy and
are having just one baby (not twins or triplets), you can probably donate. But not
everyone is eligible, and donations can be rejected for a variety of reasons. To
find out about your eligibility, check out this list of donor guidelines.

33.PRIVATE BANKS
-Private banking is costly to insures and private parties , averaging .
-The ability to use the cord blood may also depend on long-term commerical
viability of the enterprise .

In private cord blood banking, parents pay to have their baby's cord blood banked
for his or her own use in the future, or for use by a family member (like a parent
or sibling). The family "owns" the cord blood and can make most key decisions about
how it's used.
The cost of private banking varies depending on the bank, ranging from $1,350 to
$2,500 for the initial collection of the blood, followed by annual storage fees of
$100 to $350 a year. (Some banks also offer free or discounted programs for
families who have a child with a disease that could be treated with stem cells.)

For some, private banking may be the right choice. The American Academy of
Pediatrics (AAP) suggest that you only consider private cord banking if you have a
family member with a genetic disease that may be treatable with stem cells. That’s
because your baby’s cord blood may be a better match for that sick family member
than a non-family donation.
Families also choose to save their baby’s cord blood as a kind of health insurance.
Some emerging therapies for conditions like autism and cerebral palsy use a child’s
own stem cells. In the event that, down the line, more diseases may be treatable
with stem cells, you’ll have those genetically unique cells available to your
family.

34.Contd……
-It is important to ensure the credentials of any potential private bank .
-In the United States , the Food and Drugs Administration regulates cord blood
under the category of “Human Cells , Tissues , and Cellular and Tissue Based –
Products .

35.Contd……
-The odds that two siblings will have the 6/6 match required for a bone marrow
transplant are 25% .
-The odds that two siblings will have the 4/6 match required for a cord blood
transplant are 39 % .

36.SAFETY AND EFFECTIVENESS

-Using one’s own cord blood cells might not wise or effective , especially in cases
of childhood cancers and leukemia .
-Children who develop an immunological disorder often are unable to use their own
cord blood for transplant because the blood also contains the same genetic defect .

37.USABILITY OF ONE’S OWN SAMPLE UNKNOWN

-Most cord blood samples up to 75% may be too small to be used for transplantation
because they don’t contain enough stem cell .
-While a private bank will store a sample , the sample may be too small to be
usable , even by a child .

38.cord blood banking cost

-There are usually two fees involved in cord blood banking;.
-The first is the initial fee which covers enrollment, collection and storage for
at least the first year.
-The second is an annual storage fee. Some facilities vary the initial fee based
upon the length of a predetermined period of storage.

39.Contd……
-Depending on the predetermined period of storage, the initial fee can range from
$900 to $2100.
-Annual storage fees after the initial storage fee are approximately $100 .

40.Contd……
-It is common for storage facilities to offer prepaid plans at a discount and
payment plans to help make the initial storage a more attractive option for baby
and the family .

41.AVAILABLE SERVICE IN NEPAL

-Cord blood banking established in Nepal at 2008 A.D . -Cord blood immediately
courier at store/lab in INDIA within 48 hours .
-Interested parents should inform the specialist during 5-7 months of pregnancy ,
need to pay Rs.20,000 then at the time of delivery need to pay Rs.58,000 ( TOTAL
AMOUNT IN NEPAL FOR CORD BLOOD BANKING IS Rs.78,000 ) .

42.AVAILABLE CORD BLOOD BANKS

COUNTRIES NAME ESTABHLISHED DATE FLORIDA 1983 A.D

GENEVA 1989 A.D
INDIA 2006 A.D
BANGKOK 2008 A.D
KENYA 2011 A.D
SINGAPORE 2013 A.D

43. FLOW CHART OF CORD BANK USER

44. BABY PARENTS GRAND PARENTS PARENTS SIBILING BABY SIBILING MATERNAL
PATERNAL

45. REFERENCES
46. Ty.