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Thursday, June 1, 2023

Banking Blood to Hedge Future

Carla Castro enlisted her husband to remember something the moment they dashed out the door to the hospital for the delivery of their second daughter.

The package didn’t contain her favorite slippers or snacks for the long haul ahead. Instead, it held an empty plastic bag, alcohol pads and a needle used to collect her daughter’s umbilical cord blood.

A sample of this blood, rich in stem cells, could be the key to saving a family member’s life in the future.

Cord blood has been used in the treatment of at least 70 different diseases so far, with leukemia the most common among them, according to the New YorkBloodCenter, the world’s oldest and largest public bank.

“Increasingly, cord blood is becoming the first choice for children as a source of stem cells,” states the center’s Web site. “Just like bone marrow, cord blood stem cells are capable of generating all the cellular elements in the blood and immune system.”

Castro, director of the parenting magazine Mamá Joven, said she has relatives with cancer. “That motivated me to think that you never know if at some time you could use those cells, that blood.

“For me, this is like life insurance; I don’t want to use it, but it’s insurance just in case.”

Castro is one of at least 1,300 mothers who have chosen to store their children’s umbilical cord blood at Provida, a cord blood bank located in Barrio Escalante in eastern San José. For a fee, Provida cryogenically freezes the blood samples and stores them for future use in treatments against bloodborn or immune system diseases.

The privately owned Provida made news in early June when the Constitutional Chamber of the Supreme Court (Sala IV) ruled in favor of a client who requested her child’s umbilical cord blood be collected in Hospital México.

Storing cord blood is gaining popularity, with public and private banks sprouting up worldwide. While public banks receive donated blood and serve as a resource for those who have no private matching donor, private banks store blood samples for paying clients to use in case of a medical emergency.

Provida is the sole provider of such services in Costa Rica, charging $1,100 for the initial service and $100 per year for the blood’s storage.

The Social Security System (Caja) has approved launching a public cord blood bank at the San Juan de Dios Hospital. The public bank could be open by the end of the year, should all the necessary equipment arrive in time, according Priscilla Orlich, a hematologist and immunologist who focuses on cord blood research at San Juan de Dios.

A public bank, she said, would be a source of hope for many people with few resources suffering from genetic disease.

“They don’t have a treatment option,” Orlich said. “We are going to be able to offer it to them.”

For those who can pay, Dr. Eduardo Glenn has welcomed proud parents-to-be to Provida since 2004, explaining to them everything from the cord blood’s collection to its curative potential.

“There are a lot of myths and realities that surround the use of cord cells,” Glenn said. “There are people who can have unreal expectations.”

Glenn stepped into a modest laboratory where a white board hung with a list of 15 women’s names. All were expecting births in coming days, and all planned to store their baby’s blood at Provida.

Each woman receives a kit to bring to the hospital. Once the baby is born, a gynecologist or Provida on-call doctor extracts blood from the umbilical cord while the placenta is still inside the mother.

Within 24 hours, the blood must be transferred to Provida, where samples are extracted and placed into test tubes, purified and placed into a safe-like freezer filled with liquefied nitrogen.

With chilly smoke billowing around his gloved hand, Glenn pulled a column of boxes from the cryogenic system. Each blood sample, he explained, is kept at minus 196 degrees Celsius.

Touching the pressurized gas in liquid form would be deadly, so all lab personnel wear special gloves, aprons and face guards to handle the chemical.

Invoking scenes from the movie “The Terminator,” he said that chemical spills could freeze body parts instantaneously. No such accidents, however, have been reported in this lab, he said.

As it is easy to collect and does not have to perfectly match the patient, cord blood is seen as a more accessible tool than bone marrow for treating disease.

Cord blood’s potential has not missed the attention of Glenn’s clients.

“People see that there is a greater chance that stem cells can be used (to fight disease),” said Glenn, adding that one in 450 children develop an illness requiring such a transfusion.

The AmericanCollege of Obstetricians and Gynecologists casts doubt on Glenn’s estimate, however.

“Some experts estimate this likelihood (of using saved cord blood) at 1 in 2,700, while others argue the rate is even lower,” stated a February 2008 ACOG press release. “Physicians should also disclose to their patients that it is unknown how long cord blood can successfully be stored.”

Using cord blood transfusions can be risky. Samples tend to be small and patients could contract illnesses carried in the donor’s blood, if it is not thoroughly screened, ACOG reported.

So far, Castro’s family has not had to use their blood stock. Looking at her healthy daughter, Castro said she does not regret the decision she made more than two years ago to store the blood.

“I am making a bet,” she said. “There are many possibilities where this sample could be the base of some treatment,” Castro said. But, “I hope not.”



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