OneMatch Stem Cell and Marrow Network

heidi_elmoazzen

In 2011, Canadian Blood Services set out to build Canada’s national public cord blood bank to collect, test and store a reserve of lifesaving stem cells that reflects the diversity of all Canadians. Pulse talks with Dr. Heidi Elmoazzen, director of the national public cord blood bank, to learn more about umbilical cord blood and Canadian Blood Services’ work in building the national bank.

Q:  What are blood stem cells?

A:  Blood stem cells are immature cells that develop into the cells found in the bloodstream: red blood cells for oxygen transportation, platelets for blood clotting and white blood cells for fighting infections. They come from three sources: umbilical cord blood, bone marrow and peripheral blood stem cells that can be collected from whole blood.

Q:  What is special about umbilical cord blood?

A:  Cord blood has three big advantages over other sources of blood stem cells:

1) They can be collected in advance, tested and stored so they are ready to use right away, decreasing patient wait times for a stem cell donor search.
2) Cord blood allows for easier patient matches. Before they have a transplant, patients have tissue typing tests to match the proteins in their blood — HLA markers or histocompatibility antigens — to those of potential donors. Because cord blood stem cells are immunologically immature compared to Continued on page 14 adult stem cells from adult donors, more lenient HLA matching is possible. For adult donors, a perfect match to the patient is required for the best outcome, but for cord blood donors, a lesser degree of matching to the patient will achieve a similar outcome, which increases the possibility of finding a match for patients. This is good news for ethnically diverse patients who tend to be harder to match.
3) Lastly, because cord blood transplants don’t require a strict match, there is less risk that patients will develop complications, such as graft-versus-host disease, after their transplant.

Q:  What are blood stem cells?

A:  Blood stem cells are immature cells that develop into the cells found in the bloodstream: red blood cells for oxygen transportation, platelets for blood clotting and white blood cells for fighting infections. They come from three sources: umbilical cord blood, bone marrow and peripheral blood stem cells that can be collected from whole blood.

Q:  Why does Canada need a national public cord blood bank?

A:  Until recently, Canada was the only G7 country that did not have a national public cord blood bank. This meant that we relied heavily on international sources for stem cells. By developing our own national public cord blood bank, we are increasing the likelihood for Canadian patients to find their match, as well as contributing to the international database for patients around the world.

By having a national public cord blood bank in Canada comprised of cord blood units from Canadians, we are also increasing the chances for Canadians of all ethnic backgrounds to find a stem cell match. If we can create an inventory that reflects the diversity of this country, we have a greater chance of treating the 50 per cent of Canadian patients who still cannot find a stem cell match within the international database.

Q:  How is the cord blood tested and stored?

A:  Canadian Blood Services tests the mother’s blood for a series of diseases, such as human immunodeficiency virus (HIV, the virus that causes AIDS), hepatitis B and C, human T-lymphotropic virus, syphilis, and West Nile virus. These tests are similar to the ones done on donated whole blood.

The baby’s cord blood is tested for HLA markers, cytomegalovirus (CMV), blood type, and potential hemoglobin abnormalities or disorders.

Once the cord blood units are found to be safe, they are stored in liquid nitrogen at a temperature of minus 196 degrees Celsius, and can be stored for a very long time before being used. There are examples of cord blood stem cells being transplanted after 13 years without any detected deterioration in quality.

Q:  What types of diseases are stem cells from cord blood used to treat?

A:  Cord blood is used to treat over 80 diseases and disorders, including leukemia, lymphoma and aplastic anemia, as well as many other inherited immune system and metabolic disorders. Ongoing stem cell research also looks promising for the potential use of cord blood in many other treatments in the future.

Q:  If you donate your baby’s umbilical cord blood to the national public cord blood bank and later change your mind, can you get it back?

A:  Yes, provided it has not already been used in a transplant. Once a cord blood unit has been donated to the national public cord blood bank, those stem cells are made available to any patient in need of a stem cell transplant around the world. If a mother were to change her mind and request her baby’s cord blood be removed from the bank, the unit would be removed and discarded as medical waste.

Q:  Can you direct your baby’s stem cells from cord blood to a specific person?

A:  No. The donated cord blood units banked through Canadian Blood Services’ national public cord blood bank are to be available at all times for any patient in need of a stem cell transplant around the world. They can’t be reserved or directed toward a specific person.

Q:  Can anyone receive a cord blood transplant, including people living outside of Canada?

A:  Yes. Canada’s national public cord blood bank is part of an international registry of available stem cells, which includes 22 million potential adult donors and 600,000 publicly banked cord blood units. While anyone has access to the units collected and stored in Canada, we hope that by building a bank of stem cells that reflects our country’s diversity, we will not only help patients internationally, but provide a much greater chance for Canadians to find a stem cell match here at home.

Q:  Can the stem cells from one umbilical cord donation be used to treat multiple patients or is there only enough to treat one patient?

A:  One cord blood unit is always used for one patient — usually a child or small adult. Most adults who need a stem cell transplant would need the stem cells from two cord blood units or from one adult stem cell donation. Because stem cell transplants require a certain number of stem cells per kilogram, the number of stem cells needed varies from patient to patient.

Q:  What are the differences between the national public cord blood bank and a private bank?

A:  The national public cord blood bank charges no fees to donors and makes donated stem cells available to any patient in need around the world. It increases the number and diversity of cord blood units available to all patients, making it easier to find matches for patients who can’t otherwise find one.

In contrast, private banks charge customers a one-time collection fee and annual storage fee, and store cord blood units for personal use only.

Q:  Where can I donate cord blood?

A:  The national public cord blood bank currently collects cord blood donations at four hospitals: The Ottawa Hospital General and Civic campuses in Ottawa, the William Osler Health System’s Brampton Civic Hospital, the Alberta Health Services’ Lois Hole Hospital for Women in Edmonton, and the BC Women’s Hospital and Health Centre in Vancouver.

Q:  How is cord blood donated?

A:  Expectant mothers who plan to deliver at one of the four participating hospitals will be provided with an information packet from their physician or midwife while pregnant. They can also download the info package from blood.ca/cordblood.

Expectant mothers must sign a Permission to Collect form, which they can give to their health professional at any point during their pregnancy or present at the hospital during delivery (the form can’t be signed while in active labour). Mothers should also let their delivery nurse know they would like their baby’s cord blood donated.

Cord blood will be collected in one of two ways: either after your baby is delivered but before the placenta is delivered (in utero) by a hospital physician or licensed midwife or it is collected by a designated Canadian Blood Services personnel after both your baby and placenta are delivered (ex utero). The cord blood unit will be sent to one of our manufacturing facilities in Ottawa or Edmonton, where it will be processed, tested and stored in a special freezer.

Q:  Does it cost money to donate cord blood to the national public cord blood bank?

A:  No. All donations are made through the generosity of each individual donor.

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