FAQ

 

Cord blood is the blood remaining in the blood vessels of the placenta and umbilical cord after the child’s birth and it contains a large number of haematopoietic stem cells. The placenta and blood remaining in it are destroyed after the delivery.

 

After the delivery of the child, blood containing a large number of haematopoietic cells similar to the cells from bone marrow remains in the blood vessels of the placenta and umbilical cord. These cells can generate all types of blood cells (red blood cells, leukocytes, platelets). Since they can regenerate bone marrow, these cells can be transplanted instead of bone marrow cells to treat haematological diseases and severe immune system deficiencies. The placenta is destroyed after delivery. Due to its biological capacity, the blood remaining in the placenta started to be procured and stored on a long-term basis on very low temperatures. To this day, over 600,000 doses of cord blood have been stored worldwide in public banks, with numbers growing each day. Thanks to that, over 14,000 haematopoietic cord blood stem cell transplantations have been performed.

 

Haematopoietic stem cells (HSC) can be procured from bone marrow, peripheral blood and cord blood. These cells have been successfully used for transplantations treating various diseases. Bone marrow is the most frequent source of allogeneic (from another person) haematopoietic stem cells. Peripheral blood contains larger amounts of haematopoietic stem cells only after inducing bone marrow cells with certain medication. It is only then that they can be procured in numbers sufficient for transplantation. The procurement of bone marrow and haematopoietic stem cells from peripheral blood are procedures that carry a certain risk for healthy donors, unlike cord blood procurement.

 

The most frequent purpose of stem cell transplantation from a matching donor is the treatment of patients suffering from leukaemia and other malignant diseases of the circulatory system, and patients with hereditary disorders of the immune system, metabolism and haemoglobin synthesis (severe anaemias).

Malignant diseases: acute lymphoblastic leukaemia, acute myeloid leukaemia, chronic myeloid leukaemia, myelodysplastic syndrome, neuroblastoma.

Non-malignant diseases: adrenoleukodystrophy, amegakaryocytic thrombocytopenia, Blackfan-Diamond syndrome, congenital dyskeratosis, Fanconi anemia, Gunther’s disease, Hunter syndrome, Hurler syndrome, severe aplastic anaemia, Kostmann syndrome, Lesch-Nyhan syndrome, osteopetrosis, severe combined immunodeficiency, thalassaemia, X-linked lymphoproliferatives.

 

Most women can donate umbilical cord blood. However, we must be certain that the donated cord blood is safe for the recipient. Therefore, each donor of cord blood must fill in a health questionnaire asking about her health and the health of her family members, including questions about the pregnancy and any medication she might be taking. A part of the questions concerns the donor’s current and previous lifestyles and includes questions on sexual activity and drug abuse. Donors of cord blood must be legally of age (over 18).

 

You can donate cord blood for the public bank in 23 delivery centres in Croatia in which the Ana Rukavina Cord Blood Bank has conducted an education programme licensing the staff to procure cord blood. The delivery centres hold cord blood procurement kits, while the Bank organises the transportation of the procured blood from the delivery centre to the Bank.

Apart from the delivery centres in Zagreb, you can donate cord blood in other cities, such as: Rijeka, Pula, Split, Zadar, Šibenik, Dubrovnik, Metković, Knin, Osijek, Slavonski Brod, Karlovac, Sisak, Čakovec, Virovitica, Vinkovci, Koprivnica, Varaždin and Zabok.

In the delivery centres in Zagreb you can donate cord blood 24/7.

In the delivery centres outside Zagreb we can only collect donations on working days, that is from Sunday 3 P.M. until Friday 1 P.M. This is so because the process organisation depends on the working hours of delivery services, as cord blood must be processed and stored within 48 hours after the delivery of the child.

 

Cord blood is procured only in cases in which the mother has given explicit consent. In other cases, the placenta and the umbilical cord are simply destroyed alongside all other biological waste.

Filled in and signed forms of consent (Informed Consent for Cord Blood Donation, Health Questionnaire for Cord Blood Donors, Identification Form for Cord Blood Donors) must be taken to the delivery centre and handed in to the staff on the day of delivery.

The staff does not need to be notified of cord blood procurement in advance unless otherwise stated in the List of delivery centres where cord blood donation is possible.

 

According to the provisions of the Regulation on the procedures of procurement, storing and use of haematopoietic stem cells, the mother must be notified of the procurement procedures and give her written consent before procurement.

 

  1. You are not legally of age (under 18).
  2. You are carrying twins.
  3. You have an untreated infection at the time of delivery.
  4. Meconium liquor, unclarified temperature or other signs of infection.
  5. You have AIDS or an HIV infection.
  6. You have hepatitis B or hepatitis C, or an HBV or HCV infection.
  7. You are in one of the following behavioural risk groups:
  • drug or alcohol addicts
  • intravenous drug abuse
  • frequent change of sex partners
  • receiving money, drugs, or other kinds of compensation for sex
  • sex with a partner who is in a behavioural risk group
  • sex with a person who has homosexual sex
  • sex with a person who with a history of intravenous drug abuse
  • sex with a person suffering from haemophilia or taking clotting factor concentrates
  • you have or were treated for syphilis
  • sex with a person with an HIV infection
  • residence in the UK between 1986 and 1997 for a period over 6 months
  • residence in an area with an HIV subtype O incidence rate.

 

Yes. Caesarean-sections do not affect the procurement process.

 

No. Unfortunately, cord blood donation is not possible in the case of a twin or other multifoetal pregnancy. Since the placenta is smaller in multifoetal pregnancies than in single-foetal pregnancies, an amount of blood sufficient for storing in the public bank cannot be procured after delivery.

 

The process of cord blood procurement is safe for you and your child. It is performed after delivery, once the umbilical cord has been severed. The process of cord blood procurement is painless and safe both for the mother and the baby.

 

Cord blood is procured after an uncomplicated delivery (vaginal or caesarean section) using a procedure which is not harmful to the mother or the newborn. The procurement process does not require the physician and midwife to change the usual delivery management procedure. The child is separated from the placenta by severing the umbilical cord at least 30-60 seconds after birth. While the placenta is still in the womb, the umbilical cord is disinfected after which the umbilical vein is pierced with a syringe connected to a bag, which enables the collection of as much of the blood remaining in the placenta as possible. In most cases the process of procurement takes around 5 minutes, as normal processes of coagulation in the umbilical cord and placenta start taking place after that. Procurement is painless, simple and safe for the mother and child.

 

Yes. Once cord blood is processed, tested and stored it is available to every patient in Croatia and abroad. Stored cord blood is tagged with a unique ID number and registered in the national and international Cord Blood Registries.

 

Procured cord blood must be processed and stored within 48 hours of the child’s birth. Immediately after procurement, the blood is delivered to the bank under controlled conditions. In case of donations, the Bank organises the delivery of procured cord blood in controlled conditions. The Bank staff assesses the quality of the received blood by means of laboratory tests and by checking the documentation. A cell processor separates a layer of cored cells containing haematopoietic stem cells from the cord blood and removes plasma and red blood cells, which improves the quality of cryopreservation of the separated cells. The volume of cord blood after processing reduces to 25-30 mL. A solution preventing cells from rupturing during freezing is added to the cell concentrate. The newest methods of storing include storing blood in plastic bags with a small compartment (20% of content), which is specially sealed and can be used for ex vivo cell expansion to increase their number (This is not common: only a few centres in the world conduct transplants this way).

In order to maximally decrease cell damage, cord blood freezing is programmed to an optimal cooling speed in a unit of time. Once at least -80°C is reached, the cord blood can be transferred to liquid nitrogen tanks where it stays until it is issued for transplant. The cells are preserved at a temperature of -196°C.

 

Cord blood samples are tested for histocompatibility antigens (HLA antigens). These tests are necessary to determine the compatibility of tissues of the cells from cord blood and the patient’s cells. In case they are chosen for transplant, cord blood samples are additionally tested for hereditary diseases, such as Gaucher’s disease, adrenoleukodystrophy and haemoglobinopathy. The tests prevent the transmission of haematopoietic stem cells with hereditary changes to the recipient. The number of haematopoietic cells and the growth of haematopoietic colonies are determined in the procured blood samples. The microbiological safety of the procured blood is tested. These tests assess the quality of cord blood products.

 

After delivery, a blood sample will be collected from you for the purpose of testing for blood-borne communicable diseases. Blood samples will NOT be collected from your child!

Your blood will be tested for hepatitis B and hepatitis C viruses, HIV 1/2 (the virus causing AIDS), cytomegalovirus (CMV), human lymphotropic virus type 1 and 2 (HTLV 1 and 2) and syphilis. If one of the tests is positive, your cord blood will not be stored in the bank. The tests can include determination of histocompatibility antigens. Part of your blood will be frozen and stored for future tests for currently unknown diseases.

 

Unfortunately, cord blood procurement is not always successful. Sometimes the volume of cord blood is insufficient or the blood clots during the procedure. This does not mean that there is a problem with your health or the health of your child.

In general, every third donated blood meets the criteria for storage in the public bank.

 

Volume is especially important when donating cord blood to the public bank, which stores grafts for treating adult patients. If cord blood is stored for personal use, the volume matters, but is not essential for storage, as it is not known whether the cord blood will be used for treating a child or an adult, or whether it will be used to restore damaged tissue, which requires a smaller number of cells.

 

The cord blood that does not meet the public bank quality requirements can be used for improving the blood processing and storing procedures and for research into transplant improvements.

 

If you are donating cord blood, the information on your identity and the identity of your child will not be revealed to anyone, except in case of a legal obligation or your Request for Providing Information. Donated blood is joined with a unique number used for identification in the bank, registry and transplantation centre. We will do everything necessary to protect your identity and the identity of your child.

 

Yes. It is necessary to collect every millilitre of cord blood. The number of stem cells is proportionate to the volume of cord blood. The greater the volume is, the greater the possibility of a large number of cells.

 

No. The Ana Rukavina Cord Blood Bank is a public bank and does not charge the procurement, testing or storing of cord blood.

 

No. You do not receive financial recompense for donating cord blood.

 

It is still unknown how long a frozen cord blood product can be preserved. Research shows that even after more than 15 years of cryopreservation cord blood has the same biological features as before freezing. The technology of cryopreservation is still developing, so it is possible that further testing will show that the life expectancy of these cells is limited. However, it is also possible that haematopoietic stem cells can be preserved indefinitely.

 

If tests show that procured cord blood does not meet the quality requirements for transplantation, the blood will be used for research in the field of haematopoietic stem cell transplantation and cell therapy. The blood will be used for research only if you have granted written consent. According to current Croatian legislation, the research must be approved by the Ethics Commission. Should the blood be used for research, the data on you and your child will be protected. UNDER NO CIRCUMSTANCES will cord blood be used for cloning or commercial purposes.

 

Cord blood stored in the Ana Rukavina Public Cord Blood Bank is available for public use and is not stored specifically for the needs of the donor and her family. Should you or someone from your family need a cord blood graft, the Stem Cell Donor Registries and Cord Blood Registries will be searched for the most suitable product in terms of histocompatibility antigens. This may be the product you donated. However, if your child’s cord blood has already been issued for transplantation for another patient, it will no longer be available.

 

All the donated cord blood that has fulfilled the quality requirements will be registered in the Cord Blood Registries and will be available for all patients. In case the transplantation centre issues a solicitation, the cord blood will be issued for treatment. Large cord banks issue 3-5% of the stored doses.

The family bank, i.e. the Cord Blood Bank for Personal Needs, is not registered in the Cord Blood Registries, as it is not intended for the treatment of people other than family members.

 

In case that a child who has their own (autologous) cord blood stored needs a transplant for treatment purposes, the physician decides on whether the stored cells will be used or not. The use of this graft depends on the characteristics of the disease that makes the transplantation necessary. If the diseases to be treated are childhood leukaemias or hereditary diseases, there is a good chance that the stored haematopoietic stem cells carry a genetic defect that contributed to the development of the disease and the physician will not make use of them. Chances that autologous cord blood will be used for transplantation are very small. They are difficult to assess, but chances before the age of 20 are around 1:2,500 to 1:200,000. Cord blood stored for personal needs has shown to be more useful in treating family members.

 

Today’s treatment method consists of destroying sick bone marrow with high doses of cytostatics and radiation. However, this destroys the patient’s stem cells in the process. Without umbilical blood, that is other stem cells, be it the patient’s own cryopreserved stem cells or the stem cells of a donor, the patient would not be able to survive. Without the help of these cells patients cannot survive for more than two to three months.

 

When deciding on cord blood donation it is important to understand the difference between storing in a public cord blood bank and a private cord blood bank.

By donating cord blood to a public bank, the mother concedes the right to manage the blood to the bank. The bank will register all stored blood meeting the quality requirements in the Cord Blood Registries. Stored cord blood will be available for all HLA matching patients needing a haematopoietic stem cell transplant. The cord blood donor has no financial expenses in relation to the donation. Blood is NOT stored exclusively for the needs of the newborn’s family.

At the moment, there is a large number of patients in the world who need a haematopoietic stem cell transplantation but cannot find a suitable donor. Cord blood stored in public banks increases the possibility of finding a graft that could save someone’s life.

Family, private banks store cord blood for personal needs so that, in case of necessity, the blood would be used to treat family members. This blood is a type of biological insurance. The financial costs of processing and storing cord blood are covered by the family. Chances that autologous cord blood will be used for transplantation are very small. They are difficult to assess, but chances before the age of 20 are around 1:2,500 to 1:200,000. If the child develops leukaemia or a hereditary disease, it is very unlikely that the child’s own cord blood will be used in the treatment. It is more likely that haematopoietic stem cells from a related donor or a matching cord blood dose from the public bank will be used in these cases. It has been proved that in some forms of leukaemia haematopoietic stem cells are changed even during foetal life.
The decision to donate cord blood must be made on the basis of complete and accurate information.

 

Based on today’s scientific knowledge it is not possible to foresee the future clinical application of stem cell therapy for diseases where damaged tissue needs to be regenerated (myocardial infarction, cerebral infarction, spinal cord trauma, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, diabetes). Even though extensive research is done in this branch of medicine, this type of treatment is still not clinically applied. Also, the question remains whether these cells will be more suitable than the patient’s haematopoietic stem cells from bone marrow or peripheral blood. Since the purpose the cells will be used for in the future is not precisely known, there are no strictly defined quality requirements that autologous cord blood stored in the private bank must meet. Therefore, the family private bank stores all the blood procured from the umbilical cord that can be properly processed.

 

Cord blood for family needs can be stored in the Cord Blood Bank for Personal Needs of UHC Zagreb. After signing the contract, the family receives the cord blood procurement kit. The future mother chooses a delivery centre and makes arrangements on cord blood procurement there. She does not have to choose only between the delivery centres cooperating with the Public Bank. The transport of the blood to UHC Zagreb is organised by the family. If you wish to order a contract, please contact the Counselling centre of the Cord Blood Bank of UHC Zagreb on the following phone number +385 1 2388 708.

 

UHC Zagreb has a programme of related donor cord blood procurement for families with medical indications, intended for families with a child receiving treatment for a haematological disease who might be in need of a transplant some day. On request by the patient’s physician (haematologist, oncologist), the UHC Zagreb Transplantation team issues a clearance for cord blood storage according to the Code for Approving Cord Blood Storage for Medical Reasons. If the Team approves the storage, the Croatian Health Insurance Fund covers the costs of procurement, collection and storage.

 

No. In order to enlist in the Stem Cell Donor Registries you need to fill in an application form and give a blood sample on one of the Register’s/Fund’s activities. Donated cord blood meeting the quality requirements is registered in the Cord Blood Registries, and not in the Stem Cell Donor Registries. Donors from Cord Blood Registries cannot be asked to donate haematopoietic stem cells from bone marrow or peripheral blood.