Frequently Asked Questions

About Cord Blood and Haematopoietic (Blood) Stem Cells

Cord blood is the blood that remains in the umbilical cord and in the placenta after child birth. The umbilical cord and the placenta together with the blood in it, is usually discarded after the baby has been delivered. The blood in the umbilical cord is found to be a rich source of blood stem cells, which are also known as “haematopoietic” stem cells. These stem cells have been successfully used in the treatment of blood related cancers, immune and genetic diseases.

Stem cells are the primitive cells found in various tissues of the body that can differentiate into the specific functional cells of various tissues. They are the source of tissue renewal, repair and growth. Blood stem cells, or “haematopoietic” stem cells, are those that produce the steady stream of blood cells, such as white, red cells and platelets that will keep the body healthy. The source of blood stem cells are bone marrow, mobilized peripheral blood and umbilical cord blood.

Stem cells harvested from the umbilical cord blood are the earliest source of stem cells available and is at the most naïve state. It is able to accept a higher level of mismatch due to this naivety compared to adult stem cells harvested from mobilized peripheral blood or the bone marrow. The benefits of using umbilical cord blood stem cells include:-

  • Lower risk of Graft-vs-Host Disease
  • Easier to search for a match as tissue typing is done once the CBU is banked.
  • Immediate availability when required.
  • Cord blood collection is safe and painless with minimal risk to the mother and baby.

Blood stem cells can be used to treat diseases such as leukaemia, lymphoma and other blood disorders, as well as immune deficiencies and metabolic diseases. A list of indications, which can be treated by cord blood transplants, can be found at http://cordbloodforum.com/images/pdf/cbt_indications.pdf. The stem cells from the cord blood are transfused into the patient by the Transplant Physician as part of the treatment.

The Singapore Cord Blood Bank (SCBB) is not able to accept a cord blood storage from an expectant mother with twin or multiple pregnancies as it is considered a high-risk pregnancy. SCBB advocates that the safety of the mother and baby is/are of utmost importance. Further, there could be a possibility of mixing or confusing the tissue types of the two umbilical cords. As the tissue types are used to match a cord blood unit (CBU) to a patient, any potential mix-up in the tissue types would not be favorable for the immune-compromised patient receiving the cord blood unit to survive.

SCBB adheres to international public cord blood banking guidelines for Unrelated Haematopoietic Stem Cell Transplants (HSCT). As an affiliate member bank of the National Marrow Donor Program (NMDP) in the US, the SCBB follows FDA guidelines and stringent public cord blood banking criteria, thus, not all donated umbilical cord blood can be stored at the SCBB. In order to meet international requirement for a life-saving cord blood transplant, all collected CBUs will be evaluated for volume of blood, cell count, cell viability, and infectious disease amongst other panel of testing requirements. These will ensure only samples of the highest quality are banked and made available to patients in need of cord blood stem cells for cord blood transplant procedures. Suitable samples will then be prepared for storage at -180° Celsius, in cryogenic tanks, until they are required for HSCT. When CBUs do not meet the banking requirements, it may be assigned for approved research. In cases where the maternal donor has indicated that she does not want the cord blood unit for research, it will be discarded according to normal hospital protocols.

Options for Storing Umbilical Cord Blood

Umbilical cord blood can be donated to the public cord blood bank or stored at a private cord blood bank.

 

SCBB offers Community Cord Blood Banking, a comprehensive and holistic approach to cord blood banking. It comprises public cord blood donation and family cord blood banking services (with the option of potential donation in future). While SCBB remains committed to our mission of saving lives with a focus on public cord blood banking, family cord blood banking is a service for parents who choose to store for their family.

The umbilical cord blood is collected after the baby is delivered and the cord has been clamped and cut by the obstetrician. The cord blood is collected from the umbilicus vein from the section of the cord that remains attached to the placenta.

Studies have shown good cord blood cell recovery after up to 20 years of storage. The cell viability and functionality beyond this period has not been evaluated, but the scientific community will continue to monitor the situation and collect data to ascertain the maximum shelf-life of a stored cryopreserved cord blood unit.

Public Cord Blood Donation

Umbilical cord blood is rich in life-saving stem cells, as described above. Rather than discard it after delivery, which is done frequently, you can donate it to give someone a chance at a cure.

 

Donating cord blood to a centralised public cord blood bank such as the SCBB increases the number of cord blood units available to all potential stem cell transplant patients. This therefore increases the chances of finding a match for the patient.

 

Donation is even more urgent when data shows that ethnicity plays an important role in finding a stem cell match. The donation of umbilical cord blood units that matches the ethnicity of the population is critical in helping to save lives of needy patients.

 

Since the first unrelated umbilical cord blood transplant in 1993, over 30,000 cord blood transplants have been performed around the world. These patients received unrelated cord blood units that were generously donated to a public cord blood bank.

Cord blood donation is medically safe. The process poses minimal health risks to the mother or baby. The birth experience will also not be affected as the cord blood is only collected after the safe delivery of your baby. The blood is collected from the umbilicus vein from the section of the cord that remains attached to the placenta, not the baby. The safety and well being of both mother and baby will always be of primary importance.

Ten delivering hospitals, both restructured and private, in Singapore are participating in our cord blood donation programme.

 

These are the restructured hospitals:

  • KK Women’s and Children’s Hospital (KKH)
  • National University Hospital (NUH)
  • Singapore General Hospital (SGH)

The private hospitals include:

  • Gleneagles Hospital (GEH)
  • Mount Alvernia Hospital (MAH)
  • Mount Elizabeth Novena Hospital (MNH)
  • Mount Elizabeth Orchard Hospital (MEH)
  • Raffles Hospital (RH)
  • Parkway East Hospital (PEH) formerly known as East Shore Hospital
  • Thomson Medical Centre (TMC)

The criteria for donors can be summarised as follows:

  • Donors should be fit to donate blood by international criteria of blood banks.
  • Donors should not have any infectious diseases, which could be transmitted, or are at risk of transmitting any form of infectious diseases by donation.
  • Donors should not have any genetic disorders within the immediate family, which could be transmitted.
  • Mothers having twins, triplets or other multiple births in one pregnancy will also be excluded.
  • Mothers experiencing high-risk pregnancies will also be excluded, so that the delivering doctor (obstetricians) can focus on the pregnancy at hand.

SCBB collects about 30mls of blood (about three soup spoons) from the mother when she is the Labour Ward / Delivery Suite. This will be evaluated for infectious diseases to ensure that the blood is safe for the immune-compromised patient.

You can talk to your gynaecologist/obstetrician about your intention. He or she will alert SCBB, who will arrange for a donor coordinator to contact you. Alternatively, you can call SCBB’s donor recruitment coordinators at 6394-5011 or email donate@scbb.com.sg.

The following are the procedures and processes which need to be undertaken to ensure that cord blood collected meets stringent quality standards for transplants.

  1. Pre-screening evaluation of eligibility
    A pre-screening evaluation of donation eligibility can be conducted on our website or via telephone interview. questions to ensure that the mother and infant donor meets scbb’s established criteria for donation, including the birth parents and family medical history, will be asked. this will help to ascertain donor suitability before proceeding to the next stage of donation.>

     

  2. Informed consent
    The next stage involves taking informed consent from the mother. SCBB’s donor coordinators will arrange for a counselling session for the mother to understand the implications and process of donation. The mother would need to complete and sign the Volunteer and Informed Consent Form and the Maternal Risk Questionnaire.

     

  3. Affirmation of consent
    The mother, who signed the informed consent in the previous stage, would need to reaffirm her consent for the collection of the umbilical cord blood, when she has been admitted and awaiting delivery in the delivery suite.

     

  4. Collection of maternal sample
    The next stage involves the collection of blood sample from the mother before delivery takes place. Approximately 30mls, about three soupspoons, will be collected and used for evaluation of infectious diseases. This procedure is necessary to ensure that all cord blood units collected are free of all infectious diseases and safe for transplant.

     

  5. Collection of umbilical cord blood
    The next stage involves the collection of the umbilical cord blood; which is done after the delivery has been completed and when the delivering doctor has ensured the well-being and safety of both mother and baby. The collected units will then be transported to SCBB for processing.

The Consent Process is when the potential donor is required to go through a counselling process to understand the implications and process of donation. The following forms are required to be signed and completed.

  • The Volunteer Information and Informed Consent Form
  • The Maternal Risk Questionnaire

These forms MUST be completed before going into the delivering hospital’s Labour Ward / Delivery Suite.

The completion of Maternal Risk Questionnaire is required to determine the suitability of the donor and to ensure the safety of the patient during the transplant process. If the Maternal Risk Questionnaire is not completed, the cord blood unit will not be collected.

Any identifying information is never exchanged between a cord blood donor and cord blood recipient. The identity of cord blood donor is kept confidential at SCBB.

SCBB has a strict confidentiality clause. All information will only be released directly to the respective donor upon request via telephone, email or in person unless authorisation is given by the donor in writing.

When you decide to donate your baby’s cord blood, you will need to contact the SCBB after 32nd weeks to go through the Consent Process. You would also need to speak with your delivering doctor on the collection of cord blood. The donation of cord blood should be decided before labour and not after delivery.

Yes, if you are having a Caesarean section, you may wish to speak with your delivering doctor on your intention to donate your cord blood.

If there are any complications during the delivery process, the cord blood will not be collected. The safety and well being of both mother and baby are of primary importance.

The cord blood donation to SCBB is free. SCBB raises its own funds to collect, process, store and distribute the donated CBU. There are no fees paid to the staff and doctors involved in the cord blood collection process; neither are they financially rewarded by the SCBB. However, the rights to the donated CBU will be relinquished by the donor to SCBB, upon collection of the CBU at delivery. The donated unit however is made available to anyone who requires it for treatment, and not kept specifically for the donor’s and/or the family’s personal use.

The number of stem cells harvested from umbilical blood is limited. The splitting of precious cord blood will result in insufficient stem cells to meet the international public cord blood banking requirements.

It is optional to participate in approved ethical research in the Volunteer Information and Informed Consent form. If you have indicated that you do not wish to participate in research, it will be discarded.

Community Cord Blood Banking

SCBB Community Cord Blood Banking is an ethical approach to cord blood banking which provides parents with clear and balanced information to educate and enable parents to make an informed decision, with full autonomy of choice. It includes both public donation as well as family banking services. Public banking (also known as Cord Blood Donation) remains SCBB's core mission and focus.

The key difference is that parents can choose to donate their cord blood in future, subject to the donation criteria, if they decide not to continue with family storage. This will potentially increase the public inventory, to save the lives of more patients with blood cancer or disorder.

SCBB offers an initial storage period of five years. Depending on the growth and well-being of the child in the first five years, parents can then decide if they would like to continue storage.

What Happens after Donation

After the umbilical cord blood has been collected, it will be evaluated for volume, cell count, viability (i.e. 90% of counted cells should be ‘alive’), clots, and infectious and genetic diseases. These will ensure only samples of the highest quality are banked and made available to patients in need of cord blood stem cells for medical transplant procedures. Suitable samples will then be prepared for storage at -180, in cryogenic tanks, until they are required for transplantation.

Donors will not be informed of the release of the cord blood unit as SCBB respects and protects the confidentiality of both donors and recipients.

About the SCBB

SCBB’s mission is to provide quality cord blood units through internationally accredited practices to improve transplant outcomes, support cellular therapy and related research

A public cord blood bank such as the SCBB will help to increase the number of cord blood units available for unrelated blood stem cell transplant patients; hence increasing treatment options.

 

While there are cord blood banks in the region, they are only for domestic use and most do not have the multi-racial ethnic profile that is present in Singapore. Thus, it would be difficult for a Singaporean to find a match in these banks. Each year, about 60% of patients in Singapore are not able to find a suitable stem cell match from bone marrow donors and other public cord blood banks. Likewise, about 65 to 80 per cent of Asians worldwide are also unable to find a suitable match.

SCBB is an affiliate member of National Marrow Donor Programme (NMDP) the largest stem cell registry around the world and is also registered with the United States of America (USA) Food and Drug Administration (FDA). The NMDP is the national registry for bone marrow and umbilical cord blood units in America. Any accredited and licensed transplant physician and/or transplant centre searching through the NMDP for a life-saving cord blood unit, will also be searching SCBB for a matching unit.

No. All participating hospitals, their staff and doctors involved in the collection process for SCBB are not rewarded monetarily by SCBB.

Access to Units stored at SCBB

The umbilical cord blood units stored with the SCBB will be made available to any Singaporean or overseas patients who require a life-saving stem cell unit for treatment, as assessed by their transplant physicians.

SCBB manages both donors and non-donors in the same manner. We appreciate every donation received and every search for a life-saving cord blood unit is a priority for us. If a donor’s cord blood unit meets the criteria for banking, and is still in storage at that time, the cord blood unit would be available for the patient who will benefit most from it; this could be the donor or someone else. Although the donor would have the first priority, in an unlikely simultaneous need, it would be up to the Transplant Physician to determine if it is deemed wise to use the donor’s own cord blood unit in this instance. Data have shown most unlikely that the donor should ever need his own cord blood unit as most transplant physicians may not feel that the patient’s own cord blood unit is the best choice. This is because it may already carry the genetic abnormality that led to the blood or immune system failure or cancer in the first place.

SCBB is able to facilitate transplants overseas. Its units are searchable by transplant physicians worldwide in view of its membership with the NMDP (National Marrow Donor Program®). The membership connects SCBB to an international network of other registries and transplant centres.

Public cord blood banks, such as the SCBB, do not reserve any cord blood units for the specific family’s usage. However, if the family requires the unit and it is still available in the bank, we will work with your Transplant Physician on the release of the unit, if it has been found to be suitable. If the cord blood unit has already been released for transplantation, we will also work with your Transplant Physician on finding another suitable unit.

 

However, statistics show that the donor’s own unit may not be the best sample for transplantation. Most Transplant Physicians may not feel that the patient’s own cord blood unit is the best choice. This is because it may already carry the genetic abnormality that led to the blood or immune system failure or cancer in the first place.

Chances that the donor’s parents will match the donor’s cord blood unit is extremely low. Each child inherits half of their genetic material from each parent. To facilitate a successful cord blood transplant, about 67% match between donor and recipient is required.

We do not reserve any cord blood unit for the child or a specific family’s usage. If the donated cord blood unit meets the criteria for banking, and is still in SCBB at that time, the unit would be made available for the patient who would benefit most from it; this could be the donor or another recipient. Research has shown that there is an extremely low probability that the donor should ever need or benefit from his/her own cord blood unit. Transplant Physicians may not feel that the patient’s own cord blood unit is the best choice as it may already carry the genetic abnormality that led to the blood disorder or immune system failure. The donated cord blood unit, would have to be removed from the public cord blood inventory, as it would have at that point, failed the medical history, and would not be suitable for public use.

 

The CBU will only be released based on the following:-

  • CBU met SCBB’s stringent banking criteria, and was banked
  • CBU available in SCBB at the time of request
  • CBU is to be used and/or released to the donor upon advice of the Transplant Physician.

If the three criteria above are met, the CBU will be released to the donor, through the Transplant Centre, upon advice of the Transplant Physician provided he/she feels that it is the unit most beneficial to the donor.

SCBB conducts searches for licensed and accredited Transplant Centres only. All search requests through these licensed Transplant Centres requires specific request forms to be completed. If you require a search for a life-saving cord blood unit, you may wish to speak with your oncologist and/or haematologist.

There are constant searches for SCBB’s CBUs both locally and internationally. There is an average of 40 cord blood searches through SCBB every month.

Searches conducted through the SCBB’s Cord Blood Registry are not charged a fee.

There will not be any fee imposed if the infant donor or any of the sibling requires the donated unit, provided the request is made by the transplant physician.

For donors, regardless of whether their donated cord blood unit is available or not, SCBB will work with the Transplant Centre to find a suitable match from its public inventory, without any charge.

 

For non-donor patients, the cost of a unit ranges between S$6,800 and S$28,500 for the first unit (based on cell dosage required) and flat rate of S$3,500 for the second unit (if needed) for the same patient. This cost recovery practice allows SCBB to sustain its operations so that it can continue to save lives. Patients with financial difficulties have been able to seek support with the help of their hospital's Medical Social Worker.

All cord blood units are tested for Human Leukocyte antigen (HLA) before banking. The results of this HLA testing go into a central register so that when anyone needs a cord blood unit, they can search the register, compare it with that of the transplant patient, and see, if there is a match. It is too late to start testing for a match only when a patient needs it. That is why it is important to make sure that HLA typing results are all on a public cord blood bank register.

After a patient undergoes chemotherapy and/or radiation treatment to destroy their diseased marrow, the healthy cord blood stem cells are given directly into the patient’s bloodstream, akin to a blood transfusion. These cord blood stem cells will then travel to the bone marrow where they begin to function and multiply. A successful transplant occurs when the new cells are engrafted (i.e. grow and established in the patient’s body).

Cord Blood and Transplant

When a patient needs a transplant, their doctor will determine the source of cells that best meets their needs. Cord blood is one of three sources of blood-forming cells used in transplant. The others are bone marrow and peripheral blood stem cells (PBSC).

No, umbilical cord blood cells are taken from the baby’s umbilical cord and placenta after the baby is born, and not from an embryo.

Stem cell Registry (Donor Registry) is a listing of potential bone marrow donors and donated umbilical cord blood units. Doctors can search the registry to find a match for their patients who need a transplant but don’t have a matched donor in their family.

 

When you donate cord blood, it’s listed on the registry and stored at a public cord blood bank. Cord blood is especially useful when:

  • There is no adult donor who is a close match for a patient. Patient outcomes are improved when the cells for transplant closely match the patient. However, studies show that cord blood does not need to match as closely as bone marrow or peripheral blood for a successful transplant.
  • A patient needs a transplant quickly. Sometimes a patient can’t wait several weeks or months for a donor to be contacted and the marrow donation to be collected. Cord blood units are stored in a public cord blood bank and ready to use.
  • A patient's ethnic background is important in predicting the likelihood of finding a match.

Studies show that when donated cells closely match a patient, their chances of transplant success improve. Patients are more likely to match someone of the same ethnic background.

 

Increasing the diversity of cord blood units on the registry makes it possible for more patients to receive a transplant. In 2016, 29% of umbilical cord blood transplants were for transplant patients of color.