Objective: To review current evidence regarding umbilical cord blood
counselling, collection, and banking and to provide guidelines for
Canadian health care professionals regarding patient education,
informed consent, procedural aspects, and options for cord blood
banking in Canada.
Options: Selective or routine collection and banking of umbilical cord
blood for future stem cell transplantation for autologous (self) or
allogeneic (related or unrelated) treatment of malignant and nonmalignant
disorders in children and adults. Cord blood can be
collected using in utero or ex utero techniques.
Outcomes: Umbilical cord blood counselling, collection, and
banking, education of health care professionals, indications for
cord blood collection, short- and long-term risk and benefits,
maternal and perinatal morbidity, parental satisfaction, and
health care costs.
Evidence: Published literature was retrieved through searches
of Medline and PubMed beginning in September 2013 using
appropriate controlled MeSH vocabulary (fetal blood, pregnancy,
transplantation, ethics) and key words (umbilical cord blood,
banking, collection, pregnancy, transplantation, ethics, public,
private). Results were restricted to systematic reviews, randomized
control trials/controlled clinical trials, and observational studies.
There were no date limits, but results were limited to English or
French language materials. Searches were updated on a regular
basis and incorporated in the guideline to September 2014. Grey
(unpublished) literature was identified through searching the
websites of health technology assessment and health technologyrelated
agencies, clinical practice guideline collections, and
national and international medical specialty societies.
Values: The quality of evidence in this document was rated using the
criteria described in the Report of the Canadian Task Force on
Preventive Health Care (Table 1).
Benefits, Harms, and Costs: Umbilical cord blood is a readily
available source of hematopoetic stem cells used with increasing
frequency as an alternative to bone marrow or peripheral stem cell
transplantation to treat malignant and non-malignant conditions
in children and adults. There is minimal harm to the mother or
newborn provided that priority is given to maternal/newborn
safety during childbirth management. Recipients of umbilical cord
stem cells may experience graft-versus-host disease, transfer
of infection or genetic abnormalities, or therapeutic failure. The
financial burden on the health system for public cord blood banking
and on families for private cord blood banking is considerable.