Cord Blood a Reservoir of Hope
By Amanda Crissup and Janet Marshall, The Free Lance Star, September 10, 2006
Cathy and her husband Billy decided to spend $1,700 to preserve their baby's umbilical-cord blood when she was expecting with her fifth child. Billy works in his parent’s seafood restaurant and Cathy is a stay-at-home mom--so spending for them is not easy. But the Manassas couple wanted the security of knowing that the blood--loaded with stem cells--would be on hand if any of their children ever got sick.
Cord blood can be an expensive and unusable form of health insurance, but can also be an extraordinary means for treating serious medical conditions.
In this case, the blood has become a source of hope for the family.
Born with severe brain damage, their baby Abby went without oxygen for a time in the womb. The stem cells have given Abby’s family a promising tool for restoring her neurological functioning. Since her birth two years ago, with exciting but uncertain results, Abby has received two infusions of her own cord blood.
"If it doesn't work, we've lost money. So what?" Cathy said. "But if it can improve her life, then it's worth every cent."
Although an increasingly common occurrence in American delivery rooms, preserving cord blood for a family is still not the rule. Without the ethical concerns of embryonic stem cells and all the promise, new born stem cells from cord blood and their storage have gained popularity. A few distinguished physicians also encourage the idea. Stem cells can enhance immune systems during cancer treatment, treat brain injuries and sickle cell anemia, they also have the potential to treat an assortment of other conditions.
But as Abby’s family has learned, the course from preserving cord blood to using it as treatment is scattered with obstacles as well as hope.
Dr. Bob at first thought cord-blood banking was a contrivance. But his wife read about it while pregnant with their third child. She was also a teenage cancer survivor and was convinced they should bank their child's blood. After doing some research, Bob was persuaded as well.
Now Dr. Bob has written about cord-blood preservation on his website and has contributed to this story by phone from his California home.
"There's so much research right now showing cord blood will treat very common childhood and adult diseases," said Dr. Bob, who is a Pediatrician.
Because stem cells are immature the treatment possibilities are broad.
"They can change and grow into any kind of body tissue that they need to," Dr. Bob said.
Dr. Bob said that collecting and storing the blood is not complicated. A doctor or midwife extracts the blood with a syringe after a baby's umbilical cord is cut. Then the blood is put into a vial for the parents--or a medical courier--to ship off to a cord-blood company's storage site.
Dr. Bob and Cathy noted that much of the moral, religious, and ethical, debates surrounding embryonic stem cells are eliminated with this procedure. Cord-blood collection involves no potential loss of human life.
"Every baby has a nice full-size unit of stem cells just sitting in the umbilical cord ready to be collected," Dr. Bob said.
Private cord-blood banks currently dot the country with more than two dozen. Families can donate without a fee to public banks as well, but they do so with the knowledge that their child’s stem cells may be used for research or to help others.
Rita, who is a manager with one of the private firms, said that more than 450,000 cord-blood samples are stored in banks around the country; in Virginia, roughly 4,000 families have stored stem cells with the private firm Rita works for.
"There has been a definite increase in new clients," she said in an e-mail.
Due to give birth to her second child in October, one of the new clients is Angie of Spotsylvania County. Angie said she paid $1,750 in her second trimester and will pay $125 annually in storage fees to preserve her baby's blood.
"I'm sure we waste that in a year going out to Starbucks," Angie said.
A health scare several years ago involving her older child Edward helped to convince her that storing her baby's cord blood was the right decision.
"If something ever happened, I would have resources," Angie said. "That's something I didn't have with my son.
Pregnant patients learn about the option at Mary Washington Hospital where Judy, coordinator of parent-child education services, informs them of the option.
"The more I learn about it, the more impressed I am," Judy said.
Still, the cost is prohibitive to many. And a level of discomfort still remains associated with it. Many families assume that conventional therapies could treat them if they got sick and that they would never need the cord blood.
As for Abby’s family, they think their story shows just how valuable the cord-blood investment can be.
"Only one in a thousand ever needs it," Cathy said, speculating on the odds. "Will, you be that one?"
'The Gift of Hope'
Cathy was sold when she saw a segment on "Oprah" about cord-blood banking.
It never occurred to her that her baby would need the blood for herself. Putting aside some of their fifth child's blood in case any of the other four got sick was what she was banking on, or so she figured.
Abby, who was born 10 days late, had a preliminary Apgar score of zero. The Apgar measures a newborn baby's wellness. Her score later jumped to seven. Not terribly uncommon, she had a bowel movement in utero. But if newborns inhale the tar-like substance, oxygen deprivation and other serious problems can occur.
"Most kids just get it in their mouth," Cathy said. "Abby got it in her lungs."
It's not clear how long she was oxygen-deprived. Abby was monitored at the hospital for two weeks. But an MRI a few months later confirmed that in three of her four lobes she had suffered moderate to severe brain damage. Doctors said she had microcephaly--a small head due to lack of oxygen.
"Her outcome, they said, would be abnormal," Cathy said.
Cathy asked if Abby's cord blood could help and the doctors told her no. But an e-mail from their cord blood bank publicizing advances using cord blood to repair neurological and spinal-cord damage gave the family renewed hope. The families Google search began as they looked for a doctor with expertise in cord-blood transplantation. Every hospital Cathy contacted about Abby's transplant said that it was no use and the cord blood would not be able to help their daughter.
"You have a lot of naysayers out there that need cold, hard facts," she said. "But the way I see it is if there's a small chance to help your child have a better quality of life, why not do it?"
A professor of pediatrics at Duke University with a specialty in stem-cell transplantation eventually came up in their search, and the family contacted Dr. Joanne.
Cathy asked Dr. Joanne if she would transplant Abby's stem cells. After several exchanges, mostly by e-mail, she got the answer she'd hoped for.
Abby's stem cells were sent to Duke at the doctor's request.
Two transplants have taken place in Durham, the first when Abby was 6 months old and the second more recently. Abby turned 2 on September 9th.
Each transplant is a costly $10,000, and insurance does not cover the experimental procedures. Despite the cost, the procedure is quite simple: an infusion of her cord blood is sent through an IV in Abby's hand.
Abby's first infusion was paid for with money raised by friends at All Saints Catholic School in Manassas, and Abby's parents refinanced their home to pay for the second. Another infusion in two years is probable.
"You've got to do whatever it takes for your kids," Abby’s father Billy said.
Dr. Joanne cautioned the family and continues to do so, telling them to keep their expectations low.
"Dr. Joanne said you have to expect nothing will happen. This is not a cure," she said. "But what she gave us was the gift of hope. I can look at Abby and say, 'Baby girl, we did everything we could to help you.'"
And Cathy and Billy are certain the procedures have helped.
"She's definitely making progress," Billy said.
Abby wouldn't lock eyes with anyone, and she couldn't focus her gaze, prior to the first infusion
"She was literally like Stevie Wonder, with her head left to right, left to right," Cathy said.
But two weeks after the first transplant, Cathy said, Abby looked straight at her during a bath and smiled.
"I was like, 'Oh my God, she sees me!'" she said. "I was just hysterical."
Abby is scheduled to have an MRI tomorrow. Cathy said Dr. Joanne has cautioned that even if the scan shows improvement, it doesn't mean the stem-cell transplants worked.
Whatever the scan shows, Abby's family is grateful that she has undergone the procedures.
"She wasn't getting better before," Cathy said. "There's no 'proof,' but I have all the proof I need."
Abby's visual therapist, Peggy, said she's uncertain if Abby's development can be attributed exclusively to the cord-blood transfusions. But along with the more conventional therapy Abby's family has done, she find it likely that the cord blood is a contributing factor.
"The combination has really gone a long way in making progress in that little girl's life," Chenoweth said.
Abby, who turned 2 yesterday, doesn't do a lot of the things most kids her age do. But she blows raspberries, gets around with a walker and makes eye contact.
"These seem like very small steps for a lot of people, but they're hurdles for Abby," her mother said. "I would love to see my daughter just run around and be fine, and I pray for that. But if not, it's OK. We've done everything."