More donating cord blood but more needed

Cord blood an important source of stem cells, with diseases such as blood cancer on the rise

More mothers are donating their newborns' cord blood, going by the rising numbers registered by the public cord blood bank.

Last year, the Singapore Cord Blood Bank (SCBB) received 3,927 cord blood donations - a 67 per cent jump from the 2,356 in 2010. This year, more than 3,000 donations were received as of Nov 30.

While this is encouraging, the SCBB is aiming to do more, said its chief executive, Mrs Tan-Huang Shuo Mei. The bank stores about 11,000 cord blood units now. It is working towards reaching 15,000 units in five years, she said.

The need to ramp up is pertinent, given that diseases such as blood cancer are on the rise, said Dr William Hwang, the SCBB's medical director.

Based on the SCBB's current inventory, there is an 80 per cent chance of finding a suitable cord blood match for Chinese patients. For Malays, the possibility is about 30 to 40 per cent; and Indians, less than 20 per cent.

At the Singapore General Hospital, for instance, outpatient chemotherapy administered for blood cancer numbered about 5,000 cycles in 2005. This grew to about 20,000 cycles in 2013, he said .

In some cases, when chemotherapy fails, or when the patient is genetically predisposed to a relapse, cord blood enters the picture.

It is an important source of stem cells which can develop into healthy blood-forming cells in the patient's body.

Based on the SCBB's current inventory, there is an 80 per cent chance of finding a suitable cord blood match for Chinese patients.

For Malays, the possibility is about 30 to 40 per cent; and Indians, less than 20 per cent.

"There is a need to boost the inventory levels to increase the potential of a match for Malay and Indian patients," noted Mrs Tan-Huang.

Moreover, a patient's chances of a match can become even slimmer if he requires more than one cord blood unit, said Dr Hwang.

Both cord blood units have to match each other, and these two units have to match the patient. An adult typically needs two cord blood units while a child usually requires one.

If more parents do not donate their babies' cord blood, doctors will have problems finding the right cord blood for patients, said Dr Yeap Min Li, an obstetrician and gynaecologist in private practice.

The SCBB is the only public cord blood bank in Singapore. It depends on philanthropic support for its cord blood collection, cryopreservation and storage activities. The units are made available to anyone in need. The cost of services like retrieval and testing of the cord blood are paid by the recipient's family.

But if a person needs his previously donated cord blood for himself and it is still in the bank's inventory, it will be released without any fee - if the transplant physician has advised that the unit will be suitable for his treatment.

There are also three private cord blood banks here which keep the donor's cord blood exclusively for a family's use, for a fee.

Since its launch a decade ago, the SCBB has facilitated 183 cord blood transplants, mostly to save people with blood-related conditions such as leukaemia and sickle-cell disease. The procedure involves a transfusion of donor's cord blood into the patient, who then has to take immunosuppressive drugs for six months to a year.

Sometimes, when a match cannot be found here, doctors may turn to foreign cord blood banks.

Dr Anselm Lee, medical director of the Children's Haematology and Cancer Centre at Parkway Cancer Centre, said it uses one or two foreign cord blood units every year. They come from Taiwan, France and the United States.

While these patients can also be helped by a bone marrow transplant, some may not have the luxury to hold out for a suitable donor.

Dr Lee said: "For patients with advanced leukaemia, time can run out. There are times when we have to hold on to a more reliable stem cell source for a transplant, instead of trying to wait for the best donor to come forward."

Despite the life-saving benefits of cord blood, only about 9 per cent of mothers today donate their babies' cord blood, said Mrs Tan-Huang. "It is perhaps not as well-known as it should be, although the service is available at all public and private obstetric hospitals."

A likely obstacle could be that parents think that the donation process is a hassle. But it needs no extra effort on their part, besides giving informed consent, she said.

The cord blood will be collected by the doctor after the baby is delivered, and will not interfere with the birth process.

Another possible factor is the low awareness of the SCBB, particularly in the private hospitals where "the influence of private cord blood banking is very strong", said Dr Yeap. "Most clinics do not actively recruit for the SCBB as there is no monetary remuneration," said Dr Yeap, who runs ML Yeap Clinic For Women at Thomson Medical Centre.

To shore up awareness, the SCBB rolled out a year-long Facebook campaign in February, featuring stories and online contests. It is also increasing discussions with community groups, such as religious organisations, and professions with a high proportion of women such as nursing and teaching.

"There is a need to spread the message beyond mothers-to-be, to get more people to talk about it," said Mrs Tan-Huang.

Parents can also do their part by raising the topic with their doctors.

Regardless of whether parents decide to opt for public or private cord blood banking, the bottom line is that the blood should not be wasted. "Hopefully, in the future, no cord blood will be discarded," said Dr Hwang. "It is such a precious resource."

A version of this article appeared in the print edition of The Straits Times on December 15, 2015, with the headline 'More donating cord blood but more needed'. Print Edition | Subscribe