By Ben Joravsky
Nina Gallo's looking for the blood of newborn babies.
Gallo, who's a nurse, and her colleagues at the University of Chicago's children's hospital are advancing a medical procedure in which they extract blood from placentas and umbilical cords.
Despite a few articles in science and medical journals, there's been little publicity about cord blood, so even otherwise well-informed mothers and mothers-to-be know little about its significance as a safer, easier, and less intrusive alternative to transplanted bone marrow. Indeed, the Chicago Community Cord Blood Bank, restricted to a few labs in the research wing of the children's hospital, is one of the only facilities of its kind in the world.
"The first operation to use cord blood was done on a boy in 1987," says Dr. Richard Moldwin, director of the cord blood bank. "Overall, worldwide there have only been about 500 cord blood transplants. But when you consider there's a backlog of at least 3,000 for bone marrow transplants, you can understand the need to build up the supply."
Gallo approaches her work like a missionary. "I go from hospital to birthing class trying to spread the word to every qualified mother I can find," she says. "I feel like Paul Revere on his horse, a lonely voice crying out my message--'Cord blood, cord blood, we need your cord blood.' Seriously, we need the blood--we need the blood badly. Usually, this blood gets discarded. It can save lives but it's just getting thrown out with the trash."
Part of her effort is to offer the public a few elementary facts about birthing. It's through the placenta by way of the umbilical cord that the fetus receives its nourishment and oxygen, and, in turn, it's from the umbilical cord that the placenta receives the fetal waste discharged for disposal. After the baby's born the umbilical cord is clipped. The placenta is forced out by contractions and discarded.
"There's vital blood in both the umbilical cord and the placenta," says Moldwin. "How much blood we can extract depends on how much blood the obstetrician lets go back to the baby. If you clamp the umbilical cord as soon as the baby comes out, you get a lot. If you wait a little while the blood goes back to the baby. We try to let the baby get as much blood as the obstetrician thinks he or she needs. We extract the blood with a syringe and we only draw blood once the cord is cut and the baby's taken care of and the mother's stabilized."
They also draw blood from the placenta. "The blood in the placenta is the baby's blood--the baby's and mother's blood do not actually mix," says Moldwin. "The placenta's usually thrown out. As someone said, 'We're taking this garbage and we turn it into gold.'"
The blood is taken to the Chicago Community Cord Blood Bank, processed, tested, and stored for up to ten years--an expensive undertaking that costs about $1,000 per unit of retrieved blood. "Generally we can get as much as four ounces if we're lucky," says Moldwin. "Sometimes we only get a drop."
But what they get is very valuable. According to a recent article in Science, cord blood's rich in stem cells that are "similar to those in bone marrow. These cells are progenitors of the body's many types of blood cells."
In other words, stem cells are the primitive cells from which all types of blood cells develop. When patients with bone marrow disorders such as leukemia are treated with chemotherapy, the stem cells in their bone marrow are destroyed. Without new stem cells the patient cannot produce enough white blood cells to fight infection, red blood cells to carry oxygen to organs and tissues, and platelets to control bleeding.
"Early results suggest that cord blood is a safe and effective transplant material that can be used to treat patients who are not related or even well matched immunologically to the donor--and with fewer complications than with bone marrow," according to Science.
The main advantage to using stem cells instead of bone marrow, says Moldwin, is availability. "You can easily build up stem cell banks from cord blood, so you can rapidly search for a match. But if you rely on unrelated bone marrow donors, it gets very complicated. You have to register the donor, you have to get their bone marrow typed. Then you have to arrange a suitable time for the transplant that's convenient to the donor and medically suitable for the patient.
"The main disadvantage is that it takes longer for the bone marrow to regenerate after the cord blood transplant. It can take from a few days to a few weeks before you see signs that bone marrow has grafted or before the patient shows signs of making his or her own blood cells. But I think that problem will be solved in the near future by using stimulants that cause stem cells to engraft at a faster rate."
When the university opened its cord blood bank in 1994, Gallo was one of its first employees. She says she's an unlikely advocate for the cord blood cause, since she was only an average science student at the old Providence High School, a Catholic school on the west side.
"I went to nursing school almost as a lark," says Gallo. "I had children and I wondered, 'Can I still think? Can I still take a test?' Why did I choose nursing? It was either nursing or handicapping horses. No, really, I always thought, 'What can be more boring than science?' But once I started I realized, 'You know, it's not boring at all. And I'm pretty good at it.'"
At least two or three times a week, Gallo makes her pitch for cord blood to the women who attend various birthing classes in the area. "I tell them it's a pain-free procedure that takes three to five minutes and it has no charge to them, there are no hidden fees. I stress that the placenta and umbilical cord are generally discarded. I tell them we're a not-for-profit organization--this is not about anyone making any money. And I emphasize that in no way do we interfere with the normal delivery procedure. We would not be hanging around waiting for our cord blood if anything extraordinary were to occur during labor.
"After I give my talk they ask questions. Someone usually wants to know why she can't have blood stored for her baby. I tell them there are several reasons not to use your own cord blood. If your baby were to need a bone marrow transplant within the first two years of life, there is a high possibility that the cord blood they would have collected at birth would be predisposed to whatever malignancy the child had. But we will designate the cord blood of a baby for a sibling or in some cases a parent, pending the match result.
"I relate to the mothers--at least I think I do. We laugh. I tell some jokes. I try not to make it sound too dreary, because it's not. It's a wonderful thing. I hope I can get them excited about the prospect of being on the ground floor of a major innovation."
Gallo and Moldwin acknowledge that the procedure is not without its ethical questions. For one, what are doctors to do with the genetic information they discover by testing the newborn's cord blood?
"Let's say we find that the blood's HIV positive--then what do we do?" asks Moldwin. "That's a problem, believe me--we've pulled a lot of hair out over this. One thing--we don't release names of donors to anybody, not even within our institution. In the case of HIV we would notify the donor, but we would not send a letter even to the donor's doctor without their consent."
Doctors have been slow to spread the news about cord blood's value. "We've got to get the word out to the OBs," says Gallo. "Pediatricians and oncologists are dying to have this blood back. Maybe all of us could do a better job of just talking to one another."
For some reason there have been surprisingly few stories in the mainstream press on the need for cord blood. "Perhaps the reporters who cover medical news think it's an old story because they know about it," says a press spokeswoman for the University of Chicago Hospitals.
"Right now we don't have the staff or money to handle much more blood than we have," says Gallo. "Where will we get the money, who knows? That's the next challenge. That's always going to be the big challenge. But someday we'll get our breakthrough. Maybe in ten years this will be a common procedure and there will be cord blood banks everywhere. We sure need them."
Art accompanying story in printed newspaper (not available in this archive): Richard Moldwin, left, Nina Gallo, right, photo by Lloyd DeGrane.