After setting out a 70:30 ratio for storing public and private cord blood units when it started collecting units in late 2008, the Chennai-based Jeevan Stem Cell Bank has today become a purely public cord blood bank. “We stopped collecting private cord blood units since 2012,” said Dr. Saranya Narayan, Medical Director of Jeevan Stem Cell Bank. “It’s now a 100 per cent public cord blood bank.”
Though the initial target was to store 35,000 public cord blood units in five years’ time, the Bank has so far stored 4,241 public cord blood units and 200 private cord blood units. Till date it has collected nearly 8,400 units. “The collection was very slow between 2008 and 2013, due to lack of funding. But after 2013 we have been collecting 2,000 samples a year,” said Dr. P. Srinivasan, Chairman of Jeevan Blood Bank.
While only 660 units were stored between 2008 and 2013, the numbers shot up after 2013. Currently 4,241 units are stored at Jeeven Stem Cell Bank.
Explaining the rationale for rejecting nearly half the number of samples collected, Dr. Srinivasan said: “We now follow the NetCord-FACT International Standards for cord blood collection. The Standards demand that there are at least 500 million mono nucleated cells per bag of stem cell stored.”
Since early last year, transplant surgeons internationally have started using cord blood cells on adults and hence prefer those units which have larger cell counts. Even in the case of children, 25 million cells per kilogram of body weight of the patient are required. Since the maximum weight of children is 30-40 kg, a higher cell count per bag is preferred.
Another reason for seeking higher cell count per bag of unit stored is the fact that during storage, which may be for years, there is a drop in the number of viable cells. As a result, the number of mono nucleated cells per bag now preferred for storage is 1.25 billion.
“We have taken the minimum cell count per bag from 500 million to 750 million,” said Dr. Srinivasan. The need for higher cell count has had it own operational impact. For instance, if as much as 80 per cent of cord blood donations were accepted earlier, it has now dropped sharply to 40 per cent. The volume of cord blood collected has become important, as those with more cord blood tend to have higher cell count. Cord blood donations less than 50 ml in volume (which includes plasma, platelets, RBCs, etc) are rejected. “The focus is on quality rather than quantity,” said Dr. Narayan.
Besides volume of cord blood collected, the cell count depends on several factors such the weight of the baby, size of the placenta, thickness and length of the umbilical cord, birth order of the baby and age of the mother. According to them, nearly 60 per cent of cord blood units stored in public cord blood banks cannot be used for transplantation owing to less cell count.
Since it is a public cord blood bank, Jeevan is making great efforts to collect units from across the country. This becomes necessary due to antigen diversity seen in the Indian population. Currently, samples are predominantly collected from Chennai in TN and other southern States. “We do get samples from rest of the country, except Kashmir and some parts of Northeast India,” said Dr. Srinivasan. “We are consciously trying to get samples from the rest of the country.”
Samples are mainly collected from private practitioners because one of the main requirements for issue of a unit from Jeeven Stem Cell bank for transplantation is that the health of the donor has to be known before the unit is given. Follow-up of patients is poor if not absent in government hospitals.
Thanks to the Rs.9 crore donation by the Tamil Nadu government, Jeeven Stem Cell Bank has been able to store more samples after 2013. It has already used the first instalment of Rs.3 crore. In April 2014, it received a loan of Rs.15.4 crore at 1 per cent interest from the Technology Services Revolving Fund managed by ICICI.
Cost to patients
Jeevan provides samples free of cost to those whose annual income is less than Rs.5 lakh; it charges Rs.50,000 from those who earn Rs.5-10 lakh per annum and Rs.2 lakh for those earning above Rs.10 lakh a year.
Since Jeevan Stem Cell Bank has received funding from the Tamil Nadu government, all patients from the State will get samples free of cost. “It’s our commitment to the Tamil Nadu government,” Dr. Srinivasan said.
Public banking favoured
The concept of public cord blood banking is much favoured even by the American Academy of Paediatrics.
In its recommendations in 2007, the Academy made a strong case for public cord blood banking. The Academy even went to the extent of clearly stating that storing cord blood for self-use or for use by a family member at a later date should be “discouraged.”
The chances of self-use when stored in private banks are slim — 1 in 1000 to 1 in 2,00,000 or less.