Every day, our cord blood collectors are there at the births of new-born lifesavers. Bill Duffy, one of our collectors, explains what happens behind the scenes of the all-important collection.
Before becoming an Anthony Nolan Cord Blood Collector, my knowledge of the placenta had been fleeting. But, on my first day of training for my new job at King’s College Hospital, the Midwife Supervisor began my education:
‘Did you know that the word “placenta” is Greek for “flat cake”?’
‘You will be working long twelve 12 and a half hour shifts,’ she continued, ‘But there is a tea trolley available 24/7 that will help you to keep going, particularly during the difficult nights.’
‘Hmm…tea and flat cake,’ I thought, ’Sounds like my sort of job!’
Four and a half years later and I’m now very familiar with placentas, and the process of collecting cord blood is second nature.
How does a cord collection work?
Despite being so central to our job that ‘Cord Blood Collector’ is our official title, the actual amount of time spent in the physical act of collecting the cord blood is relatively small, amounting to maybe 30 minutes for every unit (and that includes setting up and cleaning the equipment).
Collections are performed, much like everything else we do, by following Standard Operating Procedures. The procedure is rarely altered and so collectors become very familiar with the routine of collecting cord blood.
It is an ‘aseptic technique’ and involves draining the cord blood into a blood bag from the vein and arteries in the umbilical cord via a sterile needle and tube, much like that used in collecting whole blood from adult blood donors. We aim to collect as much cord blood as is available, as quickly as possible.
What happens during the delivery?
To explain how a cord is collected, I’ll share some examples from an average day at work. Starting with a delivery in theatre. I try to remain in the background while the pushing and pulling is going on until finally a baby girl is delivered. As soon as she cries, Mum and Dad begin crying too, and there is happiness all around. I hold back the tears and wait for the placenta.
The cord is cut, and the paediatrician begins to check that baby is fine and asks for cord gases to be taken. I have already anticipated this request and have syringes for taking blood samples from the vein and arteries in the umbilical cord. Analysis of the gases found in these blood samples give the medics extra information about the condition of the baby and as soon as I have the placenta I will collect this blood for the medics.
The samples will be given priority over the collection of cord blood for donation. Throughout the donation process the health and wellbeing of mother and baby rightly take priority over anything we are doing.
When does the collection begin?
The appearance of the placenta, 10 minutes after baby, brings me back to the present. I take it to the collecting room and extract the cord gases which I urgently return to the midwife. I then commence the cord blood collection. Everything goes smoothly and 15 minutes later I am massaging the placenta to extract the last few drops of blood.
Once the collection is complete, blood bag, cord sample and papers are gathered. The cord blood unit is labelled and weighed and swiftly deposited with the cord sample in the secure fridge. The empty placenta is labelled and left for midwife to inspect before disposal into hospital waste – the same fate as placentas from mothers not signed up to donate. Sometimes it is returned to mothers, if requested, for encapsulation into tablets, for ceremonial burial, for art, to make into smoothies, for consumption – the list goes on!
How big is the donation?
Each cord blood donation differs in size and suitability for transplant. On this day, when my colleague finishes their collection, they have a cord blood unit of over 200g – this will be the biggest of the week!
Another collection involves twins, which means possible two collections from one donor – double the benefit! For this, we set up the two collection kits. The placenta has two cords and the collections must be made separately but later linked to the same consent papers and maternal blood samples.
The cords are differentiated by having one and two cord clamps attached respectively. I will collect from twin one, my colleague from twin two. We each collect a reasonable amount of cord blood but can’t help but compare weights. My colleague collects 10g more than me. They are having a good day.
What happens after the collection?
After we collect the cord blood, we return to the mother to take some blood samples as a full blood count test is required from her six hours after delivery. Both these and the cord blood itself is tested for a wide range of infections to ensure the samples are from a healthy donor.
When I return to collect blood samples from the twins’ mother, I explain that once the collections arrive at our processing centre they will be examined. Those with the highest numbers of stem cells will be suitable for transplant, the others will be more suitable for research. I explain some of the types of research taking place, including by Anthony Nolan, as well as by researchers and developers of new lifesaving and life improving cell and gene therapies that have been approved by our Independent Review Board (IRB).
The impact donation has
It’s brilliant to be able to explain to a mother the broad impact their donation can have. When I speak to donors, I congratulate and thank them in equal measure and tell them that it is possible that their child has possibly saved lives with their first act after taking their first breath.