Giving life to others

Asweet young voice sums up the gesture made by her parents ten years ago when, just before she was born, they decided to donate the blood from the umbilical cord. "I'm very happy to have helped someone else stop being ill," says Erika, whose mother had passed the phone to her so she could tell SUR how she felt when she learned that her birth had saved someone's life.

That thread of life that joined her to her mother for nine months served, years later, to prolong the life of another person.

"A nurse rang me to say there was a possibility that the blood we had donated was compatible with a recipient. We could hardly believe it. It wasn't difficult, making the decision to donate in case it could help someone else overcome a serious illness, and that's what we have told our daughter. She is now fully aware of what her birth has meant to two families, ours and the recipient of the umbilical cord blood," says Penélope García.

It was an on-the-spot decision the couple made just before the birth at the Clínico Universitario hospital in Malaga, "but one we will always be glad that we made," she says.

"A midwife told us about the benefits of this blood, which is high in stem cells, and that it could be frozen and later used in a transplant, either for a stranger or for a sibling, and that it didn't involve any risk for the mother or the baby," says Pedro Crespo, Penélope's husband.

In Spain there are two types of donation. One is known as allogeneic, where the blood is available for anybody who is compatible, and the other is autologous, in other words the public blood banks offer the possibility of storing the umbilical cord blood exclusively for use by a relative (the donor's sibling or parent) if they suffer from an illness where a treatment of this type is medically indicated.

The umbilical cord blood bank of Andalucía is at the Civil Hospital in Malaga and is an international benchmark, not only because of the number of units which are stored ready to be taken to any country in the world and transplanted, but also because of the demanding quality filters which distinguish it from the rest. In 2010 this blood bank obtained the highest certification possible for quality from the Foundation for the Accreditation of Cellular Therapy (FATC NetCord), based at the University of Nebraska.

"This certification, which only Malaga and Barcelona have in Spain, differentiates them from the rest with regard to reliable processing, classifying and detailing of the sample. This makes it easier to identify possible compatibility and the Andalusian umbilical cord blood bank has become renowned in its nearly 30 years of existence," says director Laura Ponce, a doctor in Hematology and Hemotherapy.

After New York and Durham, and with 22,200 donations stored, this blood bank is third in a ranking which is a source of pride for those who since 1995, when it was created, have worked to obtain recognition in Spain and abroad.

At present there are only five other public banks in the country (Barcelona, Madrid, Valencia, Basque Country and Galicia). Soon - they calculate by this summer - the bank in Andalucía will have distributed 1,000 units for transplants altogether. The present figure is 961 and most of the units have been sent to the USA, UK, France and Canada to help treat patients with blood cancer, especially children with leukemia, lymphoma or immune deficiency. In 2021, Andalucía distributed 48 units of cord blood; last year it was 46.

Blood from the umbilical cord is high in stem cells, specialised in renewing blood cells and, in certain patients with diseased bone marrow, the transplant enables them to produce healthy ones.

Traditionally, these transplants were carried out by giving the patient stem cells obtained from bone marrow or peripheral blood of a healthy donor, but over time it has been found that blood from the umbilical cord contains a sufficient quantity of stem cells to carry out haematopoietic transplants.

"Unlike what happens with bone marrow stem cells, those from the umbilical cord can be used successfully even if the donor and recipient are not totally compatible. Also, the units of umbilical cord blood have the advantage of being easily located and available almost immediately because they are kept frozen in the specific banks," says Josep Carreras of the Foundation, who in 1991 created the Register of Bone Marrow Donors (Redmo) so that all patients with leukemia or another illness of the blood who needed a bone marrow transplant and lacked a compatible family donor could access a donation from a volunteer to whom they are not related.

"No blood is better or worse than any other. The two types are complementary and both can even be used at the same time in a transplant,"he explains.

The donation of umbilical cord blood carries no risk for the mother or the baby," Dr Ponce stresses. The donor must be over 18, have reached 34 weeks of gestation and have no autoimmune, infectious, neoplastic or hereditary illnesses. They can give their consent via a form which can be downloaded online or at the hospital where they are admitted to give birth, which must be an authorised maternity unit.

"The bank in Malaga works with 26 authorised maternity units of which 21 are in Andalucía," Dr Ponce says.

When this type of blood is not donated, it just goes to waste. Also, the blood which is not suitable for transplant can still be used for research purposes or for eye drops. "It is collected by gravity once the umbilical cord is cut, but while it is still joined to the placenta and that is still inside the uterus," she explains.

Despite the low risk involved in the procedure, donations of umbilical cord blood have plummeted in the past decade, from 9,684 in 2010 to 568 in 2018. Last year there were not even 300. Even though the number of donations has dropped, the quality filters are increasingly more demanding.

"In order for the blood to be suitable for use in a transplant we take into consideration the weight of the bag and the cell count. From the time it is extracted, there is a margin of 48 hours for cell viability," Dr Ponce says.

But why has the number of donations fallen? On one hand, the focus in recent years has been on bone marrow donation, and the official campaigns have concentrated on that. Penélope and Pedro can vouch for that because they were not invited to donate again when they had their two younger children.

And on the other, 'late clamping' (delaying the moment when the umbilical cord is cut) is becoming more common. The main advantage to that is that it increases iron levels in the newborn baby and reduces the risk of anaemia in the first months of life. What is the problem? The longer the delay in cutting the cord, the less blood there is in it and the lower the chance of storing it.

Nevertheless, Laura Ponce believes the two practices are compatible because collecting the blood is viable as long as it is done within one and three minutes of the cord being cut.

"The units which are ideal for being transplanted are currently kept in automised tanks of liquid nitrogen at minus 196 degrees centigrade (they were manual until the end of 2006 and then automised and known as 'bioarchives') and the 22,200 units which have been collected since 1995 are periodically checked for cellular potential to ensure they are still ideal for transplanting. And the oldest ones still are," she says.

When the time comes for a transplant, a doctor with a patient who needs a unit of umbilical cord blood will look at their HLA (human leukocyte antigen) and search the banks to see which units are most compatible.

Milagros, 54, who is a GP, went through this. On 4 December she celebrated the fifth anniversary of her transplant. She had always been healthy until 2010, when she was diagnosed with non-Hodgkin's lymphoma and had chemotherapy at the Torrecárdenas hospital in Almería. She had the support of her family and continued to have faith in the science she had always believed in.

In 2012 her illness appeared to go into remission and Milagros breathed more easily. But her happiness was shortlived. Months later, in a routine check-up, the ghosts of the past returned: the lymphoma had come back. She had more chemotherapy but this time a door also opened onto hope with the prospect of a bone marrow transplant at the Regional hospital in Malaga. The disease did not come back. "Not a single relapse," she says.

But there was another blow which she had to deal with, and it was completely unexpected.

"The treatment was so aggressive that my bone marrow stopped functioning. It wasn't producing red or white blood cells or platelets," she says. .

Milagros was becoming increasingly weak and needed blood transfusions every ten days to keep her on her feet. Something was going to have to be done, and fast, because she was deteriorating so much, and that was when the doctors began looking for compatible bone marrow so she could have a transplant from a donation.

They checked the Bone Marrow Donors Register but there was no match. Milagros' condition was getting worse: blood tests revealed an alarming lack of platelets, she was bleeding continuously and her stays in hospital were getting longer and longer because of the infections she kept getting due to her lack of defences.

And then, when everything seemed lost, they told her that during their searches they had found two units of umbilical cord blood which were compatible.

At the end of November 2017 she was admitted to the Regional hospital in Malaga and on 4 December they transfused the stem cells. "It's like celebrating another birthday," she says, happily.

She feels like that now, but with the perspective that comes with time, because even in the hospital there were doubts about whether it would work.

"They hadn't done this type of transplant in Malaga for years, but it was the only chance and we had to try it," she says.

The transplant consisted of a transfusion. "What takes the longest is destroying the bone marrow. They do that in four days with chemotherapy and then they transplant the stem cells in just half an hour," she says.

For ten days she had no defences whatsoever. "They appeared on the 11th day, but then the growth was unbelievable. You go from having ten the first time to 200 the next," she explains.

She had to spend five weeks in complete isolation with rigorous protective measures so she was not exposed to any germs. "Even so, you get complications from transplants themselves. I still have some rejection but the important thing is that I am still here. I am back at work again and leading a practically normal life," she says. And she insists: "It is so important that people donate. It is a gift of life".