Umbilical cord blood is the blood left in the umbilical cord and the blood vessels of the placenta after a baby is born.[1] It is rich in hematopoietic (blood-forming) stem cells, and since the first successful cord blood transplant in 1988[2] it has been used as an alternative to bone marrow for transplants that rebuild the blood and immune system.[3] Mesenchymal stromal cells, by contrast, come mainly from the umbilical cord tissue (Wharton’s jelly), and cord blood contains very few of them. This page explains what cord blood transplants treat, how cord blood is collected, which other uses are still being tested, and what professional bodies say about public and private cord blood banking.
Cord Blood Stem Cell Transplants
A cord blood transplant gives a patient blood-forming stem cells from a cord blood unit, usually after chemotherapy or radiation has cleared the patient’s own marrow. The first one, reported in 1989, restored blood production in a boy with Fanconi anaemia using cord blood from a sibling with the same tissue type.[4][5] By 2017, an estimated 700,000 cord blood units had been donated for public use and more than 40,000 cord blood transplants had been performed.[6]
Cord blood differs from bone marrow stem cells and blood stem cells collected from adult donors in three ways:
- Matching. The newborn’s immune cells are less mature, so graft-versus-host disease is less likely and the patient and the unit do not need to match as closely. This helps patients who cannot find a matched family or registry donor; only about 30 percent of patients in the US and Western Europe have a fully matched donor in their family.[6]
- Cell dose. One unit contains relatively few cells, which at first limited cord blood transplants to children.[3]
- Recovery. Blood counts and immune defences recover more slowly after a cord blood transplant, which can lead to infections.[6]
To speed recovery, one cord blood unit can be expanded in the laboratory before transplant. In a phase 3 trial of 125 patients with blood cancers, the expanded product omidubicel cut the median time to neutrophil recovery from 22 days to 12 days and reduced serious infections, without a significant difference in survival.[7] The US Food and Drug Administration approved omidubicel (Omisirge) on 17 April 2023.[8] As of November 2026, the FDA list of approved cellular and gene therapy products includes nine licensed cord blood products of blood-forming cells and omidubicel.[9]
Cord Tissue Collection
Cord blood and cord tissue are collected after the baby is delivered and the cord has been clamped and cut, from tissue that would otherwise be discarded. Cord blood can be collected after a vaginal or a caesarean birth.[6] There are two methods:[5]
- In utero. While the placenta is still in the uterus, the collector punctures the umbilical vein with a needle, usually 16-gauge, and the blood drains into a sterile bag containing an anticoagulant. This method gives larger volumes and more cells.
- Ex utero. After the placenta is delivered, it is taken to a nearby clean room and the blood is collected there. This is easier but carries a greater risk of bacterial contamination.
Collection should not compromise care of the mother or newborn or change the routine practice of delayed cord clamping, and the condition of mother or baby may prevent an adequate collection.[2] The international FACT-NetCord banking standards allow collection only in uncomplicated deliveries.[5] Because the donor is a newborn, it is the birth mother whose blood is tested for infections; in the United States federal rules require this for any donor one month old or younger.[10] The unit is then processed, tested, frozen and stored.[5]
Cord blood collection does not interfere with the normal delivery process.[6] An adult donor of blood-forming stem cells, by contrast, either receives injections of a growth factor (filgrastim) that move stem cells into the blood for collection from a vein by apheresis, or donates bone marrow from the hip bone. Most marrow donors report pain at the collection site, and median recovery is 3 weeks after marrow donation against 1 week after blood stem cell donation.[11] Marrow collection is described on our iliac crest page.
Conditions Treated With Cord Blood Transplants
Umbilical cord blood (UCB) transplants are an established treatment for blood cancers, inherited blood disorders, bone marrow failure, immune deficiencies and some inherited metabolic disorders.[12][13] The groups below give examples from published reports; whether a transplant is the right choice depends on the disease, its stage and the patient, and other donor sources are often used instead.
| Group | Examples |
|---|---|
| Blood cancers and related disorders | Leukaemias, lymphomas, myelodysplastic syndromes and myeloproliferative neoplasms[6] |
| Inherited red cell and hemoglobin disorders | Hemoglobin disorders such as sickle cell disease and thalassaemia[12]; Diamond-Blackfan anaemia[13] |
| Bone marrow failure | Fanconi anaemia[4] and other marrow failure syndromes[13] |
| Primary immune deficiencies | Severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome, chronic granulomatous disease, leukocyte adhesion deficiency and IPEX syndrome[13] |
| Inherited metabolic disorders | Hurler syndrome, Krabbe disease and Sanfilippo syndrome, with excellent outcomes in about 75 percent at 5 years when transplanted early in the disease, according to one review[6]; alpha-mannosidosis and adrenoleukodystrophy[13] |
| Other | Hemophagocytic lymphohistiocytosis (HLH)[13] |
Autism is not an immune deficiency, and cord blood is not an established treatment for it (see below). The US Food and Drug Administration describes the approved use of cord blood as transplants for patients with some disorders of the blood-forming system, such as certain blood cancers and some inherited metabolic and immune system disorders.[1]
Uses Being Studied
Cord blood has also been given to children with neurological conditions such as autism, cerebral palsy, hypoxic-ischaemic brain injury and traumatic brain injury.[6] Results are mixed, and none has led to an approved use:
- Autism. In a phase II randomized, placebo-controlled, double-blind trial of 180 children aged 2 to 7, a single infusion of the child’s own or donor cord blood was safe, but it did not improve social communication or autism symptoms at 6 months.[14]
- Cerebral palsy. In a randomized, placebo-controlled crossover trial of 63 young children, the child’s own cord blood did not change motor scores at 1 year overall; children who received higher doses did better in a further analysis.[15] Two Korean double-blind, placebo-controlled trials gave donor cord blood together with erythropoietin, a hormone with effects on nerve tissue, alongside rehabilitation. In the first, 96 children completed the study, and those given cord blood with erythropoietin scored higher on gross motor and Bayley development scales at 6 months than those given erythropoietin alone or double placebo.[16] In the second, 88 of 92 enrolled children completed a four-arm trial, and gross motor performance improved more with cord blood plus erythropoietin than with double placebo at 12 months.[17] These results come from one research group and have not yet been confirmed in a larger trial.
Conditions such as COPD, gout, arthritis, spinal cord injury, heart disease and degenerative disc disease are not established uses of cord blood. Research results are published as clinical trials in peer-reviewed journals.
Cord Blood and Cord Tissue
Cord blood and cord tissue are often confused. Cord blood is a liquid source of blood-forming stem cells with established transplant uses. Cord tissue is the solid cord itself, and the cells grown from its gel-like Wharton’s jelly are mesenchymal stromal cells, which do not rebuild blood and are being studied in clinical trials; as of November 2026, no product made from them is on the FDA list.[9] The cord tissue cells are described on our page on Wharton’s jelly stem cells. Other sources of stem cells collected for storage include dental pulp.
Cord Blood Banking
Parents have three choices: donate the cord blood to a public bank, store it in a private bank, or let it be discarded. A public bank stores donated units for anyone who needs a transplant and is a match; in the United States, cord blood stored for unrelated patients is regulated as a biological product and must be licensed by the FDA or used under an investigational new drug application. A private bank stores the unit for possible use by the child or a first- or second-degree relative; such units do not need FDA approval before use, but the bank must register with the FDA and follow its rules on donor screening, testing and tissue handling. Registration does not mean the FDA endorses a bank.[1]
Professional bodies advise against routine private banking:
- The American College of Obstetricians and Gynecologists (2019) states that routine private cord blood banking is not supported by the available evidence and that public banking is the recommended way to obtain cord blood. A child’s own cord blood cannot be used to treat a genetic disease or a cancer in that child, because it carries the same genetic variant or premalignant cells, and there is no current evidence to support using it in regenerative medicine.[2]
- The American Academy of Pediatrics (2017) notes that public banking is free for families, while private banking is costly, not covered by insurance and the unit may never be used, and that private banks are underused for treatment, less regulated for quality control and more expensive than public banks.[12]
Storage, testing and freezing of cells are described on our page on cell collection, cryopreservation and banking, and other common questions are answered on our frequently asked questions page.
Published Clinical Citations
[1] ^ US Food and Drug Administration. Cord Blood Banking: Information for Consumers. Content current as of 23 March 2018. https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/cord-blood-banking-information-consumers
[2] ^ American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 771: Umbilical cord blood banking. Obstetrics & Gynecology. 2019;133(3):e249-e253. https://doi.org/10.1097/AOG.0000000000003128
[3] ^ Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood. 2013;122(4):491-498. https://doi.org/10.1182/blood-2013-02-453175
[4] ^ Gluckman E, Broxmeyer HA, Auerbach AD, et al. Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilical-cord blood from an HLA-identical sibling. New England Journal of Medicine. 1989;321(17):1174-1178. https://doi.org/10.1056/NEJM198910263211707
[5] ^ Mousavi SH, Zarrabi M, Abroun S, Ahmadipanah M, Abbaspanah B. Umbilical cord blood quality and quantity: collection up to transplantation. Asian Journal of Transfusion Science. 2019;13(2):79-89. https://doi.org/10.4103/ajts.AJTS_124_18
[6] ^ Ballen K. Update on umbilical cord blood transplantation. F1000Research. 2017;6:1556. https://doi.org/10.12688/f1000research.11952.1
[7] ^ Horwitz ME, Stiff PJ, Cutler C, et al. Omidubicel vs standard myeloablative umbilical cord blood transplantation: results of a phase 3 randomized study. Blood. 2021;138(16):1429-1440. https://doi.org/10.1182/blood.2021011719
[8] ^ US Food and Drug Administration. OMISIRGE (omidubicel-onlv). Content current as of 12 February 2026. https://www.fda.gov/vaccines-blood-biologics/omisirge
[9] ^ US Food and Drug Administration. Approved Cellular and Gene Therapy Products. Content current as of 30 October 2026. https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products
[10] ^ US Code of Federal Regulations. Title 21, section 1271.80: What are the general requirements for donor testing? https://www.ecfr.gov/current/title-21/chapter-I/subchapter-L/part-1271/subpart-C/section-1271.80
[11] ^ Miller JP, Perry EH, Price TH, et al. Recovery and safety profiles of marrow and PBSC donors: experience of the National Marrow Donor Program. Biology of Blood and Marrow Transplantation. 2008;14(9 Suppl):29-36. https://doi.org/10.1016/j.bbmt.2008.05.018
[12] ^ Shearer WT, Lubin BH, Cairo MS, Notarangelo LD; Section on Hematology/Oncology; Section on Allergy and Immunology. Cord blood banking for potential future transplantation. Pediatrics. 2017;140(5):e20172695. https://doi.org/10.1542/peds.2017-2695
[13] ^ Martinez C, Aguayo-Hiraldo P, Chaimowitz N, et al. Cord blood transplantation for nonmalignant disorders: early functional immunity and high survival. Blood Advances. 2023;7(9):1823-1830. https://doi.org/10.1182/bloodadvances.2022009038
[14] ^ Dawson G, Sun JM, Baker J, et al. A phase II randomized clinical trial of the safety and efficacy of intravenous umbilical cord blood infusion for treatment of children with autism spectrum disorder. Journal of Pediatrics. 2020;222:164-173.e5. https://doi.org/10.1016/j.jpeds.2020.03.011
[15] ^ Sun JM, Song AW, Case LE, et al. Effect of autologous cord blood infusion on motor function and brain connectivity in young children with cerebral palsy: a randomized, placebo-controlled trial. Stem Cells Translational Medicine. 2017;6(12):2071-2078. https://doi.org/10.1002/sctm.17-0102
[16] ^ Min K, Song J, Kang JY, et al. Umbilical cord blood therapy potentiated with erythropoietin for children with cerebral palsy: a double-blind, randomized, placebo-controlled trial. Stem Cells. 2013;31(3):581-591. https://doi.org/10.1002/stem.1304
[17] ^ Min K, Suh MR, Cho KH, et al. Potentiation of cord blood cell therapy with erythropoietin for children with CP: a 2 x 2 factorial randomized placebo-controlled trial. Stem Cell Research & Therapy. 2020;11(1):509. https://doi.org/10.1186/s13287-020-02020-y