CORD BLOOD BANK (CBB) DATA PATIENT DATA. CB21 HPC, CORD BLOOD UNIT REPORT: Glossary. Name of cord blood bank (CBB) ISBT 128 CBB Identifier

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1 CORD BLOOD BANK (CBB) DATA Registry name CBB CBB ID: CBB accreditation: CBB licence: HLA laboratory accreditation: Testing laboratory licence Address: ZIP code: City: Phone: Fax: PATIENT DATA Patient Registry: Patient ID: Diagnosis: Date of birth: Transplant Center: Race: Gender: Weight: (kg) Blood Group/Rh(D) Name of registry Name of cord blood bank (CBB) ISBT 128 CBB Identifier Accreditation(s) held by the CBB Licence(s) held by the CBB Accreditation(s) held by the Tissue Typing Laboratory Licence(s) held by the testing laboratories CBB address CBB ZIP code City where CBB is located CBB phone number CBB fax number CBB Name of patient s registry Patient ID allocated by registry Patient diagnosis Patient date of birth (YYYY-MM-DD) Patient transplant center name Patient race Patient gender (drop down box) - Female or - Male Patient weight in kg Patient Blood Group (drop down box) A Rh(D) + A Rh(D) -

2 Date of request/registration (YYYY-MM-DD) CORD BLOOD UNIT (CBU) IDENTITY CBU ID: CBU Local ID/EMDIS: Gender: Race: Blood group Rh(D): B Rh(D) + B Rh(D) AB Rh D) + AB Rh(D) O Rh(D) + O Rh(D )- Date the request for a unit report was received or registered. CBU ISBT 128 or other identification CBU local ID or EMDIS allocated ID Gender of CBU donor (drop down box) - Female or - Male Race of CBU donor CBU Blood group Rh(D) (drop down box) A Rh(D) + A Rh(D) - B Rh(D) + B Rh(D) AB Rh D) + AB Rh(D) O Rh(D) + O Rh(D )- HLA TYPING AND CONFIRMATORY TYPING HLA A Patient HLA Typing

3 HLA B - HLA C HLA DRB1 HLA DQB1 HLA DPB1 Other HLA typing HLA A CBU (Initial Typing) HLA B HLA C HLA DRB1 HLA DQB1 HLA DPB1 Other HLA typing HLA A CBU (Initial Typing) HLA B

4 HLA C HLA DRB1 HLA DQB1 HLA DPB1 Other HLA typing HLA A MOTHER HLA B HLA C HLA DRB1 HLA DQB1 HLA DPB1 Other HLA typing Sample type used for CBU confirmatory Typing: Drop down box - Contiguous segment - Cryovial - Other

5 COLLECTION, PROCESSING, FREEZING AND STORAGE DETAILS CBU Bag ID: CBU identification on cryobag Date collected (YYYY-MM-DD) Date CBU collected (YYYY-MM-DD) CBU volume at collection: (ml) CBU volume (ml) at collection without anticoagulant CBU volume at cryopreservation: (ml) Cryopreserved volume in frozen CBU Type of bag: Type of bag used (CBU bag fractions/split unit) e.g. 80/20, 60/40, 50.50, no split. Number of bags: Number of cryobags in which CBU is frozen Protective canister dimensions: Cannister dimensions in cm Processing method Method of processing (drop down box) - Manual - Automated Type of System Equipment used for volume reduction Product modification Modifications to product Drop down box - Plasma & RBC reduced - RBC depleted - Plasma depleted - Nil RBC replete Additives used in processing Details of any additives used in processing Cryopreservation method Method of cryopreservation e.g. controlled rate freezing, manual freeze. Cryoprotectant type Cryoprotectant used Time from collection to freezing: (hr:min) The time from collection of the CBU to freezing in hours and minutes. HPC, CORD BLOOD CHARACTERISTICS AND POTENCY Total nucleated cells (TNC) (x 10^7) CBU post-processing TNC (x 10^7) content. Nucleated Red Blood Cells (nrbc) (x 10^7) CBU post-processing nrbc (x 10^7) content. WBC (TNC corrected for nrbc) x 10^7 CBU post-processing WBC content x 10^7 (TNC minus nrbc content) Mononuclear cells (x 10^7) CBU post-processing mononuclear cell content (x 10^7) RBC volume (ml) CBU post-processing RBC volume in ml

6 CD45+ 7AAD viability (%) CBU post-processing CD45+ 7AAD percent viability Viable CD34+ cells (x 10^6) CBU viable CD34+ cell content (x 10^6) CD34+ 7AAD viability (%) CBU post-processing CD34+ viability (%) Total CFU (x 10^4) CBU post-processing CFU (x 10^4) content Total nucleated cells (TNC) (x 10^7) TNC cell dose per kg for patient Nucleated Red Blood Cells (nrbc) (x 10^7) nrbc (x10^7) cell dose per kg for patient WBC (TNC corrected for (nrbc) (x 10^7) WBC (x 10^7) cell dose per kg for patient Mononuclear cells (x 10^7) Mononuclear cell dose per kg for patient RBC volume (ml) CD45+ 7AAD viability (%) Viable CD34+ cells (x 10^6) Viable CD34+ cell dose per kg for patient CD34+ 7AAD viability (%) Total CFU (x 10^4) Total CFU cell dose per kg for patient Total nucleated cells (TNC) (x 10^7) CBU TNC content (X10^7) post-thaw Nucleated Red Blood Cells (nrbc) (x 10^7) CBU nrbc (x 10^7) content post-thaw. WBC (TNC corrected for nrbc) x 10^7 CBU WBC content (x 10^7) (TNC content minus nrbc content x 10^7) post-thaw. Mononuclear cells (x 10^7) CBU mononuclear cell content (x 10^7) post-thaw RBC volume (ml) CD45+ 7AAD viability (%) CBU CD45+ 7AAD percent viability post-thaw Viable CD34+ cells (x 10^6) CBU viable CD34+ cell content (x 10^6) post-thaw CD34+ 7AAD viability (%) CBU CD34+ viability (%) post-thaw Total CFU (x 10^4) CBU CFU (x 10^4) content post-thaw SAMPLES AVAILABLE FOR SHIPMENT DNA Contiguous/attached segments Other viable cell aliquots Plasma Serum Indication of whether cord blood DNA samples are available or not (yes/no). Indication of whether CBU contiguous segments are available or not (yes/no). Indication of whether cord blood viable cell aliquots are available or not (yes/no). Indication of whether cord blood plasma samples are available or not (yes/no). Indication of whether cord blood serum samples are available or not (yes/no).

7 RBC aliquots DNA Contiguous/attached segments Other viable cell aliquots Plasma Serum RBC aliquots INFECTIOUS DISEASE MARKERS Date sampling (YYYY-MM-DD) HBsAg Anti-HBc Anti-HBs Anti-HCV Anti-HIV 1/2 plus p24 antigen combi Anti-HIV 1/2 HIV-1 NAT HCV-NAT HBV-NAT Anti-HTLV I/II Syphilis Anti- CMV IgG Anti- CMV IgM CMV DNA PCR West Nile Virus Chagas screen Malarial screen Indication of whether cord blood RBC aliquots are available or not (yes/no). Indication of whether maternal DNA samples are available or not (yes/no). Indication of whether maternal plasma samples are available or not (yes/no). Indication of whether maternal serum samples are available or not (yes/no). Indication of whether cord blood RBC aliquots are available or not (yes/no). Cord Blood Mother Mother Follow-up Date of cord blood collected Results of infectious disease marker testing for cord blood samples. Date of maternal blood collection Results of infectious disease marker testing for maternal initial blood samples. Date of maternal follow-up blood collection if performed. Results of infectious disease marker testing for maternal follow-up blood samples (if performed).

8 EBV IgG EBV IgM EBV EBNA EBV PCR Toxoplasma IgG Toxoplasma IgM Parvo-B19 PCR Other additional tests: MICROBIAL SCREEN AND HAEMOGLOBINOPATHY SCREEN Microbial screen (bacteria) Results of cord blood microbial screen for bacteria Microbial screen (fungi) Results of cord blood microbial screen for fungi Haemoglobinopathy screen Results of cord blood haemoglobinopathy screen Other screening testing Results of any other screening tests performed on cord blood. Microbial screen (bacteria) Blank field not relevant for mother Microbial screen (fungi) Blank field - not relevant for mother Haemoglobinopathy screen Results of cord blood haemoglobinopathy screen if performed on the mother. Other screening testa Results of any other screening tests performed on the mother. MATERNAL AND FAMILY HISTORY Maternal ID: Mother s identification number Date: (YYYY-MM-DD) Date maternal and family history was obtained Pregnancies Number(s) Total number of pregnancies including current pregnancy Mother's declaration Mother s risk behaviour for contracting and transmitting infectious disease. Mother at risk for vcjd Mother's vcjd/cjd risk factors including cumulative residence in UK for at least 6-months between 1980 to 1996, inclusive, treatment with growth or pituitary hormones before Mother's travel history Mother s risk of exposure to infectious disease.

9 Family medical history Date: (YYYY-MM-DD) Risk of infectious disease in mother? Risk of genetic/infectious risk in baby? ELIGIBIITY After reviewing the donor file, the mother and infant donor are deemed eligible After reviewing the donor file, the mother and infant donor are deemed non-eligible Genetic risk, including cancer, blood disorders, enzyme deficiencies, metabolic/storage disease or autoimmune diseases, identified. Date follow-up was performed. Risk of infectious disease identified in mother in the period between cord blood donation and follow-up. Risk of genetic/infectious disease identified in the baby in the period between cord blood donation and followup? Eligibility assessment after completion of unit report. Eligibility assessment after completion of unit report.