Canadian Blood Services National Public Cord Blood Bank Give Life Twice Transfusion Medicine Residents

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1 Canadian Blood Services National Public Cord Blood Bank Give Life Twice Transfusion Medicine Residents Eileen Quinlan Collection Supervisor, Brampton (GTA)

2 History One Match Stem Cell and Marrow Network: Recruits health, unrelated, volunteer blood stem cell donors Coordinates the collection and delivery of blood stem cells 10 th largest registry in the world Consists of the unrelated Adult Registry and the National Public Cord Blood Bank

3 What are Stem Cells? We collect Hematopoietic Stem Cells, or blood forming stem cells Can develop into any type of specialized blood cell RBCs WBCs Platelets These are NOT embryonic stem cells 3

4 3 Sources of Stem Cells Bone Marrow Peripheral Blood Stem Cells Cord Blood 4

5 Who Needs Stem Cells? Stem Cell Transplants are used to treat over 80 diseases and disorders: Cancer, such as leukemia, lymphoma or myelomas Bone Marrow deficiency diseases caused by abnormal RBC production, such as thalassemia or sickle cell disease Aplastic anemia Inherited immune system and metabolic disorders 5

6 The Need A National Public Cord Blood Bank is needed for Canada: Canada s population is uniquely ethnically diverse Almost 1000 patients on waiting list at any time 50% of Canadian patients who need an unrelated blood stem cell transplant unable to find a match Ethnic Composition of OneMatch Network searchable registrants= 70% Caucasian Canada was the only G7 country without a national public cord blood bank. 6

7 Why Unrelated Donors? Leila, OneMatch Registrant & whole blood donor HLA Typing: inherited genetic markers Only 25% of patients have a match in family This is why CBS maintains the OneMatch Stem Cell and Marrow Network- a network of Canadians who are ready to donate to any patient in need. 7

8 Why Cord Blood Low risk to mother or newborn baby Collected in advance, tested and frozen, ready to use More lenient HLA matching- increased chance to find a suitable donor Lower incidence of Graft vs Host Disease (GvHD) Unit is small, enough for a child or small adult 2 Cord Blood Units (CBUs) needed for adults Cost = ~$40,000/CBU purchased internationally Free for Canadian Transplant Centers 8

9 Official Announcement The National Public Cord Blood Bank: Announced in 2011 $48 million dollar investment by provincial and territorial ministers of health (excluding Quebec) Canadian Blood Services raised $12.5 million as part of our commitment

10 Our Goal Goal of the National Public Cord Blood Bank: Increase the number of stem cell donors of all ethnicities Decrease patient wait times for a matched donor Reduce Canada s reliance on internationally sourced cord blood stem cell donation

11 Collection Sites 11

12 Chosen Sites The Ottawa Hospital: General & Civic Campus Brampton Civic Hospital (WOHS) Lois Hole Hospital for Women BC Women s Hospital and Health Center 12

13 Challenges General public has little or no knowledge of public cord blood donations Some knowledge of private/family banks Mothers can donate in 4 cities only, disappointment for some Available to all Canadians and international patients Timing of recruitment-cannot consent is mother is contracting 13

14 Recruitment No pre-registration Maternal Information Kit (MIK) from Internet and/or Health Care Provider All mothers to receive MIK as part of routine prenatal information, ideally in third trimester Community Awareness Baby Shows, Magazines, Ultrasound Clinics, Social Media We need mothers to drive recruitment! 14

15 Maternal Information Kits Bilingual (English and French) Information Brochure Cord Blood for Research Program Privacy Notice for Donors Permission to Collect Consent Form 15

16 Who Can Donate All healthy pregnant women, 18 years of age or older Free of diseases or medical conditions that could be passed on to a patient who receives a cord blood stem cell transplant. 34 weeks or later at time of delivery Singleton pregnancy Delivering at participating hospitals

17 Eligibility Criteria- NOT Eligible Known positive serology for infectious diseases (HIV, Hepatitis B/C, HTLV I, II, Syphilis), Active sexually transmitted disease at time of delivery Maternal high risk behaviour (IV drug use, taking money for sex) Blood transfusion during or before delivery, or excessive maternal bleeding Mother or father of baby with history of cancer or blood disorder requiring chemotherapy Placenta trauma Delivery considered high risk for cord blood collection Malodorous placenta Maternal/Infant temperature above 102 F or 39.0 C

18 Regulations and Standards To protect the health and safety of transplant recipients, Health Canada governs cells, tissue and organ transplants through the Safety of Human Cells, Tissue regulations. NPCBB will also meet the requirements set forth by international standards. 18

19 Cord Blood Collection 19

20 Ex-Utero Collection 20

21 CB Collection Process (cont.) Ex-Utero Collection Placenta in collection container with umbilical cord hanging down Needle from the collection tubing was inserted into the umbilical vein and collection was started A collected CB unit

22 22

23 Stem Cell Manufacturing Sites Stem cell manufacturing facilities are located in Ottawa and Edmonton All cord blood units are transported from the hospital to either the Ottawa or Edmonton facility to be processed, tested and stored

24 Arrival in Manufacturing Facility Receive the CBU Assess integrity of temperature, all requirements Process the CBU (within 36 hours of collection) Test the CBU, Maternal IDM samples, HLA, ABORh Cryopreserve Liquid nitrogen storage (-196 C) Must be stored within 48 hours of collection; can be stored indefinitely 24

25 Search, Match, Select, Distribute Listed on OneMatch Registry TC Physicians (nationally and internationally) select based on the best match Information uploaded into our secure IT system that supports all our processes Testing Pack Distribute to transplant center, medical courier 25

26 Maternal History and Health Assessment - MHHAQ Maternal medical history and health assessment: Must be completed within 7 days of the cord blood unit collection Interview may be performed at the hospital or over the phone if done post discharge by CBS staff 26

27 Information that could affect the cord blood Mothers, health care professionals, and third parties are asked to report any health issues or serious conditions that could affect the collected cord blood unit Please call DONATE ( ) For cord blood units that are banked, the mother will receive a reminder letter at eight weeks and one year to report any issues. 27

28 Withdrawal of Participation Participation is voluntary and may be withdrawn at any time by calling DONATE. If a mother choses to withdraw her participation: The cord blood unit will be discarded (if not already used) A Withdrawal of Consent to Participate will be mailed to the mother Personal information that has been collected up to the date of withdrawal will remain in the secure electronic database No further information will be collected, used or disclosed. 28

29 You Can #GiveLife You have the Power to Give Life Blood Donation Stem Cell Registry Cord Blood Donation Organ and Tissue Donation Join the Movement-Visit our website to learn more 29

30 Research Depending on the collection hospital, cord blood that is not eligible for storage may be: Used and/or distributed for research purposes by the NPCBB with maternal consent Discarded 30

31 Research For information on the research program, mothers are encouraged to: Read the research information pamphlet and Visit our website at: 31

32 32

33 We would have done anything to save Nate s life. Amy, mother of cord blood recipient, Nate

34 Overview Operational Update & Ethnicity of CBUs Released September 2013 to August 2015: ~5800 mothers have donated their baby s cord blood to the National Public Cord Blood Bank ~1,100 banked units Southeast Asian 1% 1% Unknown South Asian 5% 5% Black-African Arab 5% Black-Caribbean 2% ~364 units already listed nationally and internationally Cost of CBU: No charge to Canadian transplant centres $40,000 to international transplant centres 26% Multiple Ethnicity Hispanic 1% First Nations Filipino 1% 0% Chinese 2% Central Asian 0% 51% Caucasian 34

35 Did you donate your cord blood?

36 36

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