Strategic partner for the Québec health system

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1 BLOOD PRODUCTS STABLE PRODUCTS STEM CELLS Strategic partner for the Québec health system HUMAN TISSUES MOTHER S MILK CORPORATE PRESENTATION

2 MISSION To efficiently meet the needs of the Québec population for quality blood and other biological products of human origin. VISION To become a strategic partner for the Québec health system.

3 BLOOD AND BIOLOGICAL PRODUCTS OF HUMAN ORIGIN SYSTEM IN QUÉBEC MINISTER OF HEALTH AND SOCIAL SERVICES HEALTH CANADA BIOVIGILANCE COMMITTEE HÉMA-QUÉBEC HOSPITALS DONORS RECIPIENTS 3

1998 Creation of the unrelated bone marrow donor registry in Canada Release of the Gélineau Committee report The

4 FROM SUPPLIER OF BLOOD PRODUCTS TO EXPERT First cases of HIV transmitted through blood Contaminated blood scandal Adoption of the Act Respecting Héma-Québec Héma-Québec starts its operations Creation of the unrelated bone marrow donor registry in Canada Release of the Gélineau Committee report The Red Cross announces its withdrawal from the Canadian blood program as of September 1998 Krever Commission report tabled 4

IN BIOLOGICAL PRODUCTS OF HUMAN ORIGIN Creation of the Québec Public Cord Blood Bank Creation of the no-fault compensation scheme Creation of the Québec Public Mothers Milk

Operational start-up of the first GLOBULE Mobile Blood Donation Unit Revision of the Act Respecting Héma Québec: extended mandate to biological products of human origin

5 IN BIOLOGICAL PRODUCTS OF HUMAN ORIGIN Creation of the Québec Public Cord Blood Bank Creation of the no-fault compensation scheme Creation of the Québec Public Mothers Milk Bank Acquisition of the assets of the Centre de conservation de tissus humains du Québec Opening of the first GLOBULE Blood Donor Centre Operational start-up of the first GLOBULE Mobile Blood Donation Unit Revision of the Act Respecting Héma Québec: extended mandate to biological products of human origin Opening of the Mobile Blood Drive Regional Centre Opening of the first PLASMAVIE Plasma Donor Lounge Héma-Québec assumes full management of the Stem Cell Donor Registry in Québec 5

6 HÉMA-QUÉBEC IS... CLOSE TO 225,000 BLOOD, STEM CELL, MOTHER S MILK AND HUMAN TISSUE DONORS A great team dedicated to the gift of life 1,347 OF EMPLOYEES THOUSANDS VOLUNTEERS ANNUAL REVENUE $450M 6

PERMANENT PRESENCE THROUGHOUT QUÉBEC Facility GLOBULE Mobile

donation area Drop-off point for mother s milk NEW Saguenay

Saint-Laurent Quartier Lebourgneuf (June 2018) Trois-Rivières

7 PERMANENT PRESENCE THROUGHOUT QUÉBEC Facility GLOBULE Mobile Blood Drive Regional Centre PLASMAVIE PLASMAVIE with a blood donation area Drop-off point for mother s milk NEW Saguenay (June 2018) NEW Québec Arrondissement Sainte-Foy Saint-Laurent Quartier Lebourgneuf (June 2018) Trois-Rivières NEW (Fall 2018) Montréal Gatineau Laval Brossard Sherbrooke NEW (April 2018) 7

8 BLOOD PRODUCTS Justine makes her first blood donation. 8

COLLECTIVE BLOOD SUPPLY 304,920 BLOOD PRODUCTS DELIVERED 173,244 DONORS PER YEAR (all types of donations) generated over 357,039 visits to collection sites 2,416 MOBILE BLOOD DRIVES organized each

9 COLLECTIVE BLOOD SUPPLY 304,920 BLOOD PRODUCTS DELIVERED 173,244 DONORS PER YEAR (all types of donations) generated over 357,039 visits to collection sites 2,416 MOBILE BLOOD DRIVES organized each year (including blood drives in mobile units) COLLECTION METHODS MOBILE BLOOD DRIVES CENTRES MOBILE UNITS 20% 7% 73% FROM DONATION TO DISTRIBUTION DELIVERY Products are delivered to hospitals. The blood components used vary depending on the patient. STORAGE Compliant products are labeled and stored, ready for shipment to hospitals. DONATION The blood collection takes about ten minutes. In addition to the blood bag (450 ml), samples are collected for analysis. SEPARATION OF WHOLE BLOOD The blood is separated into its various components (red blood cells, platelets or plasma). TRANSPORTATION The blood bags and their samples are packed and sent to one of Héma-Québec s laboratories. ANALYSES The blood samples collected during the donation are sent to the qualification laboratory to screen for infections. BLOOD PRODUCTS

STABLE PRODUCTS IMPROVING SELF-SUFFIENCY IN PLASMA INTENDED FOR MEDICATION MANUFACTURING Self-sufficiency rate in immunoglobulin relies on the generosity

10 STABLE PRODUCTS IMPROVING SELF-SUFFIENCY IN PLASMA INTENDED FOR MEDICATION MANUFACTURING Self-sufficiency rate in immunoglobulin relies on the generosity of our donors. SELF-SUFFICIENCY RATE IN IMMUNOGLOBULIN 21.5 % OF IN ,160 LITRES OF PLASMA collected for purposes of manufacturing medications 10

MEDICATIONS MANUFACTURED FROM PLASMA EXCLUSIVE DISTRIBUTION for 427,822 Québec STABLE PRODUCTS delivered in 2017 2018 Some including 4 50DISTRIBUTED DIFFERENT PRODUCTS MANUFACTURED from plasma

11 MEDICATIONS MANUFACTURED FROM PLASMA EXCLUSIVE DISTRIBUTION for 427,822 Québec STABLE PRODUCTS delivered in Some including 4 50DISTRIBUTED DIFFERENT PRODUCTS MANUFACTURED from plasma collected by Héma-Québec PRODUCTS MANUFACTURED BY PHARMACEUTICAL COMPANIES under agreement with Héma-Québec FROM DONATION TO DISTRIBUTION DELIVERY Products are delivered to hospitals. RETURN OF PRODUCTS TO HÉMA-QUÉBEC AND STORAGE The finished products are then returned to Héma Québec and stored, ready for shipment to hospitals. DONATION Plasma donations are made in donor centres, by appointment. The collection process lasts approximately 45 minutes. FREEZING Plasma is quickly frozen following collection. The faster you freeze it, the more protein you can extract. FRACTIONATION The plasma is sent to fractionation plants. These high-tech plants extract proteins from plasma and use them to make medications. ANALYSES Collections are sent to the qualification laboratory. All donations are tested. STABLE PRODUCTS

stem cell transplant Héma-Québec is a part of a global

12 STEM CELLS STEM CELL DONOR REGISTRY 45,690 registered donors in Québec to meet the needs of patients requiring a stem cell transplant Héma-Québec is a part of a global network that includes 32 MILLION DONORS Rosalie, cord blood recipient 12

13 PUBLIC CORD BLOOD BANK 56 Canada 27 United States 11 England 8 France 2 Italy 2 Turkey 17 Netherlands 1 Austria 1 Israel Internationally recognized expertise 1 Argentina 2 Australia FIRST BANK IN CANADA 9 PARTNER 10,776 HOSPITALS UNITS BANKED 128 UNITS DISTRIBUTED THROUGHOUT THE WORLD SINCE UNITS DISTRIBUTED IN FROM DONATION TO TRANSPLANT DONATION Cord blood is collected at birth in partner hospitals. TRANSPLANT The patient receives the transplant. CALL AND RESEARCH When our registry receives a call, we search for a compatible unit for a patient in need of a stem cell transplant C TRANSPORTATION Cord blood is transported to Héma-Québec. QUALIFICATION Cord blood is qualified based on strict criteria. PROCESSING AND STORAGE Cord blood is processed, frozen at 150 C and stored for 15 years. The units of cord blood are made available through a world registry. STEM CELLS

14 HUMAN TISSUES Claudie-Ann, customer service agent (human tissues), handles musculoskeletal products. 14

HUMAN TISSUE BANK Héma-Québec collects the following human tissues: Ocular tissues (corneas, scleras) Heart valves Skin tissues Arterial tissues (abdominal aortas, arteries.

15 HUMAN TISSUE BANK Héma-Québec collects the following human tissues: Ocular tissues (corneas, scleras) Heart valves Skin tissues Arterial tissues (abdominal aortas, arteries...) Musculoskeletal tissues (tendons, bone chips, femoral heads...) IN ,451 TISSUES DISTRIBUTED to hospitals 1,008 DONORS WHO DONATED in Québec 5,464 DONOR REFERRALS FROM DONOR REFERRALS TO TRANSPLANT TRANSPLANT The surgeon transplants the tissues. One human tissue donation can help up to 20 people. PROCESSING AND STORAGE The tissues are processed and stored until they are transplanted. Most tissues can be preserved for up to five years, with the exception of corneas that cannot be preserved beyond 14 days. COLLECTION Héma-Québec performs the collection of human tissues. DONOR REFERRALS Health professionals recommend donors to Héma-Québec. CONSENT A verification of the consent registries is made. Whether consent is registered or not, it is important for the donor to inform his or her loved ones if he or she consents to the donation of human tissues, since they will be the ones who will speak on his or her behalf at the time of his or her death. QUALIFICATION Héma-Québec conducts a thorough evaluation to verify the donor s eligibility. HUMAN TISSUES

16 MOTHER S MILK Mévick received mother s milk at birth. 16

PUBLIC MOTHERS MILK BANK FOR VERY PRETERM INFANTS IN 2017 2018 11,767 BOTTLES DISTRIBUTED 853 REGISTERED DONORS FROM DONATION TO DISTRIBUTION DELIVERY The milk is distributed to hospitals for very

17 PUBLIC MOTHERS MILK BANK FOR VERY PRETERM INFANTS IN ,767 BOTTLES DISTRIBUTED 853 REGISTERED DONORS FROM DONATION TO DISTRIBUTION DELIVERY The milk is distributed to hospitals for very premature infants who cannot be breastfed by their mothers. MICROBIOLOGICAL ANALYSES AND STORAGE Héma-Québec tests the milk to ensure that it is safe for recipients; if the results are satisfactory, the milk is frozen and stored for a year. PASTEURIZATION The milk is pasteurized to eliminate viruses and bacteria. DONATION Héma-Québec supplies the bottles; mothers collect their milk at home and freeze it. DONATION POOLING Héma-Québec combines donations from several donors into one batch. PICK-UP AND DROP-OFF POINT Depending on the region, Héma-Québec collects the bottles at the donor s home or the donor brings the milk to a drop-off point. MICROBIOLOGICAL ANALYSES Héma-Québec conducts tests on the unpasteurized milk to ensure that it meets quality standards. MOTHER S MILK

SPECIALIZED LABORATORY SERVICES FOR HOSPITALS 4,704 testing requests received from hospitals Complex cases in erythrocyte immunology 1,470 ANALYSES (patients cases) Erythrocyte genotyping of

18 SPECIALIZED LABORATORY SERVICES FOR HOSPITALS 4,704 testing requests received from hospitals Complex cases in erythrocyte immunology 1,470 ANALYSES (patients cases) Erythrocyte genotyping of blood groups 3,783 ANALYSES (patients cases and donors) Screening for virological markers 1,715 ANALYSES (donors in hospitals) Phenotypimg 21,114 PHENOTYPED PACKED RED BLOOD CELLS distributed 18

CHALLENGE OF DIVERSITY The blood supply and the Stem Cell Donor

and stem cell grafts require that the donor and recipient share

Héma-Québec works closely with cultural communities to raise

19 CHALLENGE OF DIVERSITY The blood supply and the Stem Cell Donor Registry have to be representative of the makeup of Canada s population. Andy, donor The treatment of certain hereditary blood disorders and stem cell grafts require that the donor and recipient share a similar genetic makeup. Héma-Québec works closely with cultural communities to raise awareness about blood and stem cell donations. Priscille, recipient 12 % of blood donors are of non-caucasian origin This proportion is 15% in the Québec population. 19

20 RISK AND QUALITY MANAGEMENT: A CONSTANT CONCERN 15 PATHOGENS ARE BEING MONITORED: bacteria, viruses or parasites that can be transmitted through blood PREVENTION: AN IMPORTANT ASPECT OF SAFETY SAFETY ADVISORY COMITTEE This comittee encompasses international experts and Canadian Blood Services representative. It monitors all existing and emerging pathogens and makes recommendations to the Board. Donations confirmed positive according to the markers Human immunodeficiency virus (HIV) Hepatitis C virus (HCV) Hepatitis B virus (HBV)* Human T-cell lymphotropic virus (HTLV) Syphilis Total number of donations 277, , , , ,900 *Results related to recent donor immunization are excluded as they are false positives. Héma-Québec makes every effort to provide the Québec population with biological products of human origin that are safe and of optimal-quality. HEALTH CANADA ACCREDITATIONS Blood Regulations BLOOD Safety of Human Cells, Tissues and Organs for Transplantation Regulations STEM CELLS, HUMAN TISSUES ISO Quality management systems providing a framework for the manufacturing of aortic and pulmonary heart valve allografts HUMAN TISSUES ISO Medical biology laboratories and erythrocyte, platelet and HLA analysis laboratories BLOOD, STEM CELLS AATB American Association of Tissue Banks HUMAN TISSUES ASHI American Society for Histocompatibility and Immunogenetics (HLA analysis laboratory) BLOOD, STEM CELLS NetCord-FACT International Standards for Cord Blood Collection, Banking and Release for Administration CORD BLOOD WMDA (qualified member) World Marrow Donor Association STEM CELLS 20

2017 2020 STRATEGIC PLAN How does Héma-Québec intend to become a strategic partner of the Québec health system?

21 STRATEGIC PLAN How does Héma-Québec intend to become a strategic partner of the Québec health system? 6 STRATEGIC ORIENTATIONS 1 By comparing its practices with those of the leaders in its field, and taking the necessary steps to achieve its objectives for the benefit of its partners, and assuming its responsibility for the results 2 By keeping up with the latest developments in human biological products and being proactive so that the healthcare network can benefit from this expertise 3 By managing risks in an integrated manner at all levels of the organization in accordance with best practices 4 By modernizing and streamlining its processes in order to be more effective 5 By taking advantage of digital technology to improve its communication with its partners 6 By developing the skills of its employees and mobilizing them by implementing a talent and succession management program 21

22 BLOOD PRODUCTS STABLE PRODUCTS STEM CELLS HUMAN TISSUES MOTHER S MILK

23 Published by the Direction des relations publiques, Vice-présidence aux relations publiques et au secrétariat général. Data reflects results as at March 31, Reproduction of material contained in this publication is permitted with acknowledgement of its source. Original text in French. In the event of a discrepancy between the English and French versions, the latter will prevail. Legal Deposit Bibliothèques et Archives nationales du Québec, 2018 Library and Archives Canada, 2018 ISSN (printed version) ISSN (online version)

BLOOD TRANSFUSIONS. Answers. To Your. Questions

BLOOD TRANSFUSIONS. Answers. To Your. Questions BLOOD TRANSFUSIONS Answers To Your Questions Answers to Your Questions This brochure is intended for people who may need a blood or blood product transfusion and for those who regularly receive transfusions.