Why "We" should Care Presented to: International Blood Safety Forum Jed Gorlin MD, MBA March 20, 2015 ©2015 Innovative Blood Resources, Proprietary & Confidential. All rights reserved. | InnovativeBloodResources.org | 1

Win-Win solutions Advantages for industry –Growing markets Advantages for 1 st world blood programs –Motivating Staff

S/D Factors IncreaseDecrease Demand Aging population Aggressive Cancer therapy for older patients Increased insurance coverage Cord blood vs PBSC Transplant Other cell Rx Pathogen Rx (if product loss during manufacture) Broader use of anticoagulants High deductible health plans decrease elective procedures Blood management (fewer units per transfusion, lower Tx triggers Clinical trials Blood substitutes ? Trends towards smaller family size (decreased childbirth) Supply 16 yo donors, tattoo licensing Double RBC ABO inventory issues More rationale malaria deferrals/test Blood center importers increasing collections to achieve independence Aging population Increase in Hgb eligibility, deferral period (to protect donor Iron) Trials showing older blood is “bad” Additional required tests (Babesia, Dengue, Chikungunya) or travel deferrals

Innovative Blood Resources RBC Local Usage FY2010 – FY2014 ©2014 Innovative Blood Resources, Proprietary & Confidential. All rights reserved. | InnovativeBloodResources.org | 4

Advantages for industry US RBC market is shrinking 2-5%/year (and decline shows little sign of leveling off) –Usage was >50 RBC units/1000 population Now below 45 but Canada is in mid 30’s Group purchasing and health care systems formally adopting blood management programs Choosing Wisely encouraging lower RBC use/transfusion volume (1 vs. 2 units) Accountable care intended to make all hospital spending a cost center, not a revenue driver

Emerging markets Want adequate supplies –Help in collecting enough blood –Access to economical quality blood collection equipment –Access to quality systems Software supportable by local staff and able to run on simple IT systems Want safe blood –Western model of >$1 million/QUALY not sustainable –But:Is pathogen inactivation cheaper than broad scale screening? –Pre-donation rapid tests can add a layer of safety but not adequate alone

Rwanda Blood Transfusion CNTS collects 38,000 volunteer units fully tested for HIV, Hepatitis B & C

Afghanistan Maternity Hospital (Rabia Balkhi) transfusion service ABO/Rh typing but no Antibody screen Whole blood is collected from family Replacement donors

Malalai maternity hospital Malalai hospital had exactly one O negative unit and only 3 O+ units on the shelf. They have over 120 deliveries daily!

Market opportunities Honduras Red Cross Dr. Elizabeth Vinelli –CEO received donation of older model Hemocue devices but couldn’t obtain cuvettes in local market –I contacted HemoCue North America to facilitate access to needed supplies

Market opportunities: Kazakhstan National blood program has access to NAT testing Pathogen inactivation Blood irradiation Automated collections

AIHA Central Asia Project Kazakhstan is almost as large as US but has 18 million people –GDP/capita ~12K Kyrgyzstan has ~6 million people –GDP/capita ~1K US has ~350 million people and GDP/capita ~58K

AABB poster 132 A Voluntary non-remunerated blood program in the Kyrgyz republic –Over the last 20 years, the # of active blood donors in Kyrgyzstan has declined almost 6 fold from Soviet times with current rate ~5/1,000 pop. –Majority of current donors are family/replacement donors –Program aims to increase VNRD from 23 to 50% by 2018 and reduce TTI discards from 18% to 10 % results: 34 K donations –75% FRD, 23% VNRD, 2% paid –Increase to ~6/1,000

Kyrgyz Prikaz (Order) AIHA Goal: Work with local Kyrgyz Staff to update Prikaz This is the main order that sets all rules and requirements for blood transfusion Dr. Chursin, director of Anesthesia at the largest hospital in Almaty had done similar work in Kazakhstan

KYR Blood donor center collections

Blood typing and hemoglobin screening

Donor testing tubes- no vacutainers were available, so diversion pouches were not used

KYRGYZSTAN:Whole blood platelets are made upon order for a specific patient

Market Opportunity: China Active competition to provide technology for: –Automated collections Apheresis platelets, double red cells –Advanced testing NAT testing Pathogen inactivation Qingdao blood center

Motivation for staff