PART II. Specific Provisions
Whole Human Blood is blood which has been mixed with a suitable anti-coagulant, after
collection from a human subject in normal health.
The blood shall not be obtained from a human subject:
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(a) who is known to be suffering from or to have suffered from syphilis or hepatitis,
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(b) whose blood has not been tested with negative results for evidence of syphilitic infection,
or
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(c) who is not, as far as can be ascertained after medical examination and the study of
his antecedents, free from disease transmissible by blood transfusion.
The blood shall be withdrawn aseptically through a closed system of sterile tubing
into a sterile container in which the anticoagulant solution has been placed before
the container is sterilised. The equipment used must be pyrogen-free. When withdrawal
is complete the container shall be immediately sealed and cooled to 4° to 6° C and
not opened thereafter until immediately before the blood is to be used.
The blood will be collected into a citrate solution of acid reaction containing dextrose.
No antiseptic or bacteriostatic substance shall be added. The volume of the anticoagulant
solution must not exceed 220 ml per litre of the Whole Human Blood and the haemoglobin
concentration must not be less than 97 gram per litre.
Blood Group - The blood group under the ABO system shall have been determined by examination
of both corpuscles and serum and that under the Rh system by examination of the corpuscles,
using a separate sample of the donor's blood. When there is a national standard, or
nationally recommended technique of blood grouping, that technique shall be used.
The term Rh negative is only to be used when specific tests have shown the absence
of the antigens C, D, Du and E. All other blood must be labelled Rh positive.
Blood exchange under this agreement should only be used for recipients of the corresponding
ABO group.
Storage - Whole human blood shall be kept in a sterile container sealed so as to exclude
micro-organisms and stored at a temperature of 4° to 6° C until required for use,
except during any period necessary for examination and transport at higher temperatures,
any such period not to exceed thirty minutes after which the blood must immediately
be cooled again to 4° to 6° C.
Labelling - The label on the container shall give all the information shown on the
model label (Annex 2). The Rhesus group shall be written as “Positive” or “Negative”
or, in abbreviated form, “POS” or “NEG”.
1 bis. Human red cell concentrate
A human red cell concentrate is a unit of Whole Human Blood from which most of the
plasma has been removed.
It contains most of the red cells of the unit from which it has been prepared; other
cell components may be present or may have been partially removed.
The liquid content of the concentrate will consist either of the residual plasma,
or of an appropriate isotonic artificial aqueous solution added after the plasma was
removed. The volume of red cells should constitute between 65 and 75% of the total
volume of the product, but if a greater red cell concentration is applied the approximate
percentage of erythrocyte volume (haematocrit) shall be indicated on the label.
All operations required in the preparation shall be carried out under aseptic conditions:
decantation shall be carried out using a sterile, closed system and by compression
only. No antiseptic or bacteriostatic agents should be added.
Blood group and storage - as for Whole Human Blood.
Labelling - The label on the container shall give all the information shown on the
model label (Annex 2 bis). The Rhesus group shall be written as “Positive” or “Negative”
or, in abbreviated form, “POS” or “NEG”. If an artificial aqueous solution has been
added, the label shall also indicate its volume and composition.
Dried Human Plasma is prepared by drying the supernatant fluids which are separated
by centrifuging or by sedimentation from quantities of Whole Human Blood.
During preparation no antiseptic or bacteriostatic or other substance shall be added.
Dried Human Plasma shall be obtained by freeze-drying or by any other method which
will avoid denaturation of proteins. The dried product shall be readily soluble in
a quantity of water equal to the volume of the liquid from which the substance was
prepared. The protein concentration of the solution thus obtained must not be less
than 45 gram per litre, and must not show visible evidence of the products of haemolysis.
The haemaglutinin titre shall not be greater than 1:32.
Dried Human Plasma prepared from one or two donations of blood
Donations shown to contain dangerous levels of iso-haemolysins (determined using a
sample of fresh serum) or any immune haemaglutinins shall be excluded. Unless the
plasma is pooled and frozen within 48 hours of collecting the blood, the sterility
of each unit shall be tested by culturing not less than 10 ml.
Dried Human Plasma prepared from pools of more than two donations
Pools shown to contain dangerous levels of immune haemaglutinins or of iso-haemolysins
shall be excluded. To avoid untoward effects due to the products of bacterial growth
in the plasma no individual donation shall be used if there is any evidence of bacterial
contamination, and the sterility of each pool shall be tested by culturing not less
than 10 ml. To minimize the risk of transmitting serum hepatitis, plasma should be
prepared from pools which should contain not more than twelve donations, or by any
other method that has been shown to diminish the risk in comparable manner.
Solubility in water - Add a quantity of water equal to the volume of the liquid from
which the sample was prepared; the substance dissolves completely within 10 minutes
at 15° to 20° C.
Identification - Dissolve a known quantity of the product in a volume of water equal
to the volume of the liquid from which it was prepared; the solution passes the following
tests:
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(i) by precipitation tests with specific antisera, it must be shown to contain only human
plasma proteins;
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(ii) to 1 ml add a suitable amount of thrombin or calcium chloride; coagulation occurs,
which can be accelerated by incubation at 37° C.
Loss of mass on drying - When dried over phosphorus pentoxide at a pressure not exceeding
0.02 mm of mercury for 24 hours, Dried Human Plasma must not lose more than 0.5% of
its weight.
Sterility - The final product, after reconstitution, shall be sterile when examined
by a suitable bacteriological method.
Storage - Dried Human Plasma must be kept in an atmosphere of nitrogen or in a vacuum
in a sterile container sealed so as to exclude micro-organisms and, as far as possible,
moisture, protected from light and stored at a temperature below 20° C.
Labelling - The label on the container shall give all the information shown on the
model label (Annex 3).
3. Human Albumin and Human Plasma Protein Fraction
Human Albumin and Human Plasma Protein Fraction are preparations of that protein component
which forms about 60% of the total protein mass in the plasma of Whole Human Blood.
The method of preparation used shall be one which produces a material meeting the
requirements herein described. Regardless of whether the final product is liquid or
dried, the preparation, after the addition of a suitable stabilising agent or agents,
must have been heated in the liquid state in the final container at 60° C ± 0.5° C
for 10 hours, in order to inactivate the agent causing serum hepatitis. During preparation
no antiseptic or bacteriostatic substance shall be added.
In preparations of Human Albumin, not less than 95% of the mass of the proteins present
shall be albumin. In preparations of Human Plasma Protein Fraction, not less than
85% of the protein mass shall be albumin. In both preparations, more than 10 milligram
immunoglobulin G per gram product shall be present.
When the final product is freeze-dried, it must contain not less than 950 milligram
of protein per gram product.
When Human Plasma Protein Fraction is prepared as a solution it shall have a total
protein concentration between 45 and 50 grams per litre.
When Human Albumin is prepared as a solution it shall have a total protein concentration
not less than 45 gram per litre.
Solubility of the dried product - Add water to the recommended volume; the dried preparation
must be completely soluble.
Stability - By comparison of the solutions before and after heat treatment no evidence
of significant denaturation of the proteins in solution shall have been detected as
estimated by viscosity and turbidity measurements, ultracentrifugation and electrophoresis.
The solution shall be substantially free from visible particles after heating at 57°
C and after agitation in a mechanical shaker for 6 hours at this temperature.
Identification
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(i) By precipitation tests with specific antisera, both preparations must be shown to
contain only human plasma proteins.
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(ii) By electrophoresis, using the moving boundary technique under acceptable and appropriate
conditions, it must be shown that the protein fraction having the mobility of the
albumin component of normal human plasma, is not less than 95% of the protein mass
in preparations of Human Albumin, or not less than 85% of the protein mass in preparations
of Human Plasma Protein Fraction.
Sodium content and sodium concentration - The sodium content of salt-poor Human Albumin
must not exceed 0.61 millimole per gram of albumin. In other preparations of Human
Albumin and in Human Plasma Protein Fraction, the sodium concentration must not exceed
0.15 mole per litre of solution or reconstituted dried product.
Potassium concentration - The potassium concentration of Human Plasma Protein Fraction
must not exceed 2 millimole per litre of solution or reconstituted dried product.
Acidity - The pH of either preparation shall be 6.8 ± 0.2 when measured at a temperature
of 15 to 25° C in a solution diluted to a protein concentration of 10 gram per litre
by means of a solution containing 0.15 mole sodium chloride per litre.
Loss of mass on drying - Dried preparations, when dried over phosphorus pentoxide
at a pressure not exceeding 0.02 mm of mercury for 24 hours, must not lose more than
0.5% of their weight.
Sterility - The final product shall be sterile when examined by a suitable bacteriological
method.
Storage - Dried Human Albumin must be kept in an atmosphere of nitrogen or in a vacuum
in a sterile container, sealed so as to exclude micro-organisms and, as far as possible,
moisture, protected from light and stored at a temperature below 20° C.
Solutions of Human Albumin and Human Plasma Protein Fraction must be kept in sterile
containers, sealed so as to exclude micro-organisms, protected from light and stored
at a temperature of 4° to 6°C.
Labelling - The label on the container shall give all the information shown on the
appropriate model label (Annex 4). For solutions, the date of preparation is the date
of heat treatment in the final container.
4. Human Normal Immunoglobulin
Human Normal Immunoglobulin is a preparation of the plasma proteins prepared from
Whole Human Blood, containing the antibodies of normal adults. It is obtained from
pooled liquid human plasma from not less than 1000 donors.
The method of preparation used should be one which produces a material meeting the
requirements herein prescribed and which prevents the transmission of serum hepatitis
by the final product. In addition the method of preparation shall be such that the
antibodies contained in the starting material shall be concentrated in an adequate
amount in the final product. The procedure shall be shown, for each final preparation,
to be satisfactory in this respect by titrating in the starting material and in the
final product antibodies to at least one virus and one bacterial toxin. The antibodies
chosen shall be those for which there are recognised methods of titration.
During preparation no antiseptic or bacteriostatic substance shall be added; a suitable
preservative and a stabilising agent may be added to the final preparation to maintain
bacterial sterility and stability of the final product.
The final product is issued as a solution in which the immunoglobulin concentration
shall be between 100 and 170 gram per litre.
Identification
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(i) By precipitation tests with specific antisera, it must be shown to contain only human
plasma proteins.
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(ii) By electrophoresis, using the moving boundary technique under acceptable and appropriate
conditions, not less than 90% of the mass of the proteins have the mobility of the
gamma component of the globulins of normal human plasma.
Stability - Both before and after heating the final solution at 37° C for 7 days there
should be no visible evidence of precipitation or turbidity. It is advisable also
to carry out tests using an ultracentrifugation method to determine the extent of
degradation of the product to smaller molecular weight components. The method used
should be one approved by the national control authority.
Acidity - The pH of the final solution shall be 6.8 ± 0.4 when measured at a temperature
of 15 to 25° C in a solution diluted to a protein concentration of 10 gram per litre
by means of a solution containing 0.15 mole sodium chloride per litre.
Sterility - The final product shall be sterile when examined by a suitable bacteriological
method.
Storage - Human Immunoglobulin solution must be kept in a sterile container, sealed
so as to exclude micro-organisms, protected from light and stored at a temperature
of 4° to 6° C.
Labelling - The label on the container shall give all the information shown on the
model label (Annex 5). The date of preparation is the date of filling the final container.
5. Human Specific Immunoglobulins
Human Specific Immunoglobulins contain antibodies against designated viral or bacterial
agents. Therefore they may be prepared from pools of a limited number of donations.
The following human specific immunoglobulins are included in these requirements:
Human Immunoglobulin Anti-Tetanus
Human Immunoglobulin Anti-Vaccinia.
Other specific immunoglobulins may be developed and when the appropriate international
standard is in existence they should be assayed in relation to that standard and their
potency expressed in international units.
Human Immunoglobulin Anti-Vaccinia shall contain not less than 500 IU per ml of vaccinia
antibody as determined by a neutralisation test on chorio-allantoic membranes or in
tissue culture. Human Immunoglobulin Anti-Tetanus shall contain not less than 50 IU
per ml of tetanus antitoxin as determined by a neutralisation test in animals.
Human Specific Immunoglobulins must further meet the requirements as described in
section 4, Human Normal Immunoglobulin.
Depending on the antibody content, the immunoglobulin concentration of the final solution
may vary between 100 and 170 gram per litre.
Labelling - The label on the container shall give all the information shown on the
model label (Annex 5). In addition the label shall state the potency in international
units in terms of the appropriate International Standard or International Reference
Preparation.
6. Dried Human Fibrinogen
Dried Human Fibrinogen is a dried preparation which contains the soluble constitutent
of liquid human plasma which, on the addition of thrombin, is transformed to fibrin.
The method of preparation used should be one which produces a material meeting the
requirements herein prescribed and which minimises the risk of transmitting serum
hepatitis. Plasma pools used in the preparation of fibrinogen should contain as few
donations as possible.
During preparation no antiseptic or bacteriostatic substance shall be added. The final
product shall be freeze-dried.
Solubility - Add water to the recommended volume; the dried preparation must be completely
soluble. No precipitation shall occur within 60 minutes of reconstitution.
Identification
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(i) By precipitation tests with specific antisera, it must be shown to contain only human
plasma proteins.
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(ii) The freshly reconstituted product has the property of clotting on the addition of
thrombin. When thrombin is added to a solution of Human Fibrinogen of the same concentration
as that in fresh normal plasma, clotting shall occur in not more than twice the time
taken for clotting to occur in fresh normal plasma after the addition of thrombin.
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(iii) Clottable protein. Not less than 50% of the total protein shall be clottable by thrombin.
Loss of mass on drying - Preparations, when dried over phosphorus pentoxide at a pressure
not exceeding 0.02 mm of mercury for 24 hours, must not lose more than 0.5% of their
weight.
Sterility - The final product after reconstitution shall be sterile when examined
by a suitable bacteriological method.
Storage - Human Fibrinogen shall be kept in an atmosphere of nitrogen or in a vacuum
in a sterile container, sealed so as to exclude micro-organisms and, as far as possible,
moisture, protected from light and stored at the temperature recommended.
Labelling - The label on the container shall give all the information shown on the
model label (Annex 6). The date of preparation is the date of placing into final solution
before freeze-drying.
7. Dried or frozen human coagulation factor VIII
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I
Requirements applying to donors
Donors must be in good health and, in particular, free of any communicable disease,
in accordance with the criteria adopted for dried human plasma.
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II
Requirements applying to preparations
Sterility and atoxicity - The final product must be sterile and pyrogen-free. Where
cryoprecipitation is performed in plastic bags, the product must not contain organic
solvent or other foreign substances present in the freezing mixture. The passage of
such products through the walls of the plastic bag can be prevented by placing the
bag in a second impermeable bag during the whole period of immersion. The risk of
the plastic bag tearing during storage in the frozen state can be reduced by keeping
each bag in a protective box.
Erythrocytes, leukocytes and platelets - Centrifuging should be such as to eliminate
the formed elements of the blood as soon and as completely as possible after its collection.
Solubility - The addition of the indicated quantity of appropriate solvent must result
in the complete solution of the dry product in less than 30 minutes at 37° C. Small
and easily separable aggregates of fibrinogen may persist.
Stability - The preparation conserved at 20° C, must not show any sign of precipitation
within three hours after it has been dissolved.
Potency - The reconstituted preparation should contain the indicated minimum quantity
of factor VIII, one unit corresponding to the potency of 1 ml of average normal fresh
plasma, the potency being determined by a method approved by the competent national
authority.
Absence of irregular antibodies and, if the preparation is intended for patients of
any ABO group, a titre of anti-A and anti-B antibodies not exceeding 32.
Identification - Precipitation tests with specific antisera shall show that the product
contains only human plasma proteins.
Loss of mass on drying - Freeze-dries preparations, when dried over phosphorus pentoxide
at a pressure not exceeding 0.02 mm of mercury for 24 hours must not lose more than
1.5 per cent of their weight.
Storage - Human factor VIII shall be stored in the deep frozen state at a temperature
under - 30° C, and in the freeze-dried state below 5° C, and protected from light.
The dried preparation shall be kept in an atmosphere of nitrogen or in vacuo, in a
sterile vial, stoppered so as to exclude all micro-organisms and, as far as possible,
all humidity. Storage in the frozen state shall not exceed six months, in the dried
state one year, unless the preparation has been retested for minimum required potency.
8. Dried human coagulation factor IX
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I
Requirements applying to donors
Donors must be in good health and, in particular, free from any communicable disease
in accordance with the criteria adopted for dried human plasma.
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II
Requirements applying to the concentrate
Sterility and atoxicity - The final product, tested by appropriate methods must be
sterile, pyrogen-free and free from undesirable vaso-depressor or respiratory effects.
The test for absence of vaso-depressor effects, should be performed on a dog or cat.
Solubility - The addition of the indicated quantity of the solvent must result in
complete solution in 10 minutes at 37° C.
Thromboplastin activity and absence of free thrombin - The recalcification time of
a normal plasma measured at 37° C in the presence of an equal volume of various dilutions
of the reconstituted product, must not be less than 40 seconds. The reconstituted
product, with an equal volume of fibrinogen (3g/l) added to it, must not coagulate
within six hours at 37° C.
Potency - The reconstituted preparation must contain the indicated minimum quantity
of factor IX, 1 unit corresponding to the potency of 1 ml of average normal fresh
plasma, the potency being determined by a method approved by the competent national
authority.
Yield and stability in vivo - The method of preparation must be such that the injection
of a dose of 50 units per kg body weight, rapidly, administered intravenously, using
several batches of material given to several patients, shall cause, in 15 minutes,
in the absence of a specific inhibitor and in basal conditions, an average rise of
not less than 300 units per litre plasma, and of the persistence, after 24 hours of
an average rise of not less than 60 units per litre plasma.
Identification - Precipitation tests with specific antisera shall show that the product
contains solely human plasma proteins.
Loss of mass on drying - When dried over phosphorus pentoxide at a pressure not exceeding
0.02 mm of mercury for 24 hours, the product must not lose more than 1.5 per cent
of its weight.
Storage - The preparations must be stored dry at a temperature below 5° C. The period
of storage must not exceed two years, unless the potency of the preparation has been
re-tested.