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MS. GIRAND:
      Well, when you want to build something really strong you want to build something on rock and I have to say that our next speaker has been incredibly gracious.
      Two years ago when we started thinking about this conference, originally we knew that we very much wanted to have a hematologist and practically the first physician we contacted was Dr. Gail Rock, based out of Canada.
      Dr. Rock agreed to speak. We then moved the date of the conference at least twice on her and she continued to agree to speak. And then I'm sure that her schedule has been beyond control and she continued to agree to speak. So we are very, very pleased and incredibly grateful to her coming today to give this presentation.
      I would like you to please join me in welcoming Dr. Rock.
     

DR. ROCK:
      Ladies and gentlemen, it's a pleasure for me to be here today and I would like to begin by thanking the organizing committee for inviting me here to Seattle. It gives me a wonderful opportunity to go up to Vancouver and see my daughters, as well as hearing all of the presentations today.
      What I would like to speak with you about this morning is the therapy that we have applied to adult cases of TTP and Hemolytic Uremic Syndrome.
      The major therapy that we have found over the past 10 years to be efficacious is the use of plasma exchange therapy. So I would like to spend a few minutes just simply describing what it is I mean by plasma exchange.
      Plasma exchange has now been in existence in common use only for the last 25 years. Prior to that, it was possible to remove plasma from patients, most certainly, but in not large enough quantities to be truly effective.
      Now, with the development of new, large machines, which are rather like the dialysis machine in principle, we're able to use these machines to remove large volumes of blood and plasma from a patient during a very short period of time.
      A typical plasma exchange procedure in which 1.5 to two plasma volumes of a patient are removed and exchanged are completed in two to four hours depending on the patient's size.
      Essentially what is involved is the use of the machine to draw blood from the patient through a single venipuncture. The whole blood comes out and is separated, generally by centrifugal techniques with a bowl inside that device I showed you earlier, which separates the plasma into its various components, meaning red cells, white cells and plasma.
      Then in Apheresis we are able to extract any one of these layers we want so that we can use this procedure for donor collection. Mainly, we can collect platelets from a random donor to use in a bone marrow transplantation setting, for example or, alternatively, we can remove the plasma from the patient if we, in fact, consider there to be something harmful in that plasma.
      Now, that could be the presence of a toxin, it could be the presence of a variety of antibodies and/or it could be that the plasma is lacking something which the patient requires but that can not be replaced by use of a blood concentrate.
      So now it is about 25 years since we've had the capability in North America to use large volume plasma exchange to treat a variety of patients.
      At the present time about 55 percent of the cases treated in Canada are treated for immunological disorders. About 35 percent are treated for neurological disorders, such as acute uremic syndrome where we know there's an antibody, at least one in the plasma that is harmful to the patient.
      And then there are a variety of other diseases, including collagen vascular rheumatological, etcetera, disorders for which we carry out plasma exchange.
      Canada is one of the few countries in the world that has a complete registry of every plasma exchange procedure carried out in the country. As such, we can tell you that over the past few years we have done about 10,000 plasma exchange procedures in all of our patients in 35 major medical centers across the country.
      And in putting together this data and establishing the Canadian Apheresis group, which we did 20 years ago, we have been able to carry out a number of randomized clinical trials in a variety of disorders. Some of those involve the therapy and the treatment of adult patients with TTP/HUS.
      And if I could go onto the other set of slides, now, what I would like to talk about is the results of some of our and other people's clinical trials in the therapy of these disorders.

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