October 2018

Provincial Platelet Audit – Preliminary Pediatric Results

By: Troy Thompson MLT, BAHSc (Hons), Regional Manager, Ontario Regional Blood Coordinating Network (ORBCoN) Central Region

A provincial platelet audit was held January to April 2017, with 69 hospitals participating in the audit, representing approximately 90% of the platelet utilization activity provincially. Of the 1903 platelet orders audited during this period, 210 orders were for “pediatric” patients (≤18 years of age). Pediatric platelet order data are being analyzed separately from “adult” platelet orders as the adjudication of these orders were conducted with different adjudication criteria. Ongoing analyses of these data continue and will focus on hospital service areas and sub specialties where transfusions do not meet appropriate criteria. Here we present only very preliminary results of the data analysis.

The top 3 ordering specialties for pediatric platelet orders were Pediatrics – 123/210-59%; Other category – 49/210-23%; and Neonatology – 27/210-13%. (Figure 1).

Figure 1. Ordering Specialties for Pediatric Platelet Orders.

Pediatric platelet orders were issued to Inpatient-Other and Inpatient-ICU locations in 68% of the orders with Outpatient clinic (OP) – Hematology – 10%; OP Clinic – Oncology – 7%; and OP Clinic Other – 7% of the platelet orders. (Figure 2).

Figure 2. Issue Location of Pediatric Platelet Orders.

The transfusion indication for platelets was separated into 3 major categories and the results for pediatric orders were: Prophylactic (non-bleeding, no procedure) – 85% of orders; Therapeutic (currently bleeding) – 13% of orders; and Prophylactic (before invasive procedure) – 2% of platelet orders.

Pre-transfusion platelet counts for pediatric platelet orders were divided into ranges and are displayed in the table below. Different platelet thresholds are considered appropriate depending on the clinical circumstances.

Data analyses continues and will include the appropriateness of each order and additional sub-analyses of the differences between community and teaching hospitals and those hospitals that have introduced platelet guidelines, order sets and prospective screening processes vs. hospitals that do not have these processes in place. There may be differences in the creation and uptake of pediatric platelet guidelines at pediatric specialty hospitals compared to those hospitals that have less pediatric centred services.

The auditing and evaluation of blood product utilization is a very important exercise and should be a routine activity at each hospital. One of the purposes of each hospital’s Transfusion Committee is to set criteria for the evaluation of ordering practices and to ensure regular evaluations of blood transfusion practices are conducted.¹

The results of this provincial audit will provide each participating hospital with their adjudication results and the final report will also include recommendations aimed at improving provincial platelet utilization.

Look for the final platelet audit report posted at www.transfusionontario.org in the near future!

References:

1. CSA Z902-15 Canadian Standards Association Standards for Blood and Blood Components December 2015; CSA Group

Golden Horseshoe Education Supporting Transfusionists (GHEST) Symposium 2018

By: Sheena Scheuermann, Regional Project Coordinator, SW ORBCoN

The mission of GHEST is to promote education, research, and best practices in Transfusion Medicine throughout the Golden Horseshoe region. The model is intended to be a non-profit venture therefore the symposiums are held at minimal cost to participants.

This year’s event was held in Hamilton, Ontario and the theme was Massive Hemorrhage and New Considerations in Transfusion Medicine. The symposium was well attended with 142 registrants for the day. We were very fortunate this year to have a patient speaker, Ms. Margaret Harvey who set the tone for the day by telling us her journey before, during and after her trauma and reiterating that the impact of trauma does not end once a patient leaves the hospital. Dr. Katerina Pavenski provided an update on the Massive Hemorrhage Protocol for Ontario and following the massive hemorrhage theme Dr. Michelle Zeller reviewed studies of group A plasma being used instead of AB in massive hemorrhage.

Regarding new considerations in Transfusion Medicine, Dr. Ruby Shanker presented “Inclusion of Gender Identity within Diagnostic Medicine”. This was a thought-provoking talk with many things to consider for medical professionals. Dr. Margaret Fearon from Canadian Blood Services presented “New Risks: Zika, West Nile and those unknown and what do we do?” which provided an excellent update on the impact these new diseases have on the blood supply. Troy Thompson presented an update on the Ontario Transfusion Quality Improvement Plan and Danielle Watson presented the Grey Bruce Health Services successes and challenges implementing such a program. The day was rounded out with case study presentations by Laura Aseltine, Felicia Dollinger and Melina Zarb. Including more case studies in the program has been a suggestion from attendees in the past.

Thank you to our Sponsors Octapharma, Grifols, CSTM and ORBCoN! And once again a huge thank you to the speakers and organizing committee for another successful GHEST event. Presentations will be posted on transfusionontario.org and ghestontario.com.