April 2024

In This Issue

ONIT Program Update
Needs Assessment Results: ORBCoN Bloody Easy Coagulation Simplified
Update Alert!
- Blood Transfusion: Information for Patients
Featured Resources
- Transfusionists Talk (archive)
Upcoming Events
- CSTM 2024
- 19th Annual Transfusion Medicine Education Web Symposium
- U of T Rounds

Program Update

Sarah Shehadeh¹, Stephen Betschel², Susan Waserman³, Danny Hill⁴, Donald William Cameron^1,5, Juthaporn Cowan^1,5*

¹The Ottawa Hospital Research Institute, Ottawa, Ontario
²Department of Medicine, University of Toronto, Toronto, Ontario
³Deparmtnet of Medicine, McMaster University, Hamilton, Ontario
⁴Hematology Clinic, Ambulatory Care Unit, Sault Area Hospital, Sault Ste. Marie, Ontario
⁵Department of Medicine, University of Ottawa, Ottawa, Ontario
*Corresponding author

The Ontario Immunoglobulin Treatment (ONIT) Program is an Ontario government-approved and funded initiative designed to facilitate and manage home-based self-administered subcutaneous immunoglobulin (SCIG) treatment. The program provides care through hospital-embedded outpatient clinics, with nursing coordination, education, and follow-up, and medical oversight for indication, dosage titration, health outcomes and therapeutic re-evaluation.

We first introduced the program for ORBCoN members in the newsletter published in May 2020. The program was fully implemented at three centers (The Ottawa Hospital, St. Michael’s Hospital and McMaster University Medical Center) by the end of 2020. We also created a patient-consented case registry to collect data at the point-of-care. At present, there are close to one thousand patients enrolled in the registry, reflecting the program’s significant reach and impact. This database plays a crucial role in facilitating research, quality improvement initiatives, standardize care, and ensuring the continued effectiveness and safety of immunoglobulin therapy. Through the ONIT registry, we published an article on the clinical outcomes of immunoglobulin therapy in individuals with secondary antibody deficiency (PLoS One. 2023 Nov 16;18(11):e0294408. doi: 10.1371/journal.pone.0294408). We reported that immunoglobulin treatment reduced the average annual number of infections by 82.6%, emergency room (ER) visits by 84.6%, and hospitalizations by 83.3%. Overall, 84.6% of patients reported their health as better compared to before immunoglobulin treatment. Among those patients who switched from intravenous immunoglobulin (IVIG) to SCIG, 33.3% reported their health as the same, and 62.9% reported their health as better. This study demonstrated that immunoglobulin treatment significantly improved clinical outcomes and patient-reported general health state in patients with secondary antibody deficiency. The study also further supports the use of SCIG in patients with secondary antibody deficiency.

Additionally, we have developed an internal dashboard tailored for individuals involved in the program. Discussions are underway regarding the potential external availability of this dashboard, which would provide valuable insights and transparency into program operations and patient outcomes. Since 2023, the program has expanded to include Sault-area Hospital as the fourth center. We are evaluating the program expansion implementation process with the aim to enhance effective future program implementation to other sites through the continual support from the Ministry of Health.

Needs Assessment Results: ORBCoN Bloody Easy Coagulation Simplified

Troy Thompson ORBCoN Program Manager

Dr. Rita Selby Hematologist & Medical Director, Coagulation Laboratories, University Health Network & Sunnybrook HSC, Bloody Easy Coagulation Author

The Bloody Easy Coagulation: Simplified handbook provides practical information on coagulation. It is designed to enhance the knowledge of physicians, nurses and medical laboratory technologists about the basics of coagulation from laboratory testing to anticoagulant drugs and management of bleeding disorders. ORBCoN has distributed over 15,000 handbooks to hospitals/facilities nationwide since Oct 2013 and had approximately 1000 views/downloads from our website annually.

In partnership with the Institute for Quality Management in Healthcare (IQMH), a needs assessment was conducted to gather information on the use of coagulation educational resources, especially the ORBCoN handbook, Bloody Easy: Coagulation Simplified (second edition) and its educational value to laboratory professionals in Ontario.

The following questions were added to the IQMH Proficiency Testing COAG-2308 survey.

A total of 178 laboratories participated in this survey. Results are shared below:

Question: How are the coagulation educational resources (e.g., published materials, online resources etc.) used in your laboratory? (Select all that apply*) (n=189)

*Multiple responses submitted

Question: Does your laboratory use Bloody Easy: Coagulation Simplified handbook / the online version? (n=184)

Question: Please indicate the ways in which you use ‘Bloody Easy: Coagulation Simplified (Select all that apply*) (n=121)

*Multiple responses submitted

Question: What do you like most about the current version? (Select all that apply*) (n=413)

*Multiple responses submitted

Question: How could the current edition be improved? (Please list up to 2)

Some of the suggested improvements:

Add multimer gel results for Von Willebrand Factor
Add case studies
Explain how HIL interferes with testing
Explain interference from prescription drugs
Flow charts to evaluate abnormal coagulation tests
Ways to assess competency
Slightly larger print
More details on treatments

The results of this needs assessment survey will be used to guide the revision process for the next version of the Bloody Easy: Coagulation Simplified Handbook.

We would like to thank all the participating laboratories for their responses to this survey. To order the Bloody Easy: Coagulation Simplified handbook or other ORBCoN resources please visit: transfusionontario.org/order-resources

📣 Update Alert

Blood Transfusion: Information for Patients

Risks of Transfusion Table has been corrected in the Blood Transfusion: Information for Patients document. Please discard and replace any previous versions you may have with this version