Written by: Alexis iob – ORBCoN Regional Project Coordinator & Tracy Cameron- ORBCoN Regional Manager 

ORBCoN offers a comprehensive range of resources to support best practices in Transfusion Medicine. Our goal is to ensure healthcare professionals have access to up-to-date information through regularly updated documents and tools.

Accessing Resources

Resource Categories

Bloody Easy E-tools & Publications: Register for the E-learning modules such as ORBCoN Tech Assess and upcoming Reconstitution Outside the Transfusion Medicine laboratory (TML).  Access flipbooks and PDF handbooks for Bloody Easy Blood Administration (BEBA), Bloody Easy 5.1, and Bloody Easy Coagulation Simplified. Physical copies can be ordered online. Ontario orders are free; out of province orders incur fees. To order the handbooks you will fill out a form and they will be shipped to you.

Blood Utilization Graphs & Reports: Find Provincial audit tools like the Bedside Audit of Blood Administration that hospitals can use as part of their quality improvement initiative project. Annual blood utilization information for Ontario can also be found in this section, along with other provincial reports like the Canadian Obstetrical and Perinatal Transfusion Network (COPTN) national survey report and other audit reports conducted in previous years.

IVIG/SCIG: This section features the Ontario Utilization Management Guidelines, Fact sheets for patients, how to order IG in Ontario, and the IG dose calculator. If your site is interested in gathering hospital specific IG utilization data, there is a link to register for the IG quality improvement project.

Massive Hemorrhage Protocol (MHP): Comprehensive resources for managing critical bleeding scenarios. Learn about the Ontario MHP and access companion tools such as eLearning modules, simulations, checklists and algorithms. Use the provincial MHP toolkit to aid in implementation in your hospital and to track and monitor quality metrics using the MHP quality metrics portal and dashboard.  

ORBCoN Resource: The ORBCoN Resources page is an essential access hub for transfusion professionals—offering access to past educational materials, previous ORBCoN report newsletters, helpful apps related to transfusion medicine, and more. Content is organized under main tabs: Presentation Library, Helpful Apps, Order Resources.

TM Guidelines & Standards:  These resources are designed for transfusion medicine leaders, safety officers, and clinical teams to ensure evidence-based care and regulatory compliance.  A comprehensive set of resources includes clinical guidelines for blood components and specialty areas, national recommendations from the NAC, and practical tools like bleeding management apps and transfusion safety tips. The page also offers regulatory standards, accreditation guidance, and a detailed resource manual for medical directors to support governance and quality assurance.

Quality Improvement: This resource library is currently under revision, but will showcase the Ontario Transfusion Quality Improvement Plan (OTQIP) along with a section dedicated to Health Canada and Accreditation Canada Diagnostics information to help hospitals meet the regulations and requirements set for Transfusion Medicine.

We greatly appreciate your support for ORBCoN and if you have any questions or ideas for new resources, please reach out to transfusionontario@gmail.com.

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Written By:

Andrea Tjahja, MLT, ART, BSc, BEd Vice President, Operations Medical Laboratory Professionals’ Association of Ontario

The Medical Laboratory Professionals’ Association of Ontario (MLPAO) is the fastest growing lab association in Canada. Founded in 1963 as the Ontario Society for Medical Laboratory Technologists (OSMT), the MLPAO’s membership has increased by over 73% in the past 5 years to more than 4,200 members across the province, including both MLTs and MLA/Ts.

MLPAO is your voice in Ontario.  The MLPAO advocates for the lab profession, monitoring legislative changes and engaging with the Ministry of Health, employers, and other stakeholders.  Over the past 5 years, our advocacy efforts have resulted in historic funding of over $15M for lab professionals including 700 more seats for MLTs and MRTs and inclusion in the Learn and Stay Grant, which provides free education in the MLT programs at St. Clair College and Cambrian College.  We continue to work for you to address the MLT shortage and other issues affecting the lab profession.

MLPAO members receive professional liability insurance (PLI) included in their membership.   PLI coverage also includes professional legal and HR advice as well as data security and privacy breach consulting services.  Our PLI covers MLT members across Canada. There is no extra cost for PLI – that’s a little extra that stays in your pocket!

Continuing education (CE) is top of mind at MLPAO.  Members have access to our free monthly Lab Talks webinars, hosted by laboratory experts from across the province – our members love them!  Our online CE course offerings are current, continuously updated throughout the year, and provide you with a certificate for your professional portfolio.  We are also excited to announce our 2026 Lab Summit – Together in Toronto on June 5-6th in Toronto.  We invite you to join us for a day of connection, collaboration and community.

Membership with the MLPAO gives MLTs and MLA/Ts professional liability insurance (PLI), continuing education (CE), advocacy, and so much more. Stay covered, stay current, and stay connected with your professional community.  

Learn more at mlpao.org.

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We invite you to listen to “The Inflection Point Podcast” where Dr. Kimmo Murto and Dr. Jeannie Callum address pediatric trauma, providing practical insights for paramedics, physicians, and trauma teams managing pediatric emergencies including pediatric massive hemorrhage protocol.

The Inflection Point is a Canadian paramedic podcast dedicated to advancing EMS education, prehospital care, and healthcare leadership. Hosted by Jakob Rodger and Ryan Cichowski, the show brings evidence-based discussions on pathophysiology, pharmacology, trauma, cardiac care, human factors, and clinical decision-making.

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Written by: Sheena Scheuermann – ORBCoN Regional Project Coordinator 

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 Oakville, Ontario. The symposium was well attended with 119 registrants for the day. We were very fortunate to have a patient speaker, Jules Royer who shared her journey with Multiple Myeloma. Attendees consistently express how impactful it is to have a patient speaker start the day.  

Following this, Dr. Danyal Ladha presented an Introduction to Plasma Cell Dyscrasias, which provided the audience with information regarding diagnosis, treatment and insights into new advances in treatment.

Rebecca Barty introduced the new Perinatal Recommendation statements, which followed an open discussion with the attendees on potential challenges laboratories may see with implementing the new recommendations. We thank the attendees for their participation in the discussion as it provided useful insights into the challenges and possible tools that can be developed to assist with implementation.  

The afternoon consisted of presentations by Dr. Sheharyar Raza on AI applications for blood bank, and Tracy Cameron on Blood Administration Bedside Audit followed with a live simulation of a transfusion lead by Laura Aseltine and Donna Berta. The audience was encouraged to participate and instructed to point out the errors in the process as they arose during the simulation. The feedback regarding this type of activity was positive and we look forward to doing something like this in the future.

The day was rounded out with a case study presentation regarding a patient with sickle cell anemia by Dr. Jordan Radigan.  Including more case studies in the program continues to be a suggestion from attendees.

Thank you to our Sponsors CSL Behring, Grifols, Octapharma, CSTM and ORBCoN! Once again, a huge thank you to the speakers and organizing committee for another successful GHEST event.

Presentations will be posted on transfusionontario.org.

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Written by: Erica Seelemann and Kaylee Brooks (CBS) 

Canadian Blood Services supports best practices in transfusion medicine through the development of educational resources published on our Professional Education website. Written by subject-matter experts from across Canada, our transfusion medicine resources support clinical practice and help health-care professionals stay current in an ever-changing field.

These resources have the biggest impact when they’re read and shared! We invite you to explore and share our recent publications:

Clinical Guide to Transfusion: A practical summary of current transfusion medicine for healthcare professionals in Canada.

• Chapter 2. Blood components. This chapter revision provides an overview of blood component processing at Canadian Blood Services, including red blood cells, whole blood leukocytes reduced, platelets, plasma and cryoprecipitate. It also contains additional information on component dosing, indications/contraindications and alternatives.
• Chapter 3. Albumin. This chapter has recently been updated. The revised content outlines albumin efficacy, indications, contraindications, safety, dose and administration, storage and transportation, and alternative options.
• Chapter 21. An overview of donor wellness and perspectives. This new chapter provides an overview of various aspects of donor care and well-being, including a review of current knowledge on donor motivation, donation-related health impacts, adverse reactions and management.  

Publications: Transfusion medicine resources to support clinical practice and help healthcare professionals stay up to date.

• Apheresis frozen plasma, psoralen-treated. This new publication provides information on apheresis frozen plasma, psoralen-treated, a blood group specific, pathogen-reduced human plasma for transfusion.
• FAQ: Apheresis frozen plasma, psoralen-treated. This publication provides answers to general, hospital technologist, and clinician questions regarding pathogen-reduced human plasma. This product will be available for transfusion in Canada beginning September 2025.
• FAQ: Whole blood, leukocytes reduced (LrWB) at Canadian Blood Services. This revision includes new information on the non-military use of whole blood for hospitals who are participating in clinical trials on whole blood, as well as a downloadable quick reference sheet designed for hospital staff participating in these trials.
• Summary of adverse transfusion reactions 2020-2025. This publication has recently been updated to include data from the 2024-2025 fiscal year.

If you don’t already receive our Research & Education Round Up, you can subscribe to the monthly newsletter here for updates on the latest news, publications, and events from Canadian Blood Services’ research and education network. 

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Written by: Kimberly Schonewille- ORBCoN NE Project Coordinator

In 2018, Health Canada (HC) broadened its inspection scope to include both registered and non-registered establishments, emphasizing the need for compliance within the Blood Regulations across all Canadian healthcare facilities that handle blood components. In response, the Ontario Regional Blood Coordinating Network (ORBCoN) launched a strategic initiative to support Ontario Transfusion Medicine Laboratories (TML), with compliance to the Blood Regulations, in preparing for HC inspections, and an overall goal in ensuring safer transfusion practices province wide.

Background

In October 2014, Health Canada fulfilled their final obligations to the recommendations put forward from the Krever Commission, which investigated Canada’s tainted blood scandal of the 1980’s. This final recommendation was to legislate regulations that apply to human blood collected for transfusion or further manufacture into drugs for human use. The Blood Regulations introduce specific safety requirements for whole blood and its components while consolidating existing blood safety rules in other parts of the Food and Drug Regulations. These regulations apply to all establishments who are involved in any capacity in the processing, labeling, storing, distributing (or redistributing), transforming or importing blood components. The regulations fall under the Food and Drug Act which allows for enforcement and inspections which are performed by Health Canada auditors. Establishments (i.e., Transfusion Medicine Laboratories) were to review their processes and determine their need to register with Health Canada or remain as a non-registered establishment.¹

Identifying the Need for Support

With the expansion of HC inspections to a wider range of establishments, a gap in awareness among TML leaders, particularly among non-registered sites was implied. A 2022 provincial stakeholder meeting identified key areas requiring support and proposed the development of targeted resources. ORBCoN, acting as a liaison between HC, the Ministry of Health (MOH), and Ontario hospitals, took the lead in coordinating efforts to address these needs amongst these groups.

Strategic Use of HC Inspection Reports

ORBCoN leverages HC inspection observation reports to drive improvements in five key areas:

1. Risk Identification and Mitigation

• Analyzing inspection reports to pinpoint common blood component safety risks.
• Developing and publishing education initiatives to proactively address these risks and enhance patient safety.

2. Error Tracking and Reporting

• Promoting standardized processes for reporting transfusion-related errors and injuries.
• Improving consistency and awareness across Ontario’s healthcare system.

3. Regulatory Monitoring and Support

• Keeping stakeholders informed of HC tools and updates.
• Tracking Exit Notices and Final Inspection Reports to identify provincial trends.

4. Education and Resources

• Developing and distributing resources such as internal audit tools (e.g., checklists for auditors, audit plans and example schedules, as well as audit report templates), annual report templates, Blood regulations competency assessments, and a one-page summary for non-registered sites.
• Summarizing inspection findings and recognizing trends to guide hospital preparation and further develop resources.
• Creating and presenting a Health Canada specific slide during annual hospital site visits to send a consistent message provincial-wide.

5. Stakeholder Engagement

• Facilitating the Provincial Blood Regulation Peer Working Group (BRWG) to collaboratively review inspection reports, create or revise compliance tools.

Our Goal

The aim is to improve compliance to Health Canada Blood Regulations, standardize practices across Ontario hospitals and enhance patient safety in transfusion medicine.

This initiative exemplifies ORBCoN’s commitment to fostering a culture of safety, collaboration, and continuous improvement in transfusion medicine across Ontario. By proactively addressing regulatory challenges and supporting hospitals through education and engagement, ORBCoN is helping to ensure that all sites, registered or non-registered, are prepared for Health Canada inspections and aligned with national standards.

ORBCoN’s Annual Report of Health Canada Observations

Fig.1- Observations by Health Canada in Ontario Hospitals 2024-25

Fig.2 – Overview of Observations by Health Canada in Ontario Hospitals 2019-2025

Reference:

Health Canada. Guidance document: Blood regulations [Internet]. Ottawa: Government of Canada; [cited 2025 Sep 4]. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/applications-submissions/guidance-documents/blood-regulations/guidance-document-blood-regulations.html#a1.1

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 Written by: 

Gwen Clarke MD FRCPC   Haematopathologist, Island Health, Victoria BC and  Clinical Professor, Department of Laboratory Medicine and Pathology, University of Alberta

The recognition of maternal anti-D and other antibodies to red cell antigens as the underlying cause of Hemolytic Disease of the Fetus and Newborn (HDFN) marked a significant advancement in maternal-fetal medicine. This knowledge, particularly following the discovery of Rh immune globulin (RhIg) as an effective preventative agent against anti-D development, laid the foundation for a system of laboratory testing during pregnancy.

Laboratory testing is used to assess the risk of HDFN by determining the ABO blood group and screening for the presence of antibodies. This process not only supports prevention—by identifying individuals who are RhD negative and therefore eligible for RhIg—but also aids in the diagnosis and ongoing management of pregnancies in which alloantibodies are detected.

For those who are alloimmunized, laboratory testing enables the careful monitoring of pregnancy through assessment of antibody levels by titration.

Following delivery, testing of cord or neonatal red cells for ABO and Rh blood group, Direct antiglobulin testing and antigen typing in babies born to alloimmunized mothers is also part of the process, helping to predict the risk for jaundice

The timing, technique, and reporting of laboratory testing varies widely across Canada. The Canadian Obstetrical and Paediatric Transfusion Network surveyed hospitals and labs nationwide (survey report: https://www.transfusion.ca/getmedia/62a4f003-6a81-4c9d-b089-420e79bd152a/COPTN-Survey-Report-2019-EN.pdf)), receiving responses from 580 sites. Results showed significant differences in test methods, timing, follow-up procedures, and recommendations.

To address practice variability, a modified Delphi Consensus Conference was organised with ORBCoN. A steering committee reviewed literature and drafted statements, which were then evaluated by a panel of Canadian experts at an in-person conference (https://transfusionontario.org/category/orbcon-resources/presentation-library/perinatal-consensus-conference) . Iterative voting refined the content and wording, resulting in 47 guidance statements on immunohaematology testing for pregnancy and neonatal care, including routine and high-risk scenarios and considerations for neonatal cord blood testing.

(reference: Guidance for Prenatal, Postnatal and Neonatal Immunohaematology Testing in Canada: Consensus Recommendations from a Modified Delphi Process Lieberman, Lani et al. Journal of Obstetrics and Gynaecology Canada , In Press, Available on line 27 August 2025 103088)

Many of the statements correspond to existing practices or necessitate only minimal adjustments for implementation. While certain recommendations involve recommendations for reductions in testing, others entail more substantial changes that may require allocation of additional resources, revised referral strategies, or the development of new tests. Some of the statements which may lead to practice changes are outlined below:

Recommendations for Reduced Testing:

• Statement L2 : A Routine ABO RhD and antibody screen may not be necessary at 28 weeks gestation for either RhD positive or RhD negative pregnancies. 
• Statement L4:  Maternal ABO, RhD and antibody screen at the time of delivery is only recommended when:
  • There is no prior test during the current pregnancy and/or
  • There is a clinically significant antibody and/or
  • The risk of maternal transfusion is increased and/or
  • The risk of neonatal transfusion is increased.
• Statement L7: For any pregnancy less than 12 weeks (0 days) gestational age experiencing an abortion (threatened, spontaneous or therapeutic) an ABO, RhD and antibody screen are not recommended and RhIG is not required.

(reference: VanderMeulen H, Shuman M, Fam PN, Berman R, Callum J, Clarke G, Lieberman L, Walsh C, Thorne J, Yan MTS. Transfusion Testing During Routine Pregnancies: Consensus Recommendations from a Modified Delphi Process. J Obstet Gynaecol Can. 2025 Jul 10;47(9):103034. doi: 10.1016/j.jogc.2025.103034. Epub ahead of print. PMID: 40651573.)

Recommendations for new Testing and Referral:

• Statement H4: For patients with clinically significant antibodies to RhD, C/c, E or K, non invasive prenatal testing (Cell free fetal DNA (cffDNA testing of maternal plasma) is recommended to determine if the fetus is at risk.
• Statement H3: For anti K antibodies early consultation with Maternal Fetal Medicine is recommended.

(reference: N Robitaille N and K Fung Kee Fung  et al. National Consensus Statements for Prevention of Maternal Rhesus (RhD) Alloimmunization and Management of Alloimmunized Pregnancies: A Delphi Process  JOGC, in press

The statements conform to CSA Z902-25 standards for Blood and Blood Components where relevant standards exist and are also concordant with recent guidance from the Society for Obstetrics and Gynecology of Canada (SOGC) and the Canadian Paediatric Society (CPS).

(references: Guideline No. 448: Prevention of Rh D Alloimmunization.Fung-Kee-Fung, KarenWong, KarenWalsh, JenniferHamel, Candyce Clarke, Gwen et al. Journal of Obstetrics and Gynaecology Canada , Volume 46, Issue 4, 102449 and

Eugene Ng, Gabriel Altit, Chloe Joynt, Nicole Radziminski, Michael Narvey, Fetus and Newborn Committee: Guidelines for detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks gestational age) from: https://cps.ca/en/documents/position/hyperbilirubinemia-newborns)

This guidance is designed to be flexible for various clinical settings across Canada and aims to harmonize practice. While some statements are aspirational and will require new transport logistics, referral processes, and updates to lab information systems others will be quickly achievable. Tools are being developed to support implementation and knowledge translation, facilitating adoption of these Canadian recommendations for improved care.
                                             

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Presented by:  Dr. Gwen Clarke, Dr. Lani Lieberman, Dr. Heather VanderMeulen, Dr. Nancy Robitaille

Evaluation Survey

Link: https://orbcon.limesurvey.net/647229?lang=en

QR Code:

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Donna Berta, RN, BScN

Access Pre & Post Transfusion Knowledge Questions and Answer with Rationale here

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Written by: Troy Thompson – ORBCoN CE Regional Manager & Donna Berta – ORBCoN Clinical Project Coordinator Nursing

Revised evidence-informed Clinical Practice Recommendations for the use of blood components in adult inpatients are now available on the ORBCoN Transfusion Ontario website to support hospitals in developing or updating their specific transfusion guidelines. 

 Clinical-Practice-Recommendations_March_2025_final.pdf.  

These recommendations are based on Choosing Wisely principles, current literature, Canadian transfusion practice standards, and expert opinion to support appropriate and patient-centered transfusion care.  The document includes tables outlining clinical settings, transfusion thresholds, and recommended dosing for red blood cell, platelet and plasma transfusions.  For plasma transfusions, a comprehensive weight-based dosing chart is provided to simplify and clarify the dosing of solvent detergent and frozen plasma.  Below are the recommended thresholds for each blood component, with further details available in the full recommendations document. 

Red Blood Cells (adult inpatients) 

Dose Recommendations:  

• Transfuse one unit at a time in non-urgent patient scenarios.  

• Reassess symptoms and hemoglobin (Hb) before considering additional units.  

• Always consider the underlying cause of anemia in the transfusion decision-making process. 

• Explore alternative therapies (e.g., iron) when appropriate. 

Hemoglobin Thresholds and Clinical Scenarios: 

Transfusion-Associated Circulatory Overload (TACO): identify patients at risk and implement preventative strategies as appropriate.  

Platelets (adult inpatients) 

Dose Recommendations:   

• Transfuse one pooled or apheresis (psoralen treated) unit. 

Platelet Count Thresholds and Clinical Scenarios: 

Note: Transfusion may lead to harm in some intracranial hemorrhage clinical scenarios, as specified in the document 

Plasma (adult inpatients) 

Dose Recommendation:  

• 10–15 mL/kg based on actual body weight 

• Avoid single unit plasma transfusion 

INR Threshold and Clinical Scenario: 

 Note:  

• Patients with liver disease have preserved thrombin generation despite elevated INR.  Routine correction of an abnormal INR prior to a procedure is often unnecessary. 

• For urgent warfarin reversal, use prothrombin complex concentrate (PCC), unless PCC is unavailable or contraindicated. 

Conclusion 

These practical, patient-focused transfusion recommendations aim to optimize outcomes, minimize risks, and reduce unnecessary blood component use. Hospitals are encouraged to adopt or adapt these recommendations for safer, standardized transfusion practices.   

Additional resources linked to these updated clinical practice recommendations (algorithm, order set) are currently under review and will be aligned with the updated recommendations 

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