Written By:

Tracy Cameron & Kimberly Schonewille – Ontario Regional Blood Coordinating Network (ORBCoN)

A recent paper published in Transfusion Journal by Hajjaj et al. (2024) examined an innovative approach to tackling inter-hospital redistribution of near-outdate blood products. The study conducted in Ontario, Canada, showcases the effectiveness of a province-wide program aimed at minimizing waste and optimizing resource utilization.

The Concern with Blood Product Wastage

Hospitals maintain blood product inventories to meet unpredictable demand. Surplus inventory may outdate before being allocated to a recipient. In Canada, blood product outdating is the largest contributor to blood wastage.

The Redistribution Program

To address this challenge, the Ontario Regional Blood Coordinating Network (ORBCoN) in partnership with the Factor Concentrate Redistribution Program (FCRP) launched a blood product redistribution program in 2012. The initiative involves monitoring and transferring blood products from low-usage to high-usage hospitals prior to expiring. The program operates with two validated transport container configurations based on acceptable shipping temperatures, ensuring safe and effective transportation of blood products.

Between 2012 and 2020, the program successfully redistributed 15,499 blood products through 3,412 shipments, preventing the potential loss of approximately $17.6 million worth of inventory. The total cost of operations, including shipping and staffing, was just over $44,900—significantly lower than the savings achieved.

Challenges and Outcomes

While the program proves highly cost-effective, some challenges have emerged. Transport failures led to the discard of 816 products, amounting to $388,200 in losses. The primary reason for these failures was courier transport delays, which accounted for 62% of unsuccessful shipments. Other failures identified were improper packaging/broken seals (26%), temperature check failures (5%), lost shipments (4%) and damaged packages (3%).

Despite these setbacks, the program demonstrated an overall success rate with minimal losses relative to the total savings.

Introduction of Program Improvements

The program adapted over time to enhance efficiency. Hospitals were provided with online reporting tools to track inventory expiry (less than 6 months), and shipping protocols were refined to reduce errors. However, external disruptions—such as the COVID-19 pandemic—highlighted the need for contingency planning to maintain redistribution process during crises.

Conclusion

Redistribution programs help maximize the use of available blood inventory and reduce wastage. They promote efficient blood management and should be considered by regions without such an initiative. These programs must align with regulatory and best practice requirements, transportation infrastructure, and geographic challenges. Additionally, they should be flexible enough to adapt during periods of decreased blood usage, such as pandemic or supply shortages. ORBCoN provides a blueprint for other regions to use to implement a redistribution program.

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Written by:

Troy Thompson & Stephanie Cope – Ontario Regional Blood Coordinating Network (ORBCoN)

The Blue Mountain Resort in Collingwood was chosen for ORBCoN’s annual symposium on March 26, 2025. The day focused on the release of the updated MHP recommendations – MHP 2.0 (find them here) and highlighted rural communities’ experience with the implementation and challenges of MHP 1.0.
We had 127 multi-disciplinary professionals (physicians, nurses, medical laboratory technologists and other allied health professionals) attend the symposium and we received overwhelmingly positive feedback.

From Left to Right. Co-chairs, Dr. Andrew Petrosoniak, Dr. Katerina Pavenski, ORBCoN Project Coordinator, Stephanie Cope at MHP 2.0 Symposium

The education symposium included a variety of MHP-related topics including presentations on:
• Major changes to MHP 1.0 recommendations
• MHP pediatric considerations
• Community/small hospital experience with MHP implementation
• MHP quality metrics portal and dashboard
• Pre-hospital experience and structured handover process (Ornge)
• Future considerations for inclusion in MHP
• Trauma in a community hospital simulation and debrief

The process for the MHP recommendation review consisted of a thorough evaluation of current evidence-based literature and a second modified Delphi exercise by a multi-disciplinary panel
of experts. After three iterative survey rounds, the panel achieved consensus on 44 statements. As a result, changes were made to 21 (version 1.0) recommendations; three recommendations were newly added and two (one original/one new) recommendations were removed.

Highlights of the changes include:
• Two-step activation to reduce over-activations and blood wastage;
• Fibrinogen replacement guided by laboratory evidence of hypofibrinogenemia or viscoelastic testing, not empirically;
• Structured handover between pre-hospital and hospital teams;
• Ionized calcium testing guidance;
• Restricted volume replacement strategy in the acute resuscitation phase of major hemorrhage without brain injury;
• Caution around empiric use of tranexamic acid (TXA) in gastrointestinal bleeding.

The symposium presentations generated many great questions and discussions. It also provided a forum for community hospital representatives to ask the expert panel pertinent questions regarding the proposed changes to the MHP recommendations relevant to their unique challenges and any other questions related to the care of massively bleeding patients.

Find the symposium’s archived presentations here

An evaluation survey was sent to all attendees after the symposium. As of April 4th, 98 responses have been received. Highlights of the evaluation survey are displayed below.

The MHP symposium was a highly successful event and we received very positive feedback regarding the event and the venue.  The symposium provided an opportunity for attendees to network and to discuss any MHP related successes and challenges. 

Thank-you to the chairs for their contributions, the speakers for their excellent presentations and to the attendees for their engagement and commitment to the MHP implementation process.

Further learning:

Trauma in a Community Hospital Simulation Video now available. Find it here.

Word Cloud Themes from MHP 2.0 Symposium Evaluation Comments

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Donna Berta, RN, BScN

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

Access Obstetric Indication Summary here

NOTE: Slide 29 from the March 18 presentation and recording has been modified for additional clarity.

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Author: Kaylee C. L. Brooks, PhD, Knowledge Mobilization Coordinator, Canadian Blood Services

Canadian Blood Services’ new Virtual Tour provides an easy to access, highly visual introduction to the journey of a blood donation from donor to recipient and is now available on Canadian Blood Services professional education website, Profedu.ca.

The Virtual Tour leads users through the step-by-step journey of a whole blood donation from vein-to-vein using an online, interactive and self-paced format spread across 9 sections. These Tour ‘stops’, provide an overview of Canadian Blood Services’ processes for collection, manufacturing, testing, labelling, storage and distribution, while highlighting donor and recipient stories. Though this educational resource is designed for healthcare professionals, anyone interested in learning about the blood system in Canada is welcome to take the Tour. This is emphasized by the different learning paths that users can take. Clicking through the main pages provides an overview of the blood system that can be completed in about 45 minutes, or users can take a deep dive into transfusion medicine by clicking on the curated links of resources from across Profedu.ca and blood.ca.

To develop the Tour, Dr. Melanie Bodnar, a Medical Officer with Canadian Blood Services, and co-investigators Dr. Sophie Chargé, Dr. Matthew Yan, Tricia Abe, Dr. Bryan Tordon, and Dr. Gwen Clarke received support from the 2021 competition of Canadian Blood Services’ BloodTechNet Award Program. This program facilitates the development of innovative educational projects in the transfusion, cellular therapy and transplantation communities in Canada. Together, the team of investigators, subject matter experts and many teams from across Canadian Blood Services, developed and refined the Tour content. A special thanks to Canadian Blood Services’ communications team who sourced high-quality, engaging photos from a variety of facilities and the IT team who brought the Tour pages to life. Further thanks go to the members of Canadian Blood Services’ knowledge mobilization and strategic alliances, medical, product and process development, stakeholder engagement, communications, and IT teams for comprehensive testing processes prior to publication.

As an organization that regularly engages with healthcare professionals and trainees, Canadian Blood Services recognizes the importance of providing these individuals with a foundational understanding of Canada’s blood system to support their professional development. Given Canada’s expansive geography, not all learners have access to an in-person tour of Canadian Blood Services’ facilities, and this Virtual Tour provides an online alternative that can be accessed anywhere and anytime. Take your Virtual Tour today by visiting Canadian Blood Services’ professional education website, Profedu.ca.

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Written by:

• Melanie St John- TTISS Coordinator 
• Maheen Ahmad- TTISS Assistant
• Dr. Andrew Shih- TTISS Director 

The Transfusion Transmitted Injuries Surveillance System (TTISS) plays a crucial role in safeguarding the health of Canadians by monitoring and reporting adverse reactions to blood products, including blood components and plasma derivatives. The dedication of all 159 Ontario hospitals contributes to the continuous improvement and effectiveness of TTISS.

On October 25^th, 2024, TTISS hosted a highly successful hybrid meeting, attracting just over 200 attendees. This event provided a platform for all to share insights, discuss challenges, and collaborate on enhancing transfusion safety. We were lucky enough to hear from some great speakers. A link to the speakers’ presentation can be found here: TTISS Meeting October 2025

One of the key initiatives for 2025 is the comprehensive update of the TTISS manual, which has remained unchanged since 2007. This revision aims to incorporate the latest advancements in transfusion medicine and align the manual with current best practices.

In another noteworthy development, TTISS Ontario presented a poster at the last Canadian Society for Transfusion Medicine (CSTM) conference held in Saskatchewan. The poster highlighted the benefits of the sentinel site model. Building on this success, we hope to present another poster at the next upcoming CSTM conference furthering our commitment to continuous improvement and knowledge sharing.

If interested, please visit our TTISS Website for additional resources.

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Presented by: Dr. Heather VanderMeulen

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Written By:

• Sheharyar Raza, M.D.- F.R.C.P.C (Internal Medicine, Hematology)  TM Fellow – Elianna Saidenberg Transfusion Medicine Traineeship – Canadian Blood Services

GEMINI is the largest and most comprehensive hospital data collaborative in the province of Ontario with the potential to significantly inform and accelerate transfusion medicine quality improvements and research. The database is housed at Unity Health Toronto and includes administrative and clinical inpatient data, including transfusion data for all medical and ICU admissions in their growing network of over 30 large hospitals in Ontario, covering care for approximately 60% of the province’s adult inpatients with plans for extension to pediatric inpatients in the near future. The data are extracted directly from hospital information systems and shared with GEMINI, where data quality is rigorously assessed through computational and manual validation, and data are standardized to common data models. GEMINI data can be accessed remotely and securely through a cloud environment hosted by HPC4Health, which enables high-performance computing for complex analyses.

GEMINI includes a wide range of clinical variables, with several years of data collected across hospitals to inform transfusion research. These include patient demographics (e.g., age, sex), medical diagnoses, medical co-morbidities, and laboratory results such as complete blood count and coagulation testing results. Transfusion details include time of order and issuance of blood product, and the number of units issued per order. Further details include administrative aspects of hospital admissions such as the date and time of admission and discharge, discharge disposition (e.g., deceased, alive, transferred to another healthcare facility), and information about the most responsible physician and associated medical department. Physician-level information is also collected including subspecialty, and year of medical school graduation, allowing for more nuanced comparison of transfusion practice across physician groups. Additionally, GEMINI’s rigorous data validation and quality assessment processes ensure that the data used for these analyses are reliable and accurate.

By enabling deep, nuanced, and longitudinal analyses of blood utilization, appropriate use, patient outcomes, and transfusion reactions, GEMINI can provide valuable insights into transfusion practices across different institutions. GEMINI can also be linked with other large databases (e.g. ICES Ontario) to study long-term outcomes of transfusion therapies. Through collaboration with transfusion researchers, GEMINI can contribute to improving the use of the blood supply and enhancing overall patient care.

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Written By:

Troy Thompson- CE ORBCoN Regional Manager

Sheena Scheuermann- SW ORBCoN Regional Project Coordinator

2006 marked the inception of the Ontario Regional Blood Coordinating Network (ORBCoN). One of the mandates of ORBCoN is to improve utilization and inventory management of blood and blood products.  In 2006, approximately 10,000 red blood cell units (RBC) were outdated over 158 Ontario hospitals, which equates to an outdate rate of 2.7%.

Over the past 18 years, significant efforts have been made to reduce RBC inventory and outdating by hospital Transfusion Medicine Laboratories throughout Ontario. By 2021/22, total RBC outdates had been reduced to less than 2,000 units, a remarkable reduction that has remained through to 2023/24. This achievement represents a drop in the outdate rate to less than 0.5 %, which equates to approximately 8,000 fewer RBC outdates compared to 2006/07 levels.

The success can be attributed to several key initiatives, including hospital sites taking part in provincial programs such as redistribution, using various inventory management tools developed by ORBCoN or the hospital sites themselves, and through collaborative hospital site visits between Canadian Blood Services and ORBCoN.

ORBCoN would like to take this opportunity to highlight the efforts and thank the hospitals for the successful reduction of the provincial RBC outdate rate, ensuring sustainability of the red blood cell supply for the patients who require them.
Ontario hospitals, your diligent work is appreciated! Congratulations on this amazing achievement!

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Presented by: Dr. Abi Vijenthira

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Dr. Akash Gupta and Dr. Jacob Pendergrast

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