April 2022

In This Issue

Transfusion Reaction Reporting

Donna Berta RN BScN, Clinical Project Coordinator – Nursing, ORBCoN

Hemovigilance has been described as surveillance measures spanning the entire transfusion process from blood collection to blood recipient follow-up. Information on adverse transfusion effects is compiled to limit re-occurrence. The goal of reporting and evaluating adverse events is to improve transfusion safety.

Canada’s national hemovigilance system, Transfusion Transmitted Injuries Surveillance System (TTISS), was implemented by the Centre for Communicable Disease and Infection Control (CCDIC) of the Public Health Agency of Canada (PHAC) in 2001. Each province and territory report their transfusion reactions to TTISS. 

In Ontario, the Ministry of Health commissions the McMaster Centre for Transfusion Research of McMaster University to coordinate the province’s TTISS actions (TTISS-ON). Participation is voluntary, but all Ontario hospitals have signed on to report moderate to severe transfusion reactions to blood components (red blood cells, platelets, plasma, cryoprecipitate) and plasma protein and related products (PPRP). 

Blood component serious or unexpected transfusion reactions (posing a significant risk to patient safety) and those pertaining to the safety of the blood itself must be reported to Health Canada’s Canada Vigilance Program directly or via the manufacturer (Canadian Blood Services or Héma-Québec) in addition to TTISS-ON. Effective December 16, 2019 (as per Vanessa’s Law), PPRP serious adverse reactions must be reported directly to Health Canada’s Canada Vigilance Program as well as to the manufacturer of the product. Refer to the TTISS-ON website for their interactive Ontario Guide for Reporting Transfusion Reactions to identify the reporting requirements for each transfusion reaction.

A sentinel site model (where 29 Ontario hospitals have committed to report all transfusion reactions [minor (febrile non-hemolytic, delayed serologic, and allergic) reactions in addition to major, moderate to severe, transfusion reactions] is an integral component of the TTISS-ON program. These 29 Ontario hospitals represent approximately 35% of all blood components transfused in Ontario. This sentinel site transfusion reaction data along with Canadian Blood Services (CBS) disposition data are used to calculate the Ontario incidence or frequency of transfusion reactions by type and by blood component. Sentinel site data for the 2020 calendar year are displayed in Figure 1 and 2 and Table 1. 

At annual hospital site visits, ORBCoN and CBS provide this data along with hospital specific data (based on transfusion reactions reported by that hospital) to highlight transfusion patient safety. Transfusion Medicine Services have reaction investigating and reporting accountabilities. Accordingly, transfusion prescribers and transfusionists are accountable to recognize and report transfusion reactions.  Hospital specific data reports (graphs and tables) generated from TTISS-ON and CBS data should be reviewed by Transfusion and Quality committees and shared with front line care providers to support hemovigilance. 

For more information about report generation resources, contact Joanne Duncan, TTISS-ON Coordinator (duncanj@mcmaster.ca).

Figure 1: 2020, Sentinel Sites, Minor (febrile non-hemolytic, delayed serologic, and allergic) Reactions

Figure 2: 2020, Sentinel Sites, Major (moderate to severe) Reactions

Table 1: 2020, Sentinel Sites: Transfusion Reaction Type per Blood Component and Incidence of Major, Minor, Any Reaction per Blood Component

Number of Units Transfused113,69621,65716,705152,058
Red Blood CellsPlateletsPlasmaTotal
Transfusion Reaction Type
Major
Acute Hemolytic11
Bacterial Infection22
Delayed Hemolytic1515
Hypotensive415
Other nonspecific pain22
Other results of Investigation8513
Possible TRALI1113
Severe Allergic/Anaphylactic/Anaphylactoid27110
TACO346141
TAD112
TRALI11
Minor
Delayed Serological1051106
Febrile Non-Hemolytic165552222
Minor Allergic319114136
Total36917020559
Incidence of Major Reaction1 in 1,6721 in 9411 in 4,1761 in 1,600
Incidence of Minor Reaction1 in 3771 in 1471 in 1,0441 in 328
Incidence of Any Reaction1 in 3081 in 1271 in 8351 in 272

Acknowledgement: 
Ontario Transfusion Transmitted Injuries Surveillance System (TTISS-ON) is gratefully acknowledged for the data provided.

References:
Canadian Blood Services (CBS) A guide to reporting adverse transfusion reactions [Internet]. [Ottawa], CBS; 2020 [cited 2022 Mar 7]. Available from: 
https://professionaleducation.blood.ca/en/guide-reporting-adverse-transfusion-reactions

International Society of Blood Transfusion (ISBT). Haemovigilance [Internet]. [Amsterdam, the Netherlands], ISBT; 2022 [cited 2022 Mar 7]. Available from: 
https://www.isbtweb.org/isbt-working-parties/haemovigilance.html

Ontario Transfusion Transmitted Injuries Surveillance System (TTISS-ON). Report an adverse reaction [Internet]. [Hamilton], TTISS-ON; 2022 [cited 2022 Mar 7]. Available from: https://ttiss.mcmaster.ca/?page_id=65

Canadian Society For Transfusion Medicine (CSTM) Conference 2022- May 26-29th

Troy Thompson, Program Manager ORBCoN and 2022 CSTM Conference Co-Chair

The CSTM Conference for 2022 will be located at the Westin Harbour Castle Hotel in Toronto ON.  The theme for the 2022 conference is Adapt, Transform, Personalize.  The scientific program offers educational sessions for all healthcare professionals working in or with an interest in Transfusion Medicine.  

The keynote speaker for this year’s conference is Jessica Holmes who has been a perennial favourite on Royal Canadian Air Farce for 15 years, and has brought the house down opening for giants such as Ellen DeGeneres, Russell Peters, Jerry Seinfeld, and Oprah Winfrey.
Her hilarious take on life’s challenges as well as her unique knack for impersonating celebrities will have audiences in stitches. Her customized emcee and entertainment presentations — which include motivation and wellness — are always a hit. 

Networking Opportunities
The CSTM conference provides registrants with ample opportunity for networking and socializing and will once again host an Exhibitor area and a President’s reception.  In addition, you are invited to submit abstracts for poster and/or oral presentation at the conference to highlight your individual/facility’s efforts in Transfusion Medicine and helping to connect Canada’s Transfusion Community!

The conference venue, the Westin Harbour Castle, with its two 34-storey waterfront towers, offers dreamy views of both Lake Ontario and the entire city. It is the quintessential urban convention resort located in the revived waterfront district, the hotel offers direct access to some of Toronto’s most noteworthy sites, including the Rogers Centre, Scotiabank Arena, CN Tower, high-end shopping and delicious restaurants. The hotel is located near local subway stations and bus stops for easy travel throughout downtown Toronto and is only a short taxi ride from both Pearson and Toronto Island Airports.

For more information and to register for the 2022 CSTM Conference please visit https://www.transfusion.ca/Events/2022-CSTM-Conference-Toronto/2022-General-Information

Advertisement posters highlighting the 2022 CSTM Conference are available on the conference webpage; please help to promote the conference by printing and posting at your facilities!

Discounted Early Bird registration closes after April 29, 2022, be sure to register soon!

On behalf of the 2022 CSTM Conference co-chairs- Dr. Katerina Pavenski and myself and the CSTM Conference Organizing Committee we invite you to join us at the conference in May.  We look forward to an inspiring and thought provoking conference!

Celebrating National Medical Laboratory Week 

Medical laboratories are at the centre of healthcare! Although you might not see them, #LabISEssential. On behalf of ORBCoN Happy National Medical Laboratory Week to all medical laboratory professionals for everything you do!

Register: CSTM 2022 Annual Conference

Register: Perinatal Consensus Conference

Featured Resource: IVIG Infusion Guide

Coming Soon: Transfusion Medicine Education Web Conference Archive Video

The 17th annual Transfusion Medicine Education Web Conference was held April 8th 2022. This event showcased dealing with different transfusion requirements for different types of patients with a massive bleed. If you missed the event it will be archived on the Transfusion Ontario website for viewing. Watch for it on transfusionontario.org in the coming week. We would like to extend our thanks to the organizers and the speakers for another great symposium. See you all next year!

Upcoming Event: University of Toronto Transfusion Medicine Rounds

April 28th, 2022 @ 12:00 pm – 1:00 pm
Transfusion Related Acute Lung Injury (TRALI), presented by Dr. Alexander Vlaar  

Attachment(s)

This PDF presentation aligns with the content of the new course, Bloody Easy Blood Administration eLearning Program (version 3) for reference or to download and customize for your hospital’s orientation/continuing education programs.

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2021/12/BEBA-eLearning-Dec-2021.pdf

This PowerPoint presentation aligns with the content of the new course, Bloody Easy Blood Administration eLearning Program (version 3) for reference or to download and customize for your hospital’s orientation/continuing education programs. To review the information with some simulated computer graphics, download the PowerPoint slide version.

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2022/01/BEBA-eLearning-Dec-2021_final.pptx

These files are intended for learning management systems. For those wanting to access to the ORBCoN LMS as a site admin, please contact troy.thompson@sunnybrook.ca.

Bloody Easy Blood Administration is an electronic learning tool that was developed with input from RN’s, Transfusion Safety Officers and Transfusion Personnel across Ontario. The content reflects current best practices.

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2021/12/BEBA_v3.0.2_NO-Quiz_SCORM-2004.zip

These files are intended for learning management systems. For those wanting to access to the ORBCoN LMS as a site admin, please contact troy.thompson@sunnybrook.ca.

Bloody Easy Blood Administration is an electronic learning tool that was developed with input from RN’s, Transfusion Safety Officers and Transfusion Personnel across Ontario. The content reflects current best practices.

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2021/12/BEBA_v3.0.2_HAS-Quiz_SCORM-2004.zip

These files are intended for learning management systems. For those wanting to access to the ORBCoN LMS as a site admin, please contact troy.thompson@sunnybrook.ca.

Bloody Easy Blood Administration is an electronic learning tool that was developed with input from RN’s, Transfusion Safety Officers and Transfusion Personnel across Ontario. The content reflects current best practices.

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2021/12/BEBA_v3.0.2_NO-Quiz_SCORM-1.2.zip

These files are intended for learning management systems. For those wanting to access to the ORBCoN LMS as a site admin, please contact troy.thompson@sunnybrook.ca.

Bloody Easy Blood Administration is an electronic learning tool that was developed with input from RN’s, Transfusion Safety Officers and Transfusion Personnel across Ontario. The content reflects current best practices.

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2021/12/BEBA_v3.0.2_HAS-Quiz_SCORM-1.2.zip

Transfusion adverse events or risks can be characterized as: common but not life threatening, serious
and life threatening requiring some prevention/treatment measures, and rare with life altering effects.
A synopsis is provided in the table below (for inclusive transfusion risk details, refer to
Bloody Easy Blood Administration version 3 , pages 118-9).

Attachment(s)

https://transfusionontario.org/wp-content/uploads/2021/10/BEBA_Informed_Consent_Information_for_patient_dialogue.pdf

Using Blood Wisely One Year Later – Ontario Hospitals Stepping Up to the Challenge

By Doreen Day, Project Manager, Pan-Canadian Initiatives, Choosing Wisely Canada and Dr. Yulia Lin, Transfusion Medicine Specialist, Sunnybrook Health Sciences Centre & Transfusion Lead, Choosing Wisely Canada

In September 2020, Choosing Wisely Canada in collaboration with Canadian Blood Services launched Using Blood Wisely, a national campaign to decrease inappropriate red blood cell (RBC) transfusion practices in Canada. The campaign challenges hospitals to conduct a spot audit of recent red blood cell transfusions to see how they compare to national appropriateness benchmarks. By joining, participating hospitals gain access to quality improvement resources to support efforts in reducing inappropriate RBC transfusion practices. Sites that meet or exceed benchmarks are then eligible to become a designated Using Blood Wisely Hospital.  

One year into the campaign and Using Blood Wisely is showing an overwhelming commitment from hospitals across the country seeking to improve RBC transfusion practices. To date, over 190 hospitals representing nine provinces and one territory have signed onto the campaign, accounting for 66% of all blood transfused in Canada (not including Québec). 65 of these hospitals have received national recognition as Using Blood Wisely Hospitals for meeting and maintaining benchmarks.

Ontario hospitals have shown great enthusiasm and leadership in their participation. 77 hospitals from across the province have signed on to take part, with 56 (73%) submitting benchmarking data, and to date, 13 Ontario sites have been designated as Using Blood Wisely Hospitals. The next phase of the campaign will focus on supporting sites on their quality improvement journey, to identify and address barriers and to see them through on their road to improved RBC transfusion practices.

If your hospital is not participating in Using Blood Wisely, we encourage you to join the campaign. Challenge your hospital to benchmark on appropriate transfusion practices by signing up and conducting a spot audit. If your hospital exceeds and maintains benchmarks, you are eligible for the Using Blood Wisely hospital designation. If your hospital doesn’t meet the benchmarks, follow through with the quality improvement implementation resources provided, and work towards qualifying for designation. In addition, participation in this campaign will also be acknowledged as an organizational quality improvement initiative by Accreditation Canada’s Qmentum Program.

For more information or to join the campaign, please visit www.usingbloodwisely.ca.


University of Toronto Transfusion Medicine Rounds – September 23, 2021

September 23 @ 12:00 pm – 1:00 pm

Albumin: Understanding the Controversy presented by Dr. Justyna Bartoszko


Bloody Easy Blood Administration (BEBA) Resources

By Donna Berta RN BScN, Clinical Project Coordinator – Nursing, ORBCoN 

Renewal of ORBCoN’s resource Bloody Easy Blood Administration, known as BEBA, is complete!

The BEBA Handbook version 3 has been available electronically for several months, with the French translation, print copies, and the BEBA eLearning program coming soon. These tools, for ongoing learning and for competency assessment, are ready to guide you in your day-to-day transfusion patient care.

To ensure patient safety, blood transfusion is highly regulated by Health Canada and Transfusion Medicine standards. BEBA Handbook is referenced to these standards to provide clear rationale for polices and procedures. BEBA eLearning stems from the handbook but focuses on red blood cell (RBC) transfusion, the most frequently transfused blood component (nearly 1,000 RBC units are transfused across Ontario hospitals every day).

BEBA Handbook begins with the fundamentals of transfusion safety: blood production and ABO/Rh(D) compatibility. Examples are provided to apply your understanding of compatibility, often a challenging topic. The essential knowledge for administering common blood components and products is available in table format. The transfusion process from informed consent to group and screen testing to checking blood to documentation is outlined in detail. Transfusion is not without potential complications; acute and delayed transfusion reactions and their management are explained. To practice your learning, acute transfusion reaction scenarios are presented.  Urgent transfusion basics and the 7 T’s of Ontario’s Massive Hemorrhage Protocol are illustrated. Throughout the handbook, concepts are noted in depth as well as summarized with charts for quick reference. A one-page synopsis, the Transfusion Checklist, completes the handbook. The ORBCoN website also provides the Transfusion Checklist in poster format for hospitals to tailor to their individual needs.

Transfusionist competency assessment is an explicit requirement of the standards. The BEBA eLearning program was developed to meet this responsibility. The learning module identifies current evidence-based adult transfusion guidelines for RBC, platelets, and plasma followed by a review of required actions for safe transfusion (for blood administration and in the event of a reaction). Engaging, interactive learning activities were created by ORBCoN’s accomplished Information Technology Analyst. The assessment quiz questions will be refreshed on an annual basis. The program is operationalized via ORBCoN’s new Learning Management System (further described in this Newsletter).

It is anticipated that these resources will augment your practice. Future endeavours include guidance via patient case analysis as well as developing neonatal and pediatric foci. Opportunities to enhance learning and optimize transfusion patient care are welcomed; please provide your feedback and suggestions (email transfusionontario@gmail.com).


NEW RESOURCES AVAILABLE AT TRANSFUSIONONTARIO.ORG


ORBCoN Launches New Learning Management System

By Troy Thompson, Regional Manager, ORBCoN

ORBCoN is pleased to announce the launch of a new Learning Management System (LMS) for our learning resources.  We are excited to announce a partnership with Surge Learning Inc. intended to facilitate and further enhance the ease of access to relevant and valuable educational content for healthcare professionals related to transfusion medicine. 

The Bloody Easy eLearning programs (Bloody Easy Blood Administration and Bloody Easy Lite) will be the first programs transitioned to our new platform; with the Bloody Easy Technologist assessment program being rebuilt and re-launched in the future.
The Learning Management System (LMS) makes it easy for your team to continue their online education and gain access to the resources they need while scheduling, tracking, and reporting on their progress.

More information regarding the new LMS and the registration process will be sent to each Ontario hospital.  If you require any additional information please contact troy.thompson@sunnybrook.ca.


NEW RESOURCE AVAILABLE AT TRANSFUSIONONTARIO.ORG

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