Hospital Newsletters

O Rh negative red blood cells - a finite resource

O neg RBCs (PDF)

Over the past decade, Canadian Blood Services and blood suppliers around the world have seen the utilization rate of red blood cells (RBCs) decline as a result of improved patient blood management and changes in transfusion practice. Although past years have also shown a decrease in group O Rh negative RBCs utilization, current data shows that utilization of this blood group may be starting to increase again.

Group O Rh negative RBCs collections do not always meet hospital demand and the growing imbalance between supply and demand creates a challenge for blood suppliers who face a near constant shortage.

Transfusing group O Rh negative RBCs to non-O Rh negative recipients places an added strain on blood supply and on the steady stream of group O negative donors. This reduces the availability of group O Rh negative units for recipients who should or must receive only this type.

Some of the reasons hospitals have adduced for transfusing group O Rh negative RBCs to non-O Rh negative patients include:

• The need for phenotyped units for special patient populations (e.g. sickle, thalassemia and patients with clinically significant RBC antibodies, regardless of the recipient’s blood type).
• Massive transfusion protocols.
• No patient ABO group on file.
• To prevent outdating.

Canadian Blood Services and blood suppliers around the world have increased efforts to recruit more group O Rh negative donors. And recently, Canadian Blood Services improved its phenotype testing practices to ensure that we have a sufficient supply of group-specific phenotyped units available for our hospitals.

Many hospitals have already implemented best practice guidelines and conducted audits to address appropriate utilization of group O Rh negative RBCs, but as our population ages, we must collectively continue to figure out better ways to manage this finite resource.

The following resources are available to hospitals to support group O Rh negative RBC management:

• September 2014, Canadian Blood Services issued a customer letter outlining challenges and highlighting best practices pertaining to O-negative RBCs.
• In February 2017, the National Advisory Committee on Blood and Blood Products released a position paper addressing utilization and inventory management of O Rh negative RBCs.
• In October 2018, Canadian Blood Services issued a new version of the Blood System Inventory Management Best Practices Guide.
• Choosing Wisely Canada.

Together, we have an opportunity to manage group O Rh negative RBCs and ensure their availability for patients who need them.

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The 15th Annual Transfusion Medicine Education Videoconference Symposium

Video conference announcement (PDF)

The 15th edition of the symposium titled Patients Are Not All the Same – Promoting Patient Centred Transfusion Care will be hosted by Quinte Health Care - Belleville General Hospital on April 15, 2020.

As with past editions, Canadian Blood Services has partnered with the Ontario Regional Blood Coordinating Network (ORBCoN) to support this annual educational event aimed at developing the transfusion skills of professionals working in community hospitals and improving patient outcomes.

The symposium is open to all healthcare professionals that are involved in the ordering, issuing and/or transfusing of blood and blood products, including physicians, nurses, technologists as well as residents, trainees, and students.

“For this year's event, the planning team targeted discrete patient populations in whom transfusion practice is either evolving or particularly complex,” says Dr. Robert Skeate, associate medical director of education and special projects at Canadian Blood Services and co-chair of the symposium organizing committee. “The goal is to offer specific guidance to the clinical teams that provide transfusion support for these patients on a day-to-day basis in Canadian hospitals.”

Presentations at the symposium include:

• Bleeding Risk Management for Image-Guided Interventions by Dr. Aditi Khandelwal
• Transfusion Medicine Burden in Kidney Patients: Making Hard Choices by Dr. M. Khaled Shamseddin
• The Role of Red Blood Cell Transfusion in Palliative Care by Dr. Nicolas Chin-Yee
• Culturally Safe Care for Trans and Non-Binary People: Successes, Challenges, and Opportunities by Dr. Ian Chin-Yee and Terrie Foster, RN

The videoconference is free to attend, but registration is required. Professionals who wish to attend may do so through three options: (a) register your organization and view via Ontario Telemedicine Network (OTN); (b) watch via webcast; (c) attend on-site in Belleville.

Also, there are two repeating sessions to choose from – one morning and one afternoon.

If you have any questions, please contact Amanda Nowry at amanda.nowry@blood.ca or Tracy Cameron at tcameron@toh.ca.

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Notification to establishments in receipt of co-components of a blood product that caused an adverse event in a patient

Adverse events and coomponents (PDF)

Hospitals in Canada are required to report transfusion reactions to the manufacturer when there is concern that some attribute of the blood product is connected to the reaction. This is a regulatory requirement described in customer letter 2014-15.

Canadian Blood Services review reaction information with an on-call blood center physician to determine the need for retrieval. If deemed necessary, a notification of component recall/withdrawal is sent to the hospital that received the co-components. This form is sent out based on immediately available information, so that in-date co-components can be isolated while the investigation proceeds.

The reason for recall/withdrawal is noted as donor was involved in a Transfusion Reaction.

There may or may not be additional information documented on this line about the transfusion reaction, for example: possible TRALI.

Hospitals that receive a notification of component recall/withdrawal for a co-component are required to follow the instructions on the form to either quarantine, return to Canadian Blood Services or remove and destroy the product, and to inform Canadian Blood Services by return of this form, the disposition of this product: whether transfused, discarded, returned or other. If the co-component has been redistributed to another institution, the information about the recall/withdrawal must be passed on to that institution for response.

The guidance document by the 2015 National Advisory Committee on Blood and Blood Products – Recommendations for the Notification of Recipients of a Blood Component Recall, describes that hospitals can evaluate the recipient clinical scenario to determine the need for further action, and it includes specific sections on TRALI and septic reactions. As always, a hospital is welcome to call a Canadian Blood Services physician to further discuss the case.

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Changes in blood donation process

Changes in blood donation process (PDF)

Canadian Blood Services recently introduced changes to whole blood donation process to reduce blood donor screening and rest time for repeat donors, resulting in a shorter donation time without impacting the safety of the donor.

Recent studies and industry best practices show that some donor screening requirements are no longer necessary. New evidence indicates that measuring blood pressure doesn’t have an impact on the safety or wellness of blood donors. In fact, blood operators in countries such as Denmark and the United Kingdom do not measure donor blood pressure during screening.

Also, to enhance the safety and well-being of donors, Canadian Blood Services launched steps to promote hydration and salt intake at the donation site before donation, as well as applied muscle tension exercise during donation. These steps will improve donors’ experience and reduce the likelihood of having a vasovagal reaction (feeling faint or fainting) when giving blood.

The full article highlights the changes implemented in two phases – phase 1 (March 2019) and phase 2 (September 2019).

Read the full article.

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