Diagnostic Services Ontario Year in Review 2021

Diagnostic Services “Year in Review” statistics are based on a January to December calendar year.  The calendar year provides better correlation with Health Canada birth statistics. 

Printable Version

Senior Staff and Contact Information

Laboratory Medical Director

Dr. Wendy Lau, MD, FRCPC 

(416) 313-4433 

wendy.lau@blood.ca 

Diagnostic Services Manager 

Tammy Ison, MLT, ART 

(905) 494-5281 

tammy.ison@blood.ca 

Diagnostic Services Reference Laboratory 

Telephone (905) 494-5295 

Fax (905) 494-8131

Diagnostic Services Website 

https://blood.ca/en/hospital-services/laboratory-services

 

Table of contents

  1. SENIOR STAFF AND CONTACT INFORMATION
  2. TABLE OF CONTENTS
  3. FIGURES
  4. TABLES
  5. RED CELL SEROLOGY REFERENCE LABORATORY
    1. Specimens Tested
  6. REFERRAL SAMPLES
    1. Red Cell Genotyping 
    2. Red Cell Serological Reference Testing
  7. QUALITY INDICATORS
    1. Turnaround Times
    2. Rejected Specimens
    3. Proficiency Testing
  8. DIAGNOSTIC SERVICES UPDATE 2021 
  9. PRESENTATIONS / ABSTRACTS / PUBLICATIONS LISTING

Figures

  1. Figure 1: Specimens Tested between 2017 and 2021
  2. Figure 2: Total Number of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021
  3. Figure 3: Total Number of Clinically Insignificant Antibodies Identified in Prenatal Samples between 2019 and 2021
  4. Figure 4: Frequency of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021
  5. Figure 5: Total Number of Clinically Significant Antibodies Detected in Patient Reference Samples in the Year 2021
  6. Figure 6: Frequency of Clinically Significant Antibodies in Patient Reference Samples in the Year 2021

Tables

  1. Table 1: Specimens Tested between 2017 and 2021
  2. Table 2: Samples Received Each Month in the Year 2021
  3. Table 3: Total Number Samples sent from Hospital/Private Laboratories
  4. Table 4: Total Number Samples with No Antibodies Detected
  5. Table 5: Total Number of Antibodies Detected in Prenatal Samples
  6. Table 6: Total Number of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021
  7. Table 7: Total Number of Clinically Insignificant Antibodies Identified in Prenatal Samples between 2019 and 2021
  8. Table 8: Frequency of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021
  9. Table 9: Prenatal Combination Antibodies
  10. Table 10: Perinatal Patient Antibody Titres
  11. Table 11: Total Number of Clinically Significant Antibodies Detected in Patient Reference Samples in the Year 2021
  12. Table 12: Total Number of Clinically Insignificant Antibodies Detected in Patient Reference Samples in the Year 2021
  13. Table 13: Frequency of Clinically Significant Antibodies in Patient Reference Samples in the Year 2021
  14. Table 14: Number of Investigations for Antibodies to Low Prevalence Antigens
  15. Table 15: Number of investigations for Antibodies to High Prevalence Antigens
  16. Table 16: Number of Patient Investigation for a Combination Antibodies in the Year 2021
  17. Table 17: Antibody Complex Procedures Performed
  18. Table 18: Genotype procedures referred by Canadian Blood Services
  19. Table 19: CAP Proficiency Testing Results
  20. Table 20: IQMH Proficiency Testing Results

Red Cell Serology Reference Laboratory

The Red Cell Serology Reference Laboratory, Ontario Diagnostic Services provides testing for hospitals in the Central Ontario Region and Hamilton Region, and for private laboratories. Hospital patients who are repeatedly transfused may develop red cell antibodies and as a result may have difficulty in tolerating transfusions. Diagnostic Services has specialized and experienced technologists that assist and provide consultation to hospital transfusion medicine laboratories. The Reference Laboratory identifies red cell antibodies and provides transfusion recommendations. Diagnostic Services has a varied selection of specialized procedures and rare reagents to resolve more difficult red cell antibody cases. Staff within our department may collaborate with other references laboratories such as the National Immunohematology Reference Laboratory (NIRL), Grifols Clinical Laboratory & Immunohematology Center and the New York Blood Center.

Diagnostic Services Red Cell Antibody Investigations

In 2021, hospitals have referred 2,674 requests for red cell antibody identification.

Referring hospitals have different capabilities and expertise in resolving red cell antibody investigations. Some hospitals have limited reagents for antibody identification or phenotyping of patient or donor units. Others have access to a wider variety of reagent red cell panels and methods as well as on site immunohematology expertise. A few hospital transfusion medicine laboratories have the resources to resolve the majority of serological problems and send only complex investigations for additional serological or genotyping studies.

Canadian Blood Services, Diagnostic Services provides consultation and testing support including antibody investigation, advanced or alternative techniques where required, and recommendations for compatibility testing methods and selection of appropriate donor unit phenotypes if necessary.

Reporting may include interim, final and supplemental reports, depending on the urgency of the testing, the need for patient transfusion and the complexity of investigation.

Testing Performed

The Red Cell Reference Laboratory routinely performs the following tests:

  • ABO/Rh blood type and discrepancy investigations (if required)
  • Screen for red blood cell antibodies
  • Antibody Identification, if antibodies are detected
  • Phenotyping (patient)
  • Direct Antiglobulin Test
  • Elution and Adsorption
  • Other tests and techniques, as required.

Serological samples submitted for testing are categorized into either “Prenatal Samples” or “Patient Samples”. Canadian Blood Services – Ontario Page 6 of 27 Diagnostic Services – (2021)

Antibody Screening and identification is routinely performed using a Gel Card testing methodology. A combination of Gel Card testing methodology and indirect antiglobulin tube testing using saline, enzymes or PEG enhancement are the most common antibody identification methods.

The laboratory also coordinates Red Cell Genotyping referral through the Canadian Blood Services National Immunohematology Reference Laboratory (NIRL). The Brampton laboratory is also responsible for maintaining the Central Ontario Sickle Cell Registry.

1.1. Specimens Tested

The data in this report reflects a calendar year period to enable better correlation to other government statistical data (Statistics Canada birth statistics).

Specimens Tested between 2017 and 2021 The data in this report reflects a calendar year period to enable better correlation to other government statistical data
Figure 1: Specimens Tested between 2017 and 2021

Table 1: Specimens Tested between 2017 and 2021

Specimen Type

Test Type

2017

2018

2019

2020

2021

Patient Samples for Red Cell Serology

Reference and Prenatal Samples

ABO Resolutions

51

80

82

97

377

Antibody investigations - pretransfusion

708

676

678

869

984

Antibody investigations - prenatal

277

329

410

548

645

Phenotyping (number of antigens)

2,776

2,874

3,212

3,480

4,249

Total # of Specimens Tested

3,812

3,959

4,382

4,994

6,255

Total # of Patients Tested  

716

670

987

1,107

2,674

Table 2: Samples Received Each Month in the Year 2021

Sample Type January-21 February-21 March-21 April-21 May-21 June-21 July-21 August-21 September-21 October-21 November-21 December-21
Patient 112 180 140 147 133 145 125 130 180 162 101 105
Prenatal 75 53 88 64 114 84 104 65 121 111 82 53

 

The sample total for antibody investigations is 2,674 samples in 12 months or an average of 223 samples per month.

Hospital/Private Laboratory Referrals:

Samples referred into the Brampton Diagnostic Services Laboratory are from:

  • 62 Health Care Facilities
  • 3 Private Labs (Alpha, LifeLabs and Med-Health)

Private Labs are referring in primarily prenatal samples (94%) with only 6% patient samples for antibody investigation.

Table 3: Total Number Samples sent from Hospital/Private Laboratories

Alpha Laboratories Inc.

Prenatal

73

76

 

Patient

3

 

LifeLabs

Prenatal

110

114

 

Patient

4

 

Med-Health Laboratories Inc.

Prenatal

22

28

 

Patient

6

 

 

 

 

218

Totals

 

 

 

205

Prenatal

 

 

 

13

Patient

The hospital laboratories are referring in a combination of patient and prenatal samples for investigation.

Table 4: Total Number Samples with No Antibodies Detected

Prenatal Patient Total
110 90 200

Table 5: Total Number of Antibodies Detected in Prenatal Samples

Multiple Antibody Combinations Identified

Number of Prenatal Multiple Antibody Investigation in (Current Year)

Anti-C Anti-e

1

Anti-E, Anti-Lua

1

Anti-Fya, Anti-Jka

1

Anti-D, Anti-E

1

Anti-E, Anti-Lua

1

Anti-Fya, Anti-Jka

1

Anti-Jka, Anti-Mia

1

Anti-c, Autoantibody

1

Anti-C, Anti-D

1

Autoantibody, Cold Agglutinin

1

Anti-C, Anti-e

1

Anti-Lea, Anti-M

1

Anti-E, Anti-c

3

Anti-D, Anti-G

1

Anti-D, Anti-G

1

Anti-M, Anti-Wra

1

Anti-Fya, Anti-Lub

1

Anti-c, Anti-E, Anti-Fya

1

Anti-D, Anti-G

4

Anti-D, Antibody to an HLA related antigen

1

Anti-c, Anti-Jka

1

Anti-Wra, Antibody to an HLA related antigen

1

Anti-C, Anti-D, Anti-Jka

1

Anti-E, Anti-K, Anti-M

1

Anti-C, Anti-G

3

Anti-Jkb, Anti-M

 

Figure 2: Total Number of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021

Bar chart for Total Number of Clinically Significant Antibodies, from 2019 to 2021. The following antibodies are highest among others, in the years mentioned. Anti-E is 48 in 2020, 28 in 2021, and 35 in 2019.

Table 6: Total Number of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021

Number of Prenatal Investigation for each Antibody

Clinically Significant Antibodies -Identified

2019

2020

2021

Anti-D

17

28

47

Anti-C

16

17

14

Anti-Cw

2

4

2

Anti-c

17

22

22

Anti-E

36

48

28

Anti-e

3

6

2

Anti-G

9

8

14

Anti-Fya

6

11

6

Anti-Fyb

1

5

0

Anti-H

0

2

3

Anti-Jka

10

18

15

Anti-Jkb

0

4

5

Anti-V

0

2

0

Anti-Inb

0

4

2

Anti-K

10

21

8

Anti-Jsb

0

1

0

Anti-Lub

5

2

2

Anti-M *

39

32

27

Anti-S

6

11

4

Anti-U

0

12

3

Anti-Ce

0

3

0

Anti-s

0

1

1

Anti-hrB

0

1

0

Anti-hrS

0

1

1

Anti-Lua

0

1

2

Anti-Yta

0

1

3

Anti-Lu14

0

2

1

Anti-Wra

0

6

6

Anti-PP1pk

0

1

0

Anti-Jra

0

2

0

Total

177

277

218

Figure 3: Total Number of Clinically Insignificant Antibodies Identified in Prenatal Samples between 2019 and 2021

Bar chart for Total Number of Clinically Insignificant Antibodies Prenatal, from 2019 to 2021. The following antibodies are highest among others, in the years mentioned. Passive Anti-D is 100 in 2020, 90 in 2021, and 40 in 2019.

Table 7: Total Number of Clinically Insignificant Antibodies Identified in Prenatal Samples between 2019 and 2021

Clinically Insignificant Antibodies

2019

2020

2021

Anti-Lea

14

5

6

Anti-Leb

8

6

3

Anti-P1

3

1

2

Autoantibody

8

35

70

Antibody to HLA Antigens

9

1

11

Cold Agglutinin

11

3

4

Unidentified

2

5

3

Passive Anti-D

43

104

88

Antibody to low prevalence antigen

1

1

0

TOTAL: Clinically Insignificant Antibodies

99

161

187

Figure 4: Frequency of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021

Bar chart for Frequency of Clinically Significant Antibodies, from 2019 to 2021. The following antibodies are highest among others, in the years mentioned. Anti-M is 22% in 2019, 11% in 2020, and 10% in 2021.

Table 8: Frequency of Clinically Significant Antibodies Identified in Prenatal Samples between 2019 and 2021

 Antibodies

2019

2020

2021

Anti-D

9.6%

10.1%

17.0%

Anti-C

9.0%

6.1%

5.1%

Anti-Cw

1.1%

1.4%

0.7%

Anti-c

9.6%

7.9%

7.9%

Anti-E

20.3%

17.3%

10.1%

Anti-e

1.7%

2.2%

0.7%

Anti-G

5.1%

2.9%

5.1%

Anti-Fya

3.4%

4.0%

2.2%

Anti-Fyb

0.6%

1.8%

0.0%

Anti-H

0.0%

0.7%

1.1%

Anti-Jka

5.6%

6.5%

5.4%

Anti-Jkb

0.0%

1.4%

1.8%

Anti-K

5.6%

7.6%

2.9%

Anti-Lub

2.8%

0.7%

0.7%

Anti-M *

22.0%

11.6%

9.7%

Anti-S

3.4%

4.0%

1.4%

Anti-U

0.0%

4.3%

1.1%

Anti-Wra

0.0%

0.4%

0.4%

Table 9: Prenatal Combination Antibodies

Summary: In 2021 there were 46 antibody investigations for multiple antibodies with 36 different antibody combinations examined.

Multiple Antibody Combinations Identified

Number of Prenatal Multiple Antibody Investigation in (Current Year)

Anti-Jsb, Anti-E

1

Anti-s, Anti-D

1

Anti-c, Anti-Inb

1

Anti-Kpa, Anti-D

3

Anti-N, Anti-E

1

Anti-c, Anti-Jka

1

Anti-hrS, Autoantibody

1

Anti-C, Anti-E, anti-D

1

anti-M, Anti-c

2

Anti-C, Anti-Lea

1

Anti-Fyb, Anti-M

1

anti-M, anti-Jkb

2

Anti-S, Anti-c

1

Anti-G, Autoantibody

1

Anti-G, Anti-C

2

Anti-Leb, Anti-c

1

Anti-G, Anti-c

2

Anti-Jka, Anti-Lea

2

Anti-Jka, Anti-E

2

Anti-Jka, Anti-S, Autoantibody

1

Anti-c, Anti-Jra

1

Anti-Jkb, autoantibody

1

Anti-Lea, Anti-Leb

3

Anti-Wra, Anti-K, Anti-E

1

Anti-K, Autoantibody

1

Anti-S, Anti-Lea

1

Anti-S, Anti-D

1

Anti-C, Anti-M

1

Anti-K, Anti-Fyb, Anti-E

1

Anti-D, Anti-Cw

1

Anti-S, Anti-U

1

Anti-S, Anti-Lea

1

Anti-Jka, Anti-E

1

Anti-Jkb, Anti-K

1

Anti-E, Cold antibody

1

Anti-c, Anti-Lua

1

Table 10: Perinatal Patient Antibody Titres

Antibody

Critical Level

Non-Critical Level

Non-Critical to Critical

Anti-D

2

4

1

Anti-C

0

1

0

Anti-c

0

1

0

Anti-E

0

2

0

Anti-M

0

1

0

anti-C, anti-G

0

3

1

anti-D, anti-G

1

0

0

anti-Jka

0

2

0

Anti-Jkb

0

1

0

anti-S

0

1

0

Figure 5: Total Number of Clinically Significant Antibodies Detected in Patient Reference Samples in the Year 2021

Bar chart for Total Number of Reference Antibodies, for 2021. Anti-E is 120, Anti-D is 79, Anti-C is 58 in 2021.

Table 11: Total Number of Clinically Significant Antibodies Detected in Patient Reference Samples in the Year 2021

Common Clinically Significant Antibodies in Patient Reference Samples

2021

Anti-D

77

Anti-C

56

Anti-c

43

Anti-E

118

Anti-e

9

Anti-f

2

Anti-G

15

Anti-K

45

Anti-M

46

Anti-S

33

Anti-s

5

Anti-Fya

36

Anti-Fyb

2

Anti-Jka

48

Anti-Jkb

19

Anti-U

2

TOTAL:

556

Table 12: Total Number of Clinically Insignificant Antibodies Detected in Patient Reference Samples in the Year 2021

Clinically Insignificant Antibodies

2021

Anti-A1

9

Anti-Lea

15

Anti-Leb

5

Anti-McCa

2

Anti-N

3

Anti-P1

5

Anti-Rg

1

Autoantibody

351

Antibody to HLA Antigens

33

Anti-Xga

1

Cold Agglutinin

37

Unidentified

5

TOTAL: Clinically Insignificant Antibodies

427

Figure 6: Frequency of Clinically Significant Antibodies in Patient Reference Samples in the Year 2021

Bar chart for Frequency of Clinically Significant Antibodies, for 2021. Anti-e is 22%, Anti-D is 14%, Anti-C and Anti-c is 10% in 2021.

Table 13: Frequency of Clinically Significant Antibodies in Patient Reference Samples in the Year 2021

Frequency of Clinically Significant Antibodies

2021

Anti-D

13.8%

Anti-C

10.1%

Anti-c

10.1%

Anti-E

7.7%

Anti-e

21.2%

Anti-f

1.6%

Anti-G

0.4%

Anti-K

2.7%

Anti-M

8.1%

Anti-S

8.3%

Anti-s

5.9%

Anti-Fya

0.9%

Anti-Fyb

6.5%

Anti-Jka

0.4%

Anti-Jkb

8.6%

Table 14: Number of Investigations for Antibodies to Low Prevalence Antigens

Antibody

Number Identified

Anti-Cw

2

Anti-Dia

3

Anti-Jsa

3

Anti-Lua

4

Anti-VS

1

Anti-Kpa

2

Anti-Mia

7

Anti-V

3

Anti-Dantu

1

Anti-He

1

Anti-Mia

6

Anti-Cob

3

Anti-Wra

5

Antibodies to low prevalence antigen

41

Table 15: Number of investigations for Antibodies to High Prevalence Antigens

Antibody

Number Identified

Anti-Ch

1

Anti-H

4

Anti-hrB

1

Anti-Jk3

2

Anti-Fy3

1

Anti-Kna

2

Anti-Kpb

2

Anti-hrS

2

Anti-Coa

3

Anti-LW

3

anti-Ge2

4

Anti-Dib

2

Anti-Inb

1

Anti-Lub

3

Anti-PP1Pk

1

Anti-U

2

Anti-Joa

2

Anti-Jsb

2

Anti-Yta

3

Anti-Csa

1

Anti-Hr

1

Anti-JMH

2

Antibodies to high prevalence antigen

25

Table 16: Number of Patient Investigation for a Combination Antibodies in the Year 2021

Multiple Antibodies Detected

2021

Multiple Antibodies Detected

2021

Anti-C, Anti-S

1

Anti-D, Anti-E

5

Anti-Sda, Warm Autoantibody, Cold Agglutinin

1

Anti-D, Anti-C, Anti-E, Anti-S, Anti-K, Anti-Fya

1

Anti-Wra, Antibody to HLA related antigen

1

Anti-D, Anti-C

10

Anti-E, Anti-c, Anti-Jka

2

Anti-E, Anti-Cob

1

Anti-E, Anti-VS, Anti-Jka, Anti-V, Anti-Jsa, Autoantibody

1

Anti-c, Anti-Jka

1

Anti-E, Autoantibody

15

Anti-S, Autoantibody

3

Anti-E, Anti-S, Anti-K

1

Anti-C, Anti-S, Anti-K

1

Anti-K, Autoantibody

8

Anti-E, Anti-M, Anti-Jka

1

Anti-E, Anti-S, Anti-Jka, Autoantibody

1

Anti-c, Anti-S, Autoantibody

2

Anti-C, Anti-K, Anti-Jkb, Anti-Jsa, Autoantibody

1

Anti-N, Warm Autoantibody

1

Anti-E, Anti-M

1

Anti-D, Anti-Ge2

1

Anti-M, Anti-Fya, Antibody To HLA related antigen

1

Anti-Leb, Anti-Jka

1

Anti-E, anti-c, Anti-Jka

1

Anti-E, Anti-Wra, Antibody to HLA related antigen

1

Anti-E, Anti-Lua, Anti-Jka

1

Anti-E, Anti-Cw

1

Anti-E, Anti-Lua, Antibody to HLA related antigen

1

Anti-C, Autoantibody

3

Anti-C, Anti-E, Anti-Kpa, Anti-Wra, Autoantibody

1

Anti-Jka, Autoantibody

5

Anti-C, Anti-Fya, Anti-Jkb

1

Anti-E, anti-s, Anti-Jka

1

Anti-Lua, Autoantibody

1

Anti-C, Anti-S, Anti-Kpa, Autoantibody

1

Anti-C, Anti-E, Anti-S, Anti-Fya, Anti-Jkb

1

Anti-Fya, Antibody to HLA related antigen

1

Anti-Cw, Anti-Fya

2

Anti-E, anti-c

4

Anti-K, Anti-Fya, Anti-Jka, Antibody to HLA related antigen

1

Anti-C, Anti-e, Anti-Jka, Autoantibody

1

Anti-E, Anti-K

1

Anti-c, Anti-S, Autoantibody

1

Anti-C, Anti-E, Anti-Lea, Anti-Fya, Anti-Jkb

1

Anti-D, Anti-C, Anti-P1

1

Anti-E, Anti-V

1

Anti-K, Anti-Ch

1

Anti-C, Anti-e, Autoantibody

2

Anti-Fya, Anti-Jka, Autoantibody

3

Anti-E, Anti-K, Autoantibody

1

Anti-E, Anti-Fya, Anti-Wra

1

Anti-E, Anti-K, Anti-Fya

2

Anti-C, Anti-e,

2

Anti-c, Autoantibody

1

Anti-c, Anti-S, Anti-Fyb, Anti-Mia

1

Anti-He, Anti-Wra, Autoantibody

1

Anti-D, Anti-G

3

Anti-E, Anti-c, Anti-M, Cold Agglutinin

1

Anti-Fya, Autoantibody

1

Anti-E, Anti-c, Anti-M, Autoantibody

2

Anti-s, Anti-Fya, Anti-Jkb, Autoantibody

1

Anti-E, Cold Aggultinin

1

Anti-E, Anti-S, Anti-K, Anti-Fya-, Anti-Jkb, Anti-Cob

1

Anti-D, Anti-Lua, Autoantibody

1

Anti-E, Anti-S, Anti-K, Autoantibody

1

Anti-E, Anti-S, Anti-K

1

Anti-Lea, Anti-Fya, Cold Agglutinin

1

Anti-E, Anti-c, Anti-S

2

Anti-E, Anti-c, Anti-Fya

1

Anti-E, Anti-Kpa

1

Anti-E, anti-c, Anti-Jkb

1

Anti-S, Anti-Ch

1

Anti-M, Anti-Fya, Antibody to an HLA related antigen

1

Anti-f, Anti-Fya

1

Anti-E, Anti-c, Autoantibody

1

Anti-C, Anti-Cw, Anti-Leb

1

Anti-N, Anti-S, Anti-Fya

1

Anti-E, Anti-Lua

2

Anti-C, Anti-G

2

Anti-M, Anti-Jkb

1

Anti-D, Anti-C, Anti-G

1

Summary: In 2021 there were 141 antibody investigations for multiple antibodies with 80 different antibody combinations examined.

Table 17: Antibody Complex Procedures Performed

Procedures

Number of Prenatal Samples

Number of Referral Samples

Autoadsorption

14

40

Alloadsorption

31

94

Elution

76

581

Direct Coombs

720

2567

Referral Samples

1.2. Red Cell Genotyping 

The BioArray BeadChip™ test system has been installed and validated in the Diagnostic Services Laboratory in Edmonton for RHD genotype testing used for the identification of RHD variants. The Edmonton CBS laboratory is accredited by the College of Physicians and Surgeons of Alberta (CPSA). Any patient samples requiring extended red cell genotype testing other than for D variant are referred to the National Immunohematology Reference Laboratory (NIRL) in Brampton. NIRL performs extended genotype testing using the Progenika ID Core XT™ assay.  If genotype test results are required urgently, testing results can be provided within 24 hours of the sample receipt.

Table 18: Genotype procedures referred by Canadian Blood Services

Number of Ontario Genotype Procedures 2021

Procedures 

Number 

RHD Genotype Procedures 

331 

Non-RHD Genotyping  

1737 

1.3. Red Cell Serological Reference Testing 

The National Immunohematology Reference Laboratory (NIRL) in Brampton is a highly specialized laboratory that focuses its attention on the identification and resolution of exceedingly complex red cell transfusion-related problems.  The laboratory is accredited by Accreditation Canada Diagnostics.

Quality Indicators

The laboratories monitor many quality indicators and the two which are most relevant to this document are turnaround times and rejected specimens which are presented below.

1.4. Turnaround Times

To ensure timely reporting of patient test results, Canadian Blood Services monitors turnaround time (TAT) from when the specimen is received at Canadian Blood Services in Brampton to the time when the results are available. Since monitoring of this quality indicator began in 2008, the percentage of specimens has consistently exceeded the predefined TAT threshold of 75% of samples to be tested and reported within 5 days of receipt. In 2021, 87% of the samples received were tested and reported within 5 days of receipt. Samples whose testing exceed the expected TAT are usually those where complex clinically significant antibodies are detected or where a referral to the National Immunohematology Reference Laboratory for additional investigation or genotype testing is required.

1.5. Rejected Specimens

The laboratory reserves the right to refuse improperly labelled specimens. Consistent practices for specimen rejection are employed across CBS. The laboratory takes measures to maintain specimen integrity during the process of following up on the receipt of an improperly identified specimen. The high number of specimens received by the laboratory makes it impossible to positively identify specimens that are not clearly labelled in accordance with standard specimen identification criteria. The specimen rejection rate in 2021 was 1.1% which is decreased from the 1.4% in 2020.

1.6. Proficiency Testing

  • College of American Pathologists Survey Participation
    This summary is based on all the College of American Pathologists (CAP) survey reports from the Brampton Diagnostic Services site. This summary includes all the blood group serology processes.

Table 19: CAP Proficiency Testing Results

Brampton Diagnostic Site

(Red Cell)

2019 CAP Proficiency Results

2020 CAP Proficiency Results

2021 CAP Proficiency Results

ABO/Rh Type

100%

100%

100%

Antibody Titre

100%

100%

100%

Antibody Identification

100%

100%

100%

Antibody Identification Eluate

100%

100%

100%

Direct Coombs C3

100%

100%

100%

Direct Coombs IgG

100%

100%

100%

Unexpected Antibody Detected

100%

100%

100%

Table 20: IQMH Proficiency Testing Results

Brampton: TMED

Kit #

Date Results Received

Results

Brampton

TMED-2103-Advanced

2021-03-09

100%

Brampton

TMED-2106-Advanced

2021-07-01

100%

Brampton

TMED-2109-Advanced

2021-09-14

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Updates pertain to all Diagnostic Services sites within Canadian Blood Services: Vancouver, Edmonton, Winnipeg, and Brampton

ALL

NEO Iris Analyzer implemented April to June 2021.

Eight NEO Instruments in Diagnostic Services were replaced with the next generation NEO IRIS instrument. NEO Iris performs ABO/RH and antibody testing.

  • Edmonton- 2 NEO Iris’ implemented May 2021
  • Vancouver- 2 NEO Iris’ implemented April and May 2021
  • Winnipeg- 3 NEO Iris’ implemented May and June 2021, with a fourth to be installed at CBS St.B satellite site in 2022”

Edmonton

Edmonton DS obtained the CPSA 4-year accreditation on 20021-02-25.

Edmonton

Transfer of HEA and RHCE genotype testing to Brampton, 2021-10-01

Vancouver

Awarded CAP Accreditation Dec 2021.

Vancouver

CPSBC – DAP ISO 15189 Audit. ISO 15189 accreditation pending final acceptance.

Winnipeg

Preparation for implementation of the Canadian Blood Services satellite Lab at St Boniface Hospital in March 2022. The Lab will act as a contingency site for services delivered by Winnipeg Diagnostic Services.

Winnipeg

Implementation of equipment in NPIRL – Multisizer 3 (cell counter) and thermocyclers

Winnipeg

Management of supplies, inventory and testing to ensure provision of services are not impacted during supply chain issues experienced in a pandemic.

Winnipeg

eTraceLine environments (perinatal and Crossmatch) were merged to allow better efficiency and ease of use for the labs noe that staff are cross trained.

Winnipeg

Project to implement HistoTrac and replace the access database currently used as the LIS began in Winnipeg in 2021. Projected implementation is December 2022.

Presentations / Abstracts / Publications Listing

Lhevinne Ciurcovich, Lynnette Beaudin, Arianne Fuellos, Balkar Gill, Ilona Resz, Debra Lane, Judith Hannon, Gwen Clarke, Melanie Bodnar. Comparison of Manual SIAT vs Automated Solid Phase Methodology for Perinatal Antibody Titration. Poster, CSTM 2021

Lhevinne Ciurcovich1, Sarah Manfredi2, Sarah Buchko2, Darlene Mueller2, Michelle Wong2, Mohammad Bahmanyar2, MatthewYan1, Gwen Clarke1. Anti-Ina Implicated in Hemolytic Disease of the Fetus and Newborn in an Indigenous Woman. Poster, CSTM 2021

  1. Canadian Blood Services, BC and Yukon Centre 
  2. Fraser Health Authority, British Columbia

Lhevinne Ciurcovich, Gwen Clarke, Matthew Yan. A Case of ABO Chimerism in a Perinatal Patient. Poster, CSTM 2021

Lhevinne Ciurcovich. Cell-Free Fetal DNA Testing: Advantages, Challenges and Limitations. Presentation: Virtual Conference, 22nd Annual Education Day on Blood Transfusion Issues, 2021-09-24.

Lhevinne Ciurcovich. Immunohematology Case Studies. Presentation: Immucor ImmuTECH Education Day (Virtual) 2021-05-05.

Lynnette Beaudin, Dr. Lani Lieberman MD, FRCP, Fetal and neonatal alloimmune thrombocytopenia (FNAIT): Diagnosis, Investigation and Treatment. Presentation: U of T Monthly Transfusion Rounds (Virtual) 2021-02-25

Bodnar M, Hannaford K, Montemayor-Garcia C, Hannon J.  Blindspots in Immucor BioArray RHD Molecular BeadChip Test: A Review of Cases at Canadian Blood Services Referred Out for RHD Gene Sequencing. Poster/Abstract,  CSTM 2021

Floch A, Vege S, Berardi P, Hannon J, Ochoa-Garay G, Lomas-Francis C, et al. A change in RHD is associated with aberrant transcription and very weak D phenotype. Transfusion 2021

Flegel WA, Bodnar M, Clarke G, Hannon J, Lieberman L., ‘What constitutes the most cautious approach for a pregnant person with weak D type 4.0?’ Letter to the Editor, CMAJ June 2021