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Hospital Newsletter

In this issue

Professional Education in transfusion and transplantation has brand new home

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Learn, share and advance in the fields of transfusion and transplantation medicine

In late August, after a lot of hard work, collaboration and consultation, we launched a new and improved online educational platform for health-care professionals. 

Canadian Blood Services has a mandate to strengthen and support professional development in the fields of transfusion and transplantation science and medicine to ultimately benefit patients while ensuring donor safety. We are also committed to promoting awareness and education about organ and tissue donation and transplantation in Canada and improving access to transplants for Canadians in need.

To meet these goals, we work with partners to develop educational tools, gather best and leading practices, publish original articles and reports, and organize educational events. This new web portal supports these efforts. It’s also an opportunity to integrate our educational activities in the areas of transfusion, stem cells, as well as organs and tissues. 

“We create a number of valuable resources for professionals and students working or studying in transfusion medicine, organ and tissue donation and transplantation and blood stem cell transplantation,” says Dr. Dana Devine, chief medical and scientific officer. “With this new site, these resources will be easier to access and professionals will have new opportunities to learn, share and advance in their field.”

The Professional Education site replaces two previous sites, transfusionmedicine.ca and organsandtissues.ca, and brings this content together on one new platform with a modern look and new and improved functionality.

We hope that health-care professionals and students will depend on it to be a source for relevant and engaging content and for opportunities to improve practice and as a result, patient care and outcomes.

With an eye toward continuous improvement user feedback, comments and questions are welcome.

The Professional Education offers:

  • Best and leading practices in transfusion
  • Best and leading practices in transplantation
  • Original articles
  • New publications
  • Announcements and news
  • Educational events and more

 

 

Research: A search for safer red blood cells bags for pediatric recipients

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From bottles to plastic

Over 50 years ago, plastic replaced glass as the container of choice for collection and storage of blood and blood products. This greatly improved the safety of blood for transfusion by reducing the risk of contamination and containers breaking.

Polyvinylchloride, better known as PVC, is the most popular plastic for blood bags because it is durable, strong and can resist temperature changes. However, PVC is inflexible and brittle. To make flexible bags suitable for blood storage, PVC must be combined with a chemical called a “plasticizer”, which softens the plastic.

The most widely used plasticizer in blood bags is called DEHP that is also found in toys, medical tubing, water bottles, rainwear and many other goods. Despite its extensive use, there are concerns about its toxicity. There is no clear evidence that DEHP has harmful effects in humans following transfusion, but animal studies have shown that it may affect the development of the reproductive system, particularly in males.

To explore alternative plasticizers, our researchers compared the quality of red blood cells stored in bags specifically designed for pediatric patients plasticized either with DEHP or two known less toxic plasticizers called DINCH and BTHC.

The study found that:

  • Metabolism of the red blood cells WAS affected by the bag they were stored in.
  • Metabolism was best maintained in DINCH bags, and worst in BTHC bags.
  • Red blood cells in BTHC bags had more signs of damage.
  • Arrangement of phospholipids, an important structural part of red blood cell membranes, was not different among the bags.
  • Red blood cell membranes were less damaged and better preserved in DEHP and DINCH bags than in BTHC bags.
  • Overall, red blood cells in DEHP and DINCH bags showed good quality, while red blood cells in BTHC bags stored poorly.

"It was surprising to us, how big of an impact the plasticizer choice can have on red blood cell quality," said Dr. Serrano. a research associate in Dr. Dana Devine's lab at the Centre for Blood Research at UBC. "The study shows that good alternatives to DEHP do exist."

Of the alternative plasticizers proposed so far for use in blood bags, DINCH has the lowest toxicity levels, making it an attractive option. These studies show that DINCH bags are effective at maintaining red blood cell quality during storage.

While more research is needed — for example, to understand how the plasticizers affect red blood cells stored in different storage solutions — these results support a potentially promising future for DEHP-free blood storage.

Read more about how our research teams at our Centre for Innovation labs measured quality of red blood cells.  Get the full story on RED, our research, education and discovery blog. 

Inventory Replenishment: A collaboration between hospitals and Canadian Blood Services

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The June 2016 BloodNotes newsletter featured an article describing a hospital inventory trend tool that Canadian Blood Services developed to better understanding hospital stock during times of optimal inventory. The tool, which is now widely available to all hospitals served by Canadian Blood Services, is the foundational element on which a new collaboration is being built.  

Currently limited to select hospitals in Atlantic Canada, an inventory replenishment process focused on red blood cell stock inventory levels has been successfully piloted by three hospitals since January 2016.

Prior to the pilot, the three hospitals were already sharing daily inventory with Canadian Blood Services via the web-based Blood Component and Product Disposition System (DISPO) and regularly reporting monthly disposition data for red blood cells by blood group. These data were used to calculate average daily red cell demand and inventory indices that were discussed with the hospital transfusion service. The collaborative discussion with each pilot hospital resulted in the determination of optimal red blood cell stock inventory levels. These would be used to direct automatic inventory replenishment from Canadian Blood Services.

Once the optimal inventory targets were established, the hospital and local Canadian Blood Services distribution site used the following process for inventory replenishment.
 

Hospital

Canadian Blood Services

  • Share RBC inventory levels (via the inventory submission page within the online Blood Component and Product Disposition System)
  • Access hospital submitted RBC inventory levels
  • Use replenishment calculator tool to determine # of units to ship to hospital
  • Ship RBC units to hospital per delivery schedule


The overall objective of the pilot was to determine and confirm efficiencies and process improvements. Each hospital experience was different, with positive results reported by all hospitals and the Canadian Blood Services sites. These include:

  • Decreased orders for RBC (routine, ASAP and STAT)
  • Less time spent placing/receiving orders and shipping/receiving/processing RBC boxes
  • Optimized inventory levels
  • Reduced paper-based process, leveraging existing technology (DISPO system)

The inventory replenishment process is now routine for all three hospitals and includes regular collaborative inventory review meetings to adjust target inventory levels if required. Next steps include expanding to more hospitals in Atlantic Canada and to explore further automation to reduce the manual components of the process.

"Why I Give"

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“Why I Give” is a weekly feature sent out by e-mail to all staff at Canadian Blood Services. It profiles and celebrates employees who have either donated themselves, if eligible, or recruited friends and family to donate on their behalf.

A recent edition featured Kristy Schwenning from Nanaimo, BC, a registered nurse in our Clinic Services.

As an O-negative blood donor, Kristy has a unique opportunity to help people in emergencies when there is no time to ask questions.

As you know, an O-negative blood transfusion gives trauma and accident victims a fighting chance at life. As the universal blood type, hospitals can transfuse it to almost any patient in need.

Hospital Highlight: A novel red cell inventory ordering algorithm

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Hospital transfusion services maintain an on-site inventory of red blood cells to meet the immediate needs of patients, and to ensure product is available to meet sudden unexpected patient demand.

An important step to effectively manage on-site inventory for red blood cells is to determine an inventory threshold. These thresholds are often based on manually performed calculations that consider historical demand patterns, which must be updated on a regular basis as demand trends change. In determining an inventory threshold, hospitals must also consider minimizing the number of red blood cells units that outdate, and reducing the number of ad hoc orders and deliveries from Canadian Blood Services.

Another factor that may influence the number of units held in the transfusion service may be technologist and medical director comfort levels. Many transfusion service technologists will recall a “bad bleeder” story, and memories of these experiences can impact how inventory thresholds are determined.

Recognizing these challenges, Dr. Calvino Cheng, the Blood Transfusion Service and Pathology Informatics Group at Nova Scotia Health Authority Central Zone designed and implemented an innovative red blood cell inventory ordering algorithm.

“The objective was to introduce a real-time, semi-automated quantitative ordering system for red blood cells based on current usage data”, says Dr. Cheng.

Twice a day, a query is automatically run and a report is generated for transfusion service technologists indicating the amount of red blood cells that should be ordered from Canadian Blood Services. The factors used to determine the red blood cell order include current inventory, historical inventory data, system-wide patient hematology values and blood groups.

Basically, a rolling average demand is calculated and compared with current inventory levels. If the current inventory level is less than demand, then more red blood cells are ordered. If the current inventory level is more than demand, then red blood cells are not ordered.

The system has built-in fail safes to account for unpredictable events and to allow for flexibility. For example, an “anemia index” is built into the algorithm. The system scans the institution’s laboratory information database for hematology values, blood groups, and determines potential demand based on those variables.

Dr. Cheng and his team reported that since the introduction of the algorithm on June 1, 2015, there has been compliance of the inventory thresholds, achievement of approximately a 20% average inventory reduction, and reduction of annual overall outdate rates of 0.7% vs 1.6% (Table 1).  Specifically, group O and A outdates have reduced to approximately 1/8 of their previous rate during this period.  Also, there have been time savings of at least 30 minutes per workday in determining inventory orders.

Canadian Blood Services Hospital Disposition data for the 12 month pre vs 12 month post implementation 

Time Frame

# RBC Transfused

#RBC Outdated

Group O & A Outdates

 

 

Group B & AB Outdates

Ave RBC Outdated / month

12 month Outdate Rate

June 2014 to May 2015

14238

228

63

 

165

19

1.6%

June 2015 to May 2016

14904

98

8

 

90

8

0.7%

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Does your hospital routinely stock platelets? Please read: Customer Letter 2016-06 (PDF)
 

Previous issue of BloodNotes (June 2016)