Research Units

Infusion pumps are mechanical devices commonly used in transfusion medicine. Originally designed to assist in the delivery of fluid resuscitation products like crystalloids, infusion pumps have also come to be used in the transfusion of blood products as they can offer benefits to both patients and health-care teams. These benefits can include greater consistency and calculation of flow rate, increased accuracy of infusion volume, increased flexibility in transfusion speed in outpatient settings, and decreased risk of errors compared to gravity-based infusions. However, the growing use of infusion pumps has raised questions about the risk of mechanical damage to red blood cells (RBC).  

Health-care facilities that use these pumps rely on manufacturers and regulators to determine whether specific models are approved for infusing red blood cells. There is a lack of literature available to help guide evaluation of infusion pumps for this use and to understand the effects of different conditions, rates, and pump types on the quality of RBCs. Research providing clear evidence on the effect of infusion pumps on RBCs can be valuable to regulators, manufacturers, and health-care facilities responsible for evaluating pump safety for transfusions.  

Screening blood donors to determine their eligibility to donate is an important layer of safety within the blood system. To screen prospective donors, blood operators use a donor questionnaire (DQ) that asks questions about potential exposure to infections that could be transmitted via transfusion to recipients. With the current DQ used in Canada, men are deferred from donating blood for three months since the date of their last sexual contact with a man. This screening approach has been criticized for being discriminatory. Despite incremental changes in recent years, these time-based donor eligibility criteria still exclude many sexually active gay, bisexual and other men who have sex with men (gbMSM), including some trans, non-binary and other gender diverse people, and do not consider an individual donor’s risk of exposure to sexually transmitted infections, regardless of sexual orientation. In late 2021, Canadian Blood Services filed a proposal with its regulator, Health Canada, to use an alternative approach to screen donors. If approved, questions that ask about men having sex with men will be replaced with gender neutral, sexual behaviour-based screening questions asked of all donors. This study assessed the approach’s feasibility by exploring: 

1. How donors understand proposed alternative sexual behaviour-based screening questions; 
2. How acceptable they think the questions are; and 
3. How comfortable they feel answering them.  

With a constant focus on maintaining a safe and adequate supply, Canadian Blood Services is committed to making blood donation as inclusive as possible. Currently, men can donate blood if it has been more than three months since their last sexual contact with a man. This is the latest in a series of progressively shorter time-based deferrals: from an indefinite deferral introduced in the mid-1980s, to a 5-year deferral (2013), a 12-month deferral (2016), and now a 3-month deferral (2019). These eligibility changes have been supported by significant advances over the past three decades including better testing for transfusion-transmissible infections, the introduction of information technology systems to safely manage blood inventory and a better understanding of behaviours that expose individuals to new infections. Before and after the implementation of each change in the eligibility criteria, the safety of the blood supply and donors’ observance of eligibility criteria were evaluated. Each evaluation indicated that the risk of HIV remained very low. This study looked at trends by assessing the residual risk of HIV and donor survey results between 2010 and 2021, a period encompassing all three eligibility criteria changes.

Whole blood transfusion is receiving renewed interest as a lifesaving alternative to component therapy for actively bleeding patients. In Canada, all blood products for transfusion must be leukoreduced. Leukoreduction removes white blood cells that could potentially cause infectious disease transmission or unwanted immune responses. Canadian Blood Services is evaluating a platelet-sparing filter to prepare leukoreduced whole blood for transfusion. The manufacturers of the platelet-sparing filter licensed for use in Canada recommend that whole blood be filtered within eight hours of collection. This is not always operationally feasible, especially in Canada where distances between collection and processing sites can be large. This research examined whether the whole blood collection bag, leukoreduction filtration, and the timing of filtration significantly affects whole blood quality during 21 days of cold storage. Exploring and validating alternative processing parameters, such as longer hold times before leukoreduction, could offer greater operational flexibility for blood operators.