Making the most of every drop: Using Canada’s blood supply wisely

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When donors roll up their sleeves to give, they do so with trust in our commitment to put their donation to the best use to save lives.

manages the supply of blood and in Canada (except Quebec). In addition to ensuring a safe and secure blood system, we work with our partners — hospitals, medical associations, physicians, patient groups and governments — to improve how we use and monitor the supply of blood products in Canada to reduce waste and lower costs.

In May 2014, Canadian Blood Services’ hospital Blood Component and Product Disposition System moved to the web and became accessible to hospitals through a secure login. This system is the foundation for how we share information and interact electronically with our hospital customers. Using this system, hospitals can input disposition data on all blood products, including blood groups, discards, and the number and type of patients receiving transfusions for each blood component. They can also track the number of O-negative units transfused into patients whose blood type is not O-negative.

We strongly encourage hospitals to share their daily inventories through this system. Reliable data, combined with a comprehensive understanding of hospital services, will give Canadian Blood Services better insight into the shifts in demand for blood products so we can better plan for patient needs now and in the future.

Starting in September, we will use submitted data to create reports for participating hospitals twice a month. These reports enable hospitals to compare their use of blood products against previous months and years to identify trends, such as increased use of O-negative blood. Hospitals are also able to compare their utilization rates against similar institutions. While the reports are anonymous, we encourage hospitals to work with our hospital liaison specialists to connect with other participating hospitals and share best practices.

The system has over 600 active users, and more users are scheduled to join when a new version is launched in September.

The challenge of optimal blood utilization is not unique to Canada. The AABB, formerly known as the American Association of Blood Banks, of which I serve as president, is an international association committed to advancing transfusion medicine and cellular therapies. The AABB partnered with the American Board of Internal Medicine on Choosing Wisely, a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures.

The campaign offers recommendations that physicians and patients should consider when determining treatment. These recommendations are excerpted below (slightly revised for length; see the original list at choosingwisely.org):

 

1. Don’t transfuse more units of blood than absolutely necessary.

 

Each unit of blood carries risks. A restrictive threshold should be used for the vast majority of hospitalized, stable patients without evidence of inadequate tissue oxygenation. Transfusion decisions should be influenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard for non-bleeding, hospitalized patients. Additional units should only be prescribed after patients and their hemoglobin values have been re-assessed.

2. Don’t transfuse red blood cells for iron deficiency without hemodynamic instability.

 

Blood transfusion has become a routine medical response despite cheaper and safer alternatives in some settings. Pre-operative patients with iron deficiency and patients with chronic iron deficiency without hemodynamic instability (even with low hemoglobin levels) should be given oral or intravenous iron, or both.

3. Don’t routinely use blood products to reverse warfarin.

 

Warfarin can often be reversed with vitamin K alone. Prothromobin complex concentrates or plasma should only be used for patients with serious bleeding or who require emergency surgery.

4. Don’t perform serial blood counts on clinically stable patients. 

 

Transfusion of red blood cells or platelets should be based on the first laboratory value of the day unless the patient is bleeding or otherwise unstable. Multiple blood draws to recheck whether a patient’s parameter has fallen below the transfusion threshold (or unnecessary blood draws for other laboratory tests) can lead to excessive phlebotomy and unnecessary transfusions.

5. Don’t transfuse O-negative blood except to patients with O-negative blood and in emergencies for women of child-bearing potential with an unknown blood group.

O-negative blood units are in chronic short supply due in part to overutilization for patients who do not have O-negative blood. O-negative red blood cells should be restricted to patients with O-negative blood and women of child-bearing potential with an unknown blood group who require emergency transfusion before blood group testing can be performed.

Similar conversations are also happening in Canada. As part of the Choosing Wisely Canada campaign, the Canadian Society for Transfusion Medicine has created a list that reflects Canada’s tests, treatments and procedures. This list is under review and is anticipated shortly.

These are just some of the ways we can improve blood utilization. New ideas are always on the horizon and many of these, like developing less invasive procedures and redistributing blood products between hospitals, will come from our partners. We are relying on you to share your ideas and developments with us for the betterment of Canada’s blood system.

To Canadians, we are one very large team, and we must manage the use of this precious, life-saving resource together.