1. Utilization of O-Rh-Negative Red Cells
Kathryn Webert, MD, MSc, FRCPC
Medical Director, Utilization
Canadian Blood Services
NAC Meeting
November 2014

2. Objectives To describe the distribution of O-negative red cells
To describe strategies to raise awareness of the demand on the O-Rh negative supply
BloodBriefs
Collection of hospital best practices

3. O-Negative Red Cell Units Issued
Fiscal Period
Source: CBS internal distribution data. Represents ~75% of Canadian supply

4. O-Negative Red Cell Units Issued (% of total RBC Issues)
Fiscal Period
Source: CBS internal distribution data. Represents ~75% of Canadian supply

5. O-Neg Issues by Hospital Type

6. bloodbriefs

7. September 2013 April 2014 December 2013 September 2014
Logo: Virginia Gaffney, Product Brand and Creative Development

8. Issue a ‘status report’ to top 50 hospital users:
3 years of issue data
O neg or AB plasma issues as % of:
All blood groups
Total group O blood
Ranking (1st, 2nd, 3rd etc)

9. All tables of data are anonymized.
A is customized for each receiving hospital with hospital specific data identified.
Slide from Cheryl Doncaster

10. Effectiveness and Impact
Electronic survey sent January 2013 to 64 hospitals
Both O-neg / AB plasma = 36
O-neg = 14
AB plasma = 14
25 survey respondents representing 30 hospital sites
Doncaster et al. CSTM Abstract 2013
Slide from Cheryl Doncaster

11. Survey Results
68% indicated the BloodBrief highlighted data or information that was new
84% were influenced to review transfusion practice/blood component demand
48% anticipated revision or development of new policy
Most hospitals with no planned change cited issue data below national average or already strict specific transfusion policy in place
Doncaster et al. CSTM Abstract 2013

12. Summary
Effective in promoting optimal utilization of blood components/products
Heightens hospital awareness of issue trends over time
Comparisons within hospital peer groups influences hospital transfusion practice / policy.
Doncaster et al. CSTM Abstract 2013
Slide from Cheryl Doncaster

13. Collection of hospital best practices

14. Top 20 Hospitals
% O Neg: National Avg =11.8%

15. Top 20 Hospitals continued

16. BloodBrief – O Neg RBCs
Of the top 50 hospitals in the list, 47 received an O Rh Neg BloodBrief last year.
25 of 47 decreased O Rh Neg as a % of all blood groups (0.02 to 3.34%)
31 of 47 decreased total O Rh Neg issues
32 of 47 decreased total RBC (all blood groups) issues

17. Peer Support Top 20 users - We need your assistance
We’re looking for your adult* hospital O Rh negative RBC Utilization “best practices”
Don’t assume that what your
hospital does is what everyone
else is doing!
* We will explore pediatric hospital best practices at a later date

18. Peer Support
Provide your HLS with 4-6 practices that you think contribute to your hospital’s effective O Rh Neg utilization management
We will compile and share 4-6 best practices that hospitals can employ to improve their Rh Neg RBC utilization

19. Develop and implement a policy for hemorrhaging patients whose blood group is not known
Develop and implement policies for optimal inventory management

20. Develop and implement a policy for hemorrhaging patients whose blood group is not known
Immediately collect a blood sample for ABO/Rh from all trauma patients upon admission to the Emergency Department.
Transfuse male trauma or hemorrhaging patients regardless of age with group O Rh positive red blood cells until their blood group can be determined or unless known to have anti-D.
Determine the optimal maternal age restriction for women served by your hospital, and transfuse female trauma or hemorrhaging patients above the optimal child bearing age with group O Rh positive red blood cells until their blood group can be determined or unless known to have anti-D.

21. Have a policy to switch patients to their own blood group once known.
Develop and implement a policy for hemorrhaging patients whose blood group is not known
Have a policy to switch patients to their own blood group once known.
Have a policy for switching known Rh negative hemorrhaging patients to Rh positive red blood cells unless known to have anti-D. Define the trigger at which point the patient will be switched, and if medical director consultation is required each time.

22. Develop and implement policies for optimal inventory management
Small rural hospitals should stock a mix of O Rh positive and Rh negative red blood cells.
Revaluate optimal inventory levels on a regular basis, or after hospital organizational/clinical program changes, especially those that will reduce red blood cells demand. Promptly notify your local Canadian Blood Services of any adjustments.
Transfuse oldest units first unless there are other clinical considerations.

23. Develop and implement policies for optimal inventory management
Always request group specific units for patients with red blood cell antibodies. Only use Rh negative substitutions if group specific is not available for the scheduled transfusion date. Notify your local Canadian Blood Services immediately for any difficult to fill antigen negative requests, especially those that will require ongoing transfusions.
Reduce inventory tagged for specific patient use, using strategies such as crossmatch on demand/electronic crossmatch, type and screen, and a maximum surgical blood order schedule (MSBOS).

24. Develop and implement policies for optimal inventory management
Cancel inventory tagged for specific patients after 24 hours or immediately after imminent need has passed, and make allowances for patients with red blood cell antibodies.
Share inventory between affiliated hospital sites.
Track Rh negative transfusions to Rh positive patients.
Monitor soon to outdate units and as a last resort, transfuse to Rh positive patients to avoid wastage or redistribute to larger nearby hospitals where they are less likely to expire. Track and review redistribution data, and adjust ordering practices from Canadian Blood Services if redistribution frequency is excessive.

25. Acknowledgements Cheryl Doncaster Dan Shavrnoch Rob Romans
Virginia Gaffney
Lise Bourque
CBS Hospital Liaison Specialists