Alberta Health Services Provincial Picture

2. Provincial recycling of PCC 1. Alberta Blood Office (ABO) and CTR On hold with recent provincial budget changes 2. Provincial recycling of PCC all outdating product recycled into either Edmonton or Calgary with complete utilization All jurisdictions except Calgary zone follow NAC recommendations 3. Provincial TM website live April 1st standardized TM documents, algorithms and clinical resources http://www.albertahealthservices.ca/LabServices/wf-lab-clin-tm-trxn-algrthm.pdf Patient resources hosted on a secondary public site

3. Province wide stakeholder committee for reversal of NOAC (ER, Neuro, Surg, Anesth, Hem, DI, Crit Care) DTIs & major bleeding Consider PCC 50u/kg or FEIBA 50 iu/kg If no PCC/FEIBA to be given then TxA (10 mg/kg IV) anti-Xa & major bleeding Consider PCC 50 u/kg If no PCC to be given then TxA (10 mg/kg IV) For both categories and moderate bleeding – recommending only TxA

AHS- Calgary Zone M. Taher Rad

Switching to CMV-Safe Blood Products (1) 1. Currently all adult hematology-oncology and BMT patients (excluding patients on purine analogs) will receive CMV Safe-Non-Irradiated blood components. 2. Patients on purine analog medication will get CMV Safe-Irradiated blood components. Here is the final list of drugs for irradiated product needs (from literature review and physician input):  ATG-anti-thymocyte globulin Bendamustine Clofarabine Alemtuzumab Deoxycoformicin Fludarabine Cladribine Pentostatin Busulfan

Switching to CMV-Safe blood products (2) Non-Haematological oncology patients will be transfused with routine blood components "CMV-Safe/Non-irradiated" .     Our policy regarding transfusion of paediatric oncology patients as well as neonates requiring CMV-Negative-Irradiated blood components has not been changed and we will continue to provide those patients with CMV-Negative-Irradiated blood components at this stage. Solid organ transplant patients will receive CMV Safe-Non-Irradiated blood components otherwise there is specific request by attending physicians for CMV-Negative/irradiated blood components, however these patients are required to be Donor CMV-Neg/Recipient CMV-Neg (D-/R-) supported by a recent serological testing.   We will continue to carry 5-10% inventory of CMV-Neg-Irradiated platelets for immune deficient and "just in case" patients. We don't have on site irradiator which creates some limitations.

SCM-TM Redesign Project For TM Order sets, we have created an interactive environment within HIS (SCM). Important medications correlated to blood components has been linked to blood order set. Linking Purine analog drugs  the only available option for patient with this medication will be Irradiated blood components Warfarin, Coumadin, Tranexamic acid and Dabigatran will be linked to PCC. Aspirin, NSAID and Anti-platelet will be linked to Platelet order set.

Calgary PCC Utilization Plan (CAL-3G Protocol) PCC Dosing Protocol Based On Pre-INR, Clinical Categories and Variable Targets New Changes in Dosing of PCC Clinical Groups Target INR Pre-INR <2.0 Pre-INR2.0-2.4 Pre-INR2.5-3.4 Pre-INR3.5-6.9 Pre-INR≥7.0 CNS Bleeding <1.4 1500 IU 2000 IU 2500 IU Active Bleeding <1.5 1000 IU Urgent/EM Surgery Complex Surgeries Invasive Procedure Inv. Cardiac Procedure 1.7-1.9 N/A 500 IU Complex Surgeries : Cardiac/vascular/trauma/thoracotomy and laparotomic surgeries. Invasive cardiac procedures : Angiography , angioplasty and stent placement. Patients <60Kg Weight: Maximum Single Dose: PCC 2000 IU (X4 Vials).

Audit on Fibrinogen – NAC email 95% of Fibrinogen concentrate has been utilized was due to three patients with congenital fibrinogen disorders One case of Afibrinogenemia Two cases of Dysfibrinogenemia Clinical indication: Same as very where else?? No concentrated fibrinogen used for acute acquired hypofibrinogenemia

AHS- Edmonton Zone S. Nahirniak

EZ updates IVIG changes Hereditary Angioedema patients Gammagard Liquid = 29% of our product utilization Hereditary Angioedema patients Two patients in ICU recently Blood “safe” fridges Approval to move forward with purchase for Outpatient clinic and PICU Request from STARs to place in their bases Blood Product costing study NAIT, AHS and AH collaboration due to start towards end of May 2013

Group O to Non Group O individuals 2012 Chronic Transfusion review (n=254) Plan to monitor in all patients going forth

Audit on Fibrinogen