NAC meeting April 30-May 1, 2014

13% increase in IVIG distribution in 2012/13 fiscal year; Immuneglobulin 13% increase in IVIG distribution in 2012/13 fiscal year; 28% increase in PID cases; Immunologists indicate the rise is due to increased vigilance and better identification of PID by GPs etc Patients with PID account for 30% of IVIG patient population and consume 25% of distributed product. Forecasting ~12% increase in 13/14

C1 esterase There are currently 15 patients being treated with C1INH for Hereditary Angioedema (HAE) in Nova Scotia. Of these, 7 are being treated prophylactically at home through the self administration program.

Red Blood Cells Established Nova Scotia Red Blood Cell Clinical Expert working group – endorsed AABB RBC Transfusion: A Clinical Practice Guideline. Developed algorithm with AABB criteria and issuing 1 unit of rbc’s at a time. Blood Transfusion committees and district medical advisory committees approvals being sought ,

Red Blood Cells A prospective “snapshot” audit of current RBC transfusion practices and indications for transfusion in Nova Scotia hospitals was completed in March; analysis is underway

Red Blood Cell Dashboard  

rFVIIa Issued “black box” warning on rFVIIa in March 2013. Use in massively bleeding patients decreased by 90% 2012/13- 25 patients received 2013/14- 10 patients received

Redistribution of Plasma Protein Products Sites report inventory expiring within 6 months to the NSPBCP who then facilitates the redistribution As a result of the redistribution program, 320 vials of PPPs with a net cost avoidance of $433,500 have been redistributed within Nova Scotia from January 1, 2013 to December 31, 2013. Reviewing inventory levels

Prothrombin Complex Concentrates April 1, 2013 to December 31, 2013 L/UL-I use 89.3% UL-N use 10.7% (15 patients) 11 patients were not on a vitamin K antagonist; 1 patient was on rivaroxaban 4 patients were on a vitamin K antagonist; the pre-INR was less than 1.7 All patients were either bleeding or requiring an urgent procedure or surgery

Fibrinogen April 1, 2013 to December 31, 2013 67 patients received 302 g. 70 % (211 grams) utilized in cardiac surgery. Also being used for liver transplantation, trauma, bleeding during or post surgery

Massive Transfusion Developing process whereby Paramedic identifies massively bleeding patients to ED and activate the MTP in advance of arrival in order to provide thawed plasma earlier

Bleeding Disorder Clinics Project with adult and pediatric bleeding disorder clinics to document current processes and analyze the adequacy of resourcing levels

Weak D Standardizing Weak D /partial D testing and reporting in Nova Scotia

Transition Liberal government October 2013 Deputy Minister Dr. Peter Vaughan – April 28, 2014 District Health Authorities will decrease from 10 to 2 effective April 1, 2015