1. Alberta Health Services
Provincial Picture

2. 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
Patient resources hosted on a secondary public site

3. 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

4. AHS- Calgary Zone
M. Taher Rad

5. 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

6. 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.

7. 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.

8. 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-INR
Pre-INR
Pre-INR
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
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).

9. 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

10. AHS- Edmonton Zone
S. Nahirniak

11. 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

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

13. Audit on Fibrinogen