1. Irradiation Survey
Purpose: To further confirm variability in the provision of irradiated blood components to patients across the country (NAC discussion April 2012)
Limitations: Survey was not circulated beyond NAC members (except NB).
Support to circulate beyond NAC not received from PTs
Responses: Survey completed by each province with the exception of Ontario
Not all respondents provided answers to all questions
Responses reflect practice of large TM hospitals within provinces
‘small’ large hospitals and medium/small sized hospitals not represented (except NB)
Most responding sites do not transfuse pediatrics

2. Irradiation Survey
all survey respondents stock and issue irradiated blood components

6. Irradiation Survey
Existence of established policy/protocol outlining clinical criteria for the requirement of irradiated blood components irradiated blood components:
6 – yes
1 – no
3 - skipped question

8. Irradiation Survey
Other triggers for the provision of irradiated blood components:
ALL on Dana Farber protocol
Leukopenia
CLL on campath
Upon request of pediatrician
Some facilities have a more restrictive policy than others, but it comes down to what the physician orders.
Myeloma patients on bortezomib
CLL getting alemtuzumab; fludarabine; cladribine; pentostatin
Aplastic anemia getting Atgam

9. Irradiation Survey
Patient alert tags – 100% respondents do not issue to patients at risk for graft vs. host disease
System (electronic or other) by which a patient's special requirements for transfusion (irradiation) are documented and retained – 100% respondents YES

10. Irradiation Survey Sharing of information with other hospitals:
Physician summary letter. We are working on a transfer of information between blood transfusion services
Markers are placed on patient record, physician orders are communicated to other hospital facilities (no formal process for this)
Irradiation appears as a transfusion directive in our local transfusion information system (Traceline) and is automatically electronically transferred to the provinical transfusion server accessible to all blood banks in the province

11. Irradiation Survey
Sharing of information with other hospitals (con’t):
1-page notification (developed by TMS with BMT) sent from BMT clinic to home hospital TMS at discharge. Compliance poor. SCT recipients are provided with application for medic-alert bracelet. Estimated uptake 70%
This is done at the discretion of the ordering physician
Letter of notification when patient is discharged from site initiating irradiation request goes to new physician, hospital blood bank likely to see patient in future and to CBS Patient Testing services. If it is a patient requiring irradiation following stem cell transplant, that information is captured in the provincial electronic health record
Within province, one lab information system containing this information.

12. Irradiation Survey
Are standing orders for irradiated blood components reviewed on a regular basis?
YES – 5 NO – 2 Skipped question - 3
If yes, by whom?
Technologists and if outside guidelines by supervisor and pathologist
Decision support tool for RBC/platelet order prompts ordering MD to review requirements for irradation on reverse of page
Transfusion medical director who will then send letters to the appropriate attending physician if it is unclear as to whether or not to continue.

13. Irradiation Survey Next steps?
Decision Point – Does NAC want to pursue the development of national recommendations highlighting appropriate clinical triggers for the provision of irradiated blood components to adult patients?