Manitoba was one of the highest users of red blood cells per capita in Canada. While blood transfusions can save lives, each unit transfused carries inherent risk to patients, uses valuable laboratory and nursing resources and, in some cases, provides no health benefit to the patient.
Recognizing Manitoba’s need to improve the appropriateness of our use of red blood cells, the Shared Health Transfusion Medicine Program, Best Blood Manitoba and Choosing Wisely Manitoba teamed up to implement evidence-based practice guidelines to improve the appropriateness of each unit transfused.
The Transfusion Stewardship project team:
Dr. Charles Musuka, Medical Director for Transfusion Medicine and Hematopathologist Shared Health Diagnostics, Assistant Professor University of Manitoba
Dr. Arjuna Ponnampalam, Hematology, CancerCare Manitoba, Transfusion Medicine, Shared Health, Assistant Professor, Department of Pathology / Internal Medicine, Max Rady College of Medicine, University of Manitoba
Darcy Heron, Technical Director for Transfusion Medicine, Shared Health
Shauna Paul, Manager, Blood Management Service, Winnipeg Regional Health Authority
“Blood is a finite product that is altruistically donated by Canadians. It is imperative that we use this gift judiciously for the most patient benefit.” said Dr. Charles Musuka. “We have put in place policies that encourage/enforce these aims.”
The new set of guidelines were implemented across Manitoba in March 2020. The guidelines recommend a single unit transfusion for symptomatic non-bleeding adult patients. If a second unit is required; evaluation of symptoms and recent hemoglobin should be used to guide appropriateness. “These guidelines are an important first step for Transfusion Stewardship in Manitoba. Aligning our policies with national and international best practices is key in appropriate usages of these important resources.” said Dr. Arjuna Ponnampalam.
“Considering the importance of Transfusion Stewardship in practices is crucial for health care providers. Asking questions and considering alternatives are important aspects in the use of blood products.” said Shauna Paul. Dr. Musuka suggests asking questions before deciding to transfuse: “Is the transfusion of this blood product essential? Can I achieve the same outcome with alternative therapies? What risk do I expose the patient to if I transfuse this blood product?”
“Transfusion Stewardship is responsibility.” said Darcy Heron, “the responsibility to ensure the time and effort it takes a donor to donate their red cells is valued and their donation is treated as the precious gift it is. The responsibility to make sure the donation is utilized in the most judicious and effective manner thereby ensuring transfusions are available, especially when needed the most.”
The team is proud to see positive results since implementation. There has been a reduction in two unit transfusions, signaling that fewer patients required a second unit upon re-assessment. Up from 62% in 2018 and 68% in 2019. Since implementation, Manitoba is averaging 79% of all inpatient transfusions as single unit. Two Manitoba hospitals have also earned the “Using Blood Wisely” designation from Choosing Wisely Canada with more applications for the designation pending.
More information about our Red Blood Cell Utilization project can be found here.
Following the success of this project, the team has also implemented another important Transfusion Stewardship project; more information about our Immune Globulin project can be found here.