Irene Dines M.L.T. Manager of the Lookback Traceback program Canadian Blood Services Central Ontario Region Toronto Site

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Irene Dines M.L.T.Manager of the Lookback
Traceback programCanadian Blood ServicesCentral
Ontario Region Toronto Site

• Agenda
• Overview of CBS
• The LB/TB program
• External networking
• Questions

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Canadian Blood Services

• Lookback Traceback
• Who are we, what do we do??

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Central Ontario Blood Centre 67 College Street,
Toronto
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Mission Statement

• Canadian Blood Services
• Operates Canadas blood supply in a manner that
  gains the trust, commitment and confidence of all
  Canadians by providing a safe, secure,
  cost-effective, affordable and accessible supply
  of quality blood, blood products and their
  alternatives.
• Lookback Traceback , contained within the MSRA
  ,assists with the provision of safe blood.

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Testing

• Currently all blood donations are tested for the
  following
• ABO/Rh, antibody screening,
• HBsAg, HTLV-I/II, Anti HCV, HCV RNA, HIV-RNA,
  Anti HBcore
• Selected clinics-WNV-RNA, Anti-CMV

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• Testing is both manual and automated
• NOTE CBS has 3 testing sites in Canada..Halifax,
  Toronto, Calgary.
• All donations collected have the samples shipped
  to one of these locations for testing, results
  are sent electronically to the production /
  distribution sites

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CBS Customer / Client Services

• Ways to ensure the safety of the blood supply
• General public awareness and ongoing, available
  education regarding blood donation and
  transfusion
• Health screening of donor, verbal, visual,
  questionnaire- donor must meet very strict
  criteria
• State of the art testing, current methods,
  continual QC of tests, mandatory training and
  re-certification of staff performing tests
• Post donation information system to retrieve
  products immediately upon receipt of information
  making that donors product not suitable for
  transfusion
• Internal and External Audits- we follow strict
  rules and guidelines set up Health Canada and are
  audited to ensure we follow them
• Lookback/Traceback program for donor/recipient
  follow up.

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Lookback

• A lookback is the process of identifying previous
  donations of a donor who currently is testing
  positive for a transmissible disease
  marker,including testing done at outside
  laboratories-ie PHL

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Limitations

• Incomplete donor records( pre 1980 is scattered)
• Hospital records limited
• Not always able to identify the treating
  physician
• Recipient is not able to be found- moved, died
  and therefore unable to be tested to determine if
  indeed donor was infectious at the time of that
  donation.
• Recipient might refuse to be tested

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Traceback

• A traceback is the process of identifying the
  donors of products that have been transfused to a
  patient, who now is testing positive for a
  transmissible disease.

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Limitations

• Limiting factors in Traceback investigation are
• Incomplete records ( prior to 1980- scattered)
• Unable to establish transfusion history of the
  recipient
• Unable to locate the donor- moved, died etc
• Donor Unwilling to be tested- fear factor

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Compensation

• There is financial compensation available, for
  any recipient who has been infected with a
  transmissible disease if it is determined to have
  occurred as a result of the blood transfusion.
• Hep B, HIV compensation is handled through KPMG
  organization, or private legal case to CRC
• HCV compensation is handled through either OHCAP(
  provincial) or LNP(federal)
• OHCAP Ontario Hepatitis C Assistance Program if
  transfusion happened prior to 1986 and post 1990
• LNPLitigation Notification Program if
  transfusion happened between 1986-1990.
• Pre 86 Post 90 Federal compensation program- as
  of September 2007 there has been an agreement
  between this program and CBS to provide
  information regarding possible traceback
  information on a claimant. The information in our
  files is consolidated into a report sent back to
  the Fund Administrator.( indicating that a Pos
  donor was identified, or that all the donors are
  negative, or that the case is inconclusive- some
  donors unable to locate etc)

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Limitations of the Compensation Programs

• Lengthy , time consuming process
• Recipient must attempt to obtain their own
  transfusion records from the Hospital records
  department
• Recipient must submit a test result to indicate
  positive status
• Other risk factors are considered before trace
  back is begun.
• (i.e. IV drug history, tattoos, Incarceration, )

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External Networking
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Canadian Liver Foundation

• Canadian Liver Foundation provides counseling and
  guidance in regards to questions from the general
  public or infected individual
• Contact Info Canadian Liver Foundation
• 2235 Sheppard Ave
  East, Suite 1500
• Toronto Ontario
• 416-491-3353
• 1-800-563-5483
• www.liver.ca
• email clf_at_liver.ca

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How PHL can help CBS

• HIV,HCV,HBV, are all reportable diseases. Any
  testing facility MUST report to PHL a confirmed
  positive transmissible disease test.
• When PHL recs notification of a pos , they
  obtain information from the patient
• The patient is also asked if they were ever a
  blood donor or have recd blood transfusion in
  the past at any time. NOTE The patient should
  also be asked if they perhaps had a previous
  surname at the time.
• If the patient responds, yes, or possibly,that
  they have been a donor or recipient of blood
  product then PHL notifies CBS, using a Report of
  Infectious Disease. This is forwarded to the
  local CBS site
• The information required must include WHERE
  transfusion took place- name of hospital and town
  of hospital, and/or WHERE blood donation took
  place.. Town, clinic name, at least the province
  they were living in at the time. CBS will forward
  onward to other CBS sites as needed.

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Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services
ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS
From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30

HIV HIV HTLV HTLV HCV HCV HBV HBV
Total Cases 717 717 386 386 10521 10521 296 296

Initiated through Centre Screening 430 60.0 370 95.9 6108 58.1 230 77.7
Initiated through Traceback 67 9.3 4 1.0 751 7.1 9 3.0
Initiated through Other 219 30.5 12 3.1 2721 25.9 57 19.3
Initiated through SSP 1 0.1 0 0.0 941 8.9 0 0.0
Cases Open 10 1.4 7 1.8 288 2.7 29 9.8
Cases Completed 707 98.6 379 98.2 10233 97.3 267 90.2
First-time Donors 259 36.6 194 51.2 4091 40.0 126 47.2
Repeated Donors 400 56.6 146 38.5 4336 42.4 59 22.1
Not available 46 6.5 36 9.5 1704 16.7 79 29.6
Total of Recipients Afftected 1559 217.4 685 177.5 26171 248.8 324 109.5
Recipients () 251 35.0 28 7.3 5758 54.7 27 9.1
Recipients (-) 373 52.0 162 42.0 2031 19.3 76 25.7
Recipients Not Found Status Unknown 935 130.4 495 128.2 18382 174.7 221 74.7
Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health Information provided by donor, donor's physician, Public Health
Stored Sample Project Stored Sample Project Stored Sample Project Stored Sample Project Stored Sample Project Stored Sample Project Stored Sample Project Stored Sample Project Stored Sample Project
Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected Estimated total of transfused components total number of recipients affected
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Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services Canadian Blood Services
ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS
From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30 From 1985-01-01 To 2007-11-30

HIV HIV HTLV HTLV HCV HCV HBV HBV HBV HBV
Total Cases 547 547 29 29 15430 15430 488 488 488 488

Cases Open 10 1.8 0 0.0 898 5.8 25 5.1 5.1 5.1
Cases Completed 537 98.2 29 100.0 14532 94.2 463 94.9 94.9 94.9
Outcome of Completed Cases                    
Closed 134 24.5 4 13.8 3667 23.8 149 30.5 30.5 30.5
Positive 194 35.5 14 48.3 4825 31.3 57 11.7 11.7 11.7
Negative 101 18.5 6 20.7 2312 15.0 133 27.3 27.3 27.3
Withdrawn 63 62.4 3 50.0 2553 110.4 81 60.9 60.9 60.9
Not Investigated 45 44.6 2 33.3 1171 50.6 42 31.6 31.6 31.6
Closed Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other). Case completed with no positive donors found, but some donors not assessed (either not found, deceased, refused testing or other).
Positive At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker. At least one donor subsequently tested positive for the specific marker.
Negative All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker. All donors subsequently tested and cleared negative for the specific marker.
Withdrawn Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related. Case withdrawn at the discretion of the Medical Office, usually due to evidence suggesting the infection is not transfusion related.
Not Investigated Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre. Donors/donations related to the transfusion were not investigated, usually because no documentation or records were available either from the hospital or at the Centre.
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Questions?
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Due Diligence

• As a Health Care professional, it is all of our
  responsibility to use the current available
  resources, pass along pertinent information,
  handle sensitive information with respect ,all
  the while utilizing the utmost of our abilities
  and training to achieve the best outcome for the
  Canadian public.

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Thank you