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Irene Dines M.L.T.
Manager of the Lookback Traceback program
Canadian Blood Services
Central Ontario Region
Toronto Site
Agenda
Overview of CBS
The LB/TB program
External networking
Questions
Canadian Blood Services
Lookback Traceback
Who are we, what do we do??
Central Ontario Blood Centre
67 College Street, Toronto
Mission Statement
Canadian Blood Services:
Operates Canada’s 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.
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
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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
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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.
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
Limitations
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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
Traceback
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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.
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
Compensation
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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
LNP=Litigation 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)
Limitations of the Compensation Programs
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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, )
External Networking
Canadian Liver Foundation
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Canadian Liver Foundation provides counseling and guidance in regards to
questions from the general public or infected individual
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Contact Info: Canadian Liver Foundation
2235 Sheppard Ave East, Suite 1500
Toronto Ontario
416-491-3353
1-800-563-5483
www.liver.ca
email: [email protected]
How PHL can help CBS
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HIV,HCV,HBV, are all reportable diseases. Any testing facility MUST report to PHL a
confirmed positive transmissible disease test.
When PHL rec’s notification of a ‘pos’ , they obtain information from the patient
The patient is also asked if they were ever a blood donor or have rec’d 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.
Canadian Blood Services
ENHANCED LOOKBACK OUTCOMES ON COMPLETED INVESTIGATIONS
From: 1985-01-01 To: 2007-11-30
Total Cases
#
Initiated through Centre
Screening
HIV
HTLV
HCV
HBV
717
386
10521
296
%
#
%
#
%
#
%
430
60.0%
370
95.9%
6108
58.1%
230
77.7%
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%
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%
46
6.5%
36
9.5%
1704
16.7%
79
29.6%
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%
Initiated through
Traceback
Cases Open
Not available
Total # of Recipients
Afftected***
*Information provided by donor, donor's physician, Public Health
**Stored Sample Project
***Estimated total # of transfused components = total # number of recipients affected
Canadian Blood Services
ANNUAL TRACEBACK OUTCOMES ON COMPLETED INVESTIGATIONS
From: 1985-01-01 To: 2007-11-30
Total Cases
HIV
HTLV
HCV
HBV
547
29
15430
488
#
Cases Open
%
#
%
#
%
#
%
10
1.8%
0
0.0%
898
5.8%
25
5.1%
537
98.2%
29
100.0%
14532
94.2%
463
94.9%
Closed
134
24.5%
4
13.8%
3667
23.8%
149
30.5%
Positive
194
35.5%
14
48.3%
4825
31.3%
57
11.7%
Negative
101
18.5%
6
20.7%
2312
15.0%
133
27.3%
Withdrawn
63
62.4%
3
50.0%
2553
110.4%
81
60.9%
Not Investigated
45
44.6%
2
33.3%
1171
50.6%
42
31.6%
Cases Completed
Outcome of
Completed Cases:
Closed:
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.
Negative:
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.
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.
Questions?
Due Diligence
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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.
Thank you