The Canadian Red Cross school meal study.
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Canada↗
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The Canadian Red Cross Society.
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Canada↗
Canadian Red Cross lecture. Current concepts of oxygen-transporting blood substitutes.
Blood substitutes are being developed that will provide oxygen-transporting capabilities as well as volume replacement. Perfluorochemical and hemoglobin solutions have potential clinical use. A perfluorochemical blood substitute, Fluosol-DA 20%, is being used in clinical trials in several countries. These blood substitutes are not capable of totally replacing the need for blood transfusions but could be used temporarily in situations where blood is contraindicated or not available. They may be useful for a wide range of clinical conditions other than blood replacement, such as impending tissue ischemia. Before large-scale clinical use of these products is realized, more information is needed about drug efficacy and safety so that intelligent decisions can be made about indications for this type of transfusion therapy.
Animals↗
Joint Scientific Conference of the Canadian Society for Transfusion Medicine and the Canadian Red Cross Society. 23-26 May 1996. Abstracts.
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Animals↗
Optimizing recovery of platelets in platelet rich plasma by the simplex strategy.
A Simplex is an empirical, geometric feedback strategy which progressively programs a series of experiments according to the results of the preceeding experiments. It leads to definition of conditions which maximize or minimize the result of experiments in two or more variables. When applied to study a laboratory method it dictates simultaneous variation of the conditions of an experiment, differing from the usual approach in which variables are altered sequentially and arbitrarily. A two variable Simplex (force and duration of centrifugation) has been applied to maximize platelet recovery in platelet rich plasma (PRP). The technique of Simplex is described. Maximal recovery of platelets in PRP was reached by centrifugation at 2160 X g for 2.7 minutes. To confirm the correctness of this result, platelet concentrates were prepared from PRP's separated by three different methods: 1) conditions determined by Simplex, 2) American National Red Cross recommended method (2820 X g for two minutes), and 3) Canadian Red Cross recommended method (995 X g for nine minutes). Mean recovery of 78 per cent was obtained by Simplex, significantly higher than 61 per cent with the American National Red Cross method (p greater than .005) and higher than 69 per cent with the Canadian Red Cross method. Simplex strategy is recommended as a simple, powerful technique for determining optimal experimental or laboratory conditions.
Blood Banks↗
Autologous donation error rates in Canada.
BACKGROUND: Although certain transfusion risks are eliminated by the use of autologous blood, clerical errors may still occur. In addition, because of differences in donor selection criteria and donor-patient expectations, the consequences of certain errors may be different in autologous and allogeneic donations. STUDY DESIGN AND METHODS: In January 1996, autologous donation error rates in Canada from 1989 to November 1995 were estimated by 1) a detailed questionnaire sent to hospitals supplied by the Canadian Red Cross, Blood Services, Transfusion Center of Quebec at Montreal autologous donation program (n = 31), 2) a review of that institution's quality assurance non-compliance reports, and 3) a detailed questionnaire sent to other Canadian Red Cross centers with autologous donation programs (n = 16) and hospital-based autologous programs in Canada (n = 3). The total number of autologous donations collected was determined from Canadian Red Cross annual reports and information supplied by hospital-based programs. RESULTS: There were 113 errors reported for 16,873 units collected by the Montreal center (1/149 units) based on collection center and hospital data. The most frequent errors were the late receipt of units for surgery (25% of errors) or the receipt of units in the wrong hospital (23%). Other Canadian programs reported 166 errors for approximately 53,500 units collected (1/322 units). However, this figure was based mainly on collection center, and not hospital, data. The most frequent errors were in labeling (48%) and component preparation (25%). One unit of autologous fresh-frozen plasma was transfused to the wrong recipient. Errors were more frequent if components were produced, if units were drawn in hospitals for interhospital transfer, or it units were shipped between Red Cross centers. CONCLUSION: Errors are not infrequent in autologous donation programs. Autologous transfusion should not be considered as being without risk.
Blood Donors↗
Eligibility and exclusion of hemochromatosis patients as voluntary blood donors.
BACKGROUND: Hereditary hemochromatosis patients are excluded in many countries as voluntary blood donors. In 1991, changes in the Canadian Red Cross policy allowed healthy hemochromatosis patients to become voluntary donors. STUDY DESIGN AND METHODS: The medical histories of 208 hemochromatosis patients were evaluated for eligibility for blood donation from a large prospective database of hemochromatosis patients. A survey that determined the success or exclusion of 81 patients for blood donation and the reasons for their exclusion based on Canadian Red Cross donor exclusion criteria was analyzed. RESULTS: Of 208 hemochromatosis patients, 140 (67%) were eligible for blood donation. Criteria for exclusion were other illnesses excluded by Canadian Red Cross criteria and the use of contraindicated medications. Fifty-one per cent of patients had attempted to donate blood, with only 7% being successful. CONCLUSIONS: A large number of potential blood donors are excluded from blood donation inappropriately despite changes in eligibility criteria to the contrary. Further public and health education is needed to increase awareness and, thus, increase blood donation by potential donors.
Blood Donors↗
Targeted hepatitis C lookback: Quebec, Canada.
BACKGROUND: Since March 1990, all blood donations in Canada are screened for antibodies to hepatitis C virus (HCV). Because HCV may cause chronic asymptomatic hepatitis, in February 1995, the Canadian Red Cross began targeted HCV lookback studies. STUDY DESIGN AND METHODS: From March 1990 to March 1997, the Quebec Center of the Canadian Red Cross collected 1,750,846 donations, and there were 561 anti-HCV-positive repeat donors, from whom 3,196 blood components had been issued to the hospitals. Hospital blood bank directors were asked to test recipients and return results to the Quebec Center. One hundred nine hospitals were surveyed to determine methods and resources involved in lookback. The transfusion medicine service at the Royal Victoria Hospital (RVH) developed a standard operating procedure for performing lookbacks and analyzed the costs and outcomes of lookbacks. RESULTS: As of April 1998, information has been received on 2329 (73%) of components; 1020 patients had died of unrelated causes, 590 were untraceable, and 353 were tested. Of those tested, 215 (61%) were anti-HCV positive; their average age was 47, and at least 53 percent were already aware of their HCV status. Few hospitals had received any additional resources to perform lookbacks. At the RVH, lookback on 182 components resulted in the identification of nine seropositive recipients, average age 70, who did not previously know their HCV status; four of these patients had abnormal alanine aminotransferase levels. The cost of lookback per newly diagnosed case of HCV was estimated at $2727 (US) for the Quebec Center and $6014 (US) for the RVH. CONCLUSION: Targeted lookback in the province of Quebec on 3196 components has resulted in the identification of 101 seropositive recipients who did not previously know their HCV status.
Blood Banks↗
Incidence and estimated rates of residual risk for HIV, hepatitis C, hepatitis B and human T-cell lymphotropic viruses in blood donors in Canada, 1990-2000.
BACKGROUND: Since 1990, the Canadian Red Cross Society and Canadian Blood Services have been testing blood donors for hepatitis C virus (HCV) antibody and HCV nucleic acids and have supplemented HIV antibody testing with p24 antigen testing. We report trends in the incidence of blood-transmissible viral markers and estimates of the risk of undetected infection in donors over the last decade. METHODS: We extracted anonymous donor and blood-transmissible disease information from the Canadian Blood Services National Epidemiology Donor Database for 8.9 million donations from 2.1 million donors between June 1990 and December 2000. The risk of transfusion-transmitted infection (or "residual risk") refers to the chance that an infected donation escapes detection because of a laboratory test's window period (i.e., the time between infection and detection of the virus by that test). We determined the probability of residual contamination of a unit of blood after testing by using the incidence/window period model, which is based on the incidence of infection in repeat donors and the window period for each laboratory test. The viral markers evaluated in the study were HIV, HCV, hepatitis B virus (HBV) and human T-cell lymphotropic virus (HTLV). RESULTS: Except for HBV, the transmissible-disease rates of the other evaluated viruses decreased over the study period, with less of a decrease for HTLV. In 2000, the transmissible-disease-positive rate per 100 000 donations was 0.38 for HIV, 16.83 for HCV, 12.40 for HBV and 1.77 for HTLV. The residual risk of HIV, HCV and HTLV decreased over the study period; the residual risk of HBV fluctuated throughout the decade. The current residual risk per million donations is 0.10 for HIV, 0.35 for HCV, 13.88 for HBV and 0.95 for HTLV. INTERPRETATION: Except for HBV, the estimated risk of undetected infection (residual risk) has decreased over time. The rates of transmissible disease and the probability of undetected transmission of infection are at par with, if not lower than, those reported for other industrialized countries.
Biomarkers↗
Ontario appellate court overturns judgment for plaintiffs infected through tainted blood.
On 29 November 2001, the Ontario Court of Appeal issued a lengthy decision overturning a lower-court judgment in favour of three hemophiliacs infected with HIV in 1985 through contaminated blood-factor concentrate. The joint decision in the three cases of Robb, Rintoul, and Farrow is the latest decision in litigation dating back to 1992. The plaintiffs alleged negligence by the Canadian Red Cross Society and the Canadian government for delays in introducing heat-treated concentrate after the risks posed by unheated product were known.
Blood-Borne Pathogens↗
Court approves final Red Cross bankruptcy plan to compensate blood victims.
Following two years of negotiations, the insolvent Canadian Red Cross Society received court approval on 14 September 2000 of its plan to compensate victims of Canada's tainted blood tragedy (and pay other creditors).
Bankruptcy↗
Supreme Court finds red cross negligent in screening blood donors.
On 19 April 2001, the Supreme Court of Canada released its first judgments in litigation alleging the Canadian Red Cross Society was negligent for inadequately screening blood donors in the early 1980s. It upheld an order that damages in the amount of over $2.5 million be paid to three individuals who contracted HIV between 1983 and 1985 from contaminated blood.
AIDS Serodiagnosis↗
Prevalence of factor V Leiden in a Canadian blood donor population.
OBJECTIVE: To determine the prevalence of factor V Leiden in a Canadian blood donor population. DESIGN: Cross-sectional laboratory study. SETTING: Hamilton Centre of the Canadian Red Cross Society. PARTICIPANTS: Volunteer donors who attended Hamilton Centre blood donor clinics over a 4-day period in August 1994; blood samples from 356 people were evaluable. OUTCOME MEASURES: Presence of factor V Leiden. RESULTS: Factor V Leiden was detected in 19 of the 356 people, for a prevalence rate of 5.3% (95% confidence interval 3.0% to 7.6%). All 19 people were shown to be heterozygous for the mutation. CONCLUSION: Factor V Leiden is common in the Canadian population. Its prevalence is similar to that reported in other Western countries. These data are relevant in the clinical management of patients at risk for venous thrombosis and those with recurrent thrombotic disorders.
Base Sequence↗
Court opens door to more claims under Red Cross HIV compensation fund.
The Ontario Superior Court has allowed families of deceased individuals who contracted HIV from tainted blood to proceed with their claims against the Canadian Red Cross for compensation despite the existence of a compensation plan and fund.
Compensation and Redress↗
Changes in the Canadian blood system: the Krever Inquiry, Canadian Blood Services and Héma-Québec. Krever Commission.
Beginning in 1992, Canada underwent a series of investigations into the national blood program. The Krever Commission issued an interim report in 1993 and a final report in 1997. In all a total of 93 recommendations were made. Subsequently, in 1998, the Canadian Red Cross Society (CRC) withdrew from the blood program and two new organizations, the Canadian Blood Services (CBS) and Héma-Québec (HQ) took over as operators.
Blood Banks↗
Red Cross and federal government held liable for hemophiliacs' HIV infection.
After eight years of litigation, on 21 June 2000 three hemophiliacs infected with HIV finally won a judgment against the Canadian Red Cross Society and the federal government. An Ontario trial court ruled the Red Cross and the government were negligent for having delayed the implementation of heat treatment for blood products, which resulted in the plaintiffs' infections. Since starting their lawsuits in 1992, two of the three plaintiffs died of AIDS before the trial judgment. But the damage awards were criticized by the plaintiffs' lawyer.
Canada↗
Notifying patients exposed to blood products associated with Creutzfeldt-Jakob disease: integrating science, legal duties and ethical mandates.
The issue of notifying people who have been exposed to blood products that have been associated with Creutzfeldt-Jakob disease (CJD) has arisen at a time when the Canadian blood system is under intense scrutiny. As a result, the Canadian Red Cross Society issued a recommendation to health care institutions that recipients of CJD-associated blood products be identified, notified and counselled. Although Canadian jurisprudence in the realm of informed consent may support a policy of individual notification, a review of the scientific evidence and the applicable ethical principles arguably favours a policy of a more general public notification. Indeed, situations such as this require a unique approach to the formation of legal and ethical duties, one that effectively integrates all relevant factors. As such, the authors argue that individual notification is currently not justified. Nevertheless, if a system of general notification is implemented (e.g., through a series of public health announcements), it should provide, for people who wish to know, the opportunity to find out whether they were given CJD-associated products.
Beneficence↗
Hepatitis C lookback in Canada.
BACKGROUND AND OBJECTIVES: Since March 1990, all blood donations in Canada are screened by enzyme-linked immunosorbent assay (EIA) for antibodies to HCV, with confirmatory testing done using a recombinant immunoblot assay (RIBA). Because HCV may cause chronic asymptomatic hepatitis, in 1995, the Canadian Red Cross began targeted HCV lookback studies on all confirmed positive donations. These have been continued by the two new operators of the blood system in Canada, Héma-Québec and the Canadian Blood Services. Subsequent to recommendations made in the public inquiry into the Canadian blood system, led by judge Krever, general lookback through letter notification of all patients transfused in the years prior to the introduction of anti-HCV testing was initiated in several pediatric hospitals, and later in several Canadian provinces. MATERIALS AND METHODS: Targeted HCV lookback was done for all donors confirmed positive by RIBA testing from the start of HCV testing in 1990. In 1999, stored RIBA 2 indeterminate samples were re-tested by RIBA 3, and lookback performed on confirmed positive donations. In the province of Quebec, hospitals were surveyed to determine methods and resources involved in lookback. Provinces performing general letter notification entered hospital transfusion records into a central transfusion data bank, and performed linkage with other provincial data banks to remove deceased patients and obtain current addresses. RESULTS: As of January 2000, targeted lookback had been completed on 4,859 components of 1,628 anti-HCV positive repeat donors. 2,991 recipients were deceased, and 451 were not found or tested. Of the 1,422 recipients tested, 954 (67%) were anti-HCV positive. Approximately half were already aware of their HCV status. Lookback efforts in hospitals were hampered by lack of resources and manual records. General letter notification in British Columbia (BC) and Prince Edward Island (PEI) led to the testing of 38,960 and 1,953 recipients respectively, with 5.0 and 2.2% of tested recipients found to be anti-HCV positive. CONCLUSION: In completed targeted lookback investigations, 19% of components are eventually linked to an anti-HCV positive recipient. These results are very similar to those obtained in other countries, such as Denmark and the UK. In general letter notification lookbacks, the frequency of anti-HCV in the tested recipients is approximately twice the frequency of the general population.
Antibodies, Viral↗