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

2. 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

3. CanadianBlood Services Lookback Traceback Who are we, what do we do??

4. Central Ontario Blood Centre 67 College Street, Toronto

5. 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.

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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.

12. 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

13. 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 • 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)

14. 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, )

15. External Networking

16. 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@liver.ca

17. 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 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.

20. Questions?

21. 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.

22. Thank you