Transfusion Medicine “Boot-Less” Camp

By Tseday Tegegn, Graduate Student at Pryzdial Lab

Transfusion practice plays a vital role in medicine and many doctors routinely face patients requiring blood products. However, transfusion is not covered in depth in medical schools across Canada. Residents and physicians whose specialty is not hematology, are often left out of the loop when decisions are made about transfusing a patient.

To bridge this critical gap in knowledge, a rigorous curriculum was initiated by Drs. Yulia Lin and Jeannie Callum at the University of Toronto in 2012. This program has created an opportunity for non-hematology residents to learn about the most up-to-date transfusion issues and practices. Given the success attained at the University of Toronto, many partnerships emerged in an effort to expand this program across Canada. In the most recent Canadian Blood Services Annual Report, the national expansion of “Transfusion Camp” was highlighted as one of its top achievements.

As part of this nationwide endeavor, the first ever “Transfusion Camp” in British Columbia, spearheaded by Dr. Jacqueline Trudeau, was held here in Vancouver over the course of several months in 2016-2017. Anesthesiology residents in the first, second or third years were the first Vancouver cohort to attend five full-day sessions at the Vancouver General Hospital.

A wide variety of topics were covered, including for example, preparation of blood products, patient blood management, complications related to massive transfusion, and management of patients with sickle cell anemia. Residents were given a pre-course evaluation to assess their existing knowledge and then were assessed at the end of the camp, thereby providing a measure of the quality of the program.

On June 16th, the last day of the camp, I had an opportunity to sit down with Drs. Kristen Kidson and Evan Shao, 2nd and 3rd year anesthesiology residents respectively. Both were extremely enthusiastic when speaking about their experience with the camp. Their responses were edited for clarity and flow.

Tseday (CBR): What was your overall take on the camp?

Kristen: “The parts that I appreciated the most were the exposure to all the resources available, and the willingness of the specialists to help us. For example, experts from the Canadian Blood Services and Hematopathology each shared knowledge from their areas of specialty that we didn’t have. One of the things I am going to take away from this course is the ability to tap into an amazing network of experts; these specialists are so very eager to help.”

Evan: “It has been a very positive experience for me. We covered a range of topics that should have been part of our training. The camp provided us with a structured approach to learning and gave us knowledge to better evaluate patient outcomes. I wish I knew all of these things when I was in my first year! I am now in my third year of residency and I can think back to many cases where I could have applied the knowledge that I obtained from this camp. Just recently, I was in the operating room to help manage a patient who was stabbed multiple times; I was more involved in the case because I knew what the staff were trying to accomplish and that was very helpful.”

Tseday (CBR): Was there a specific part of the camp curriculum that most sparked your interest?

Evan: “Yes for sure. Today we were studying massive transfusions, which are particularly relevant for surgery and anesthesia residents. I also found the details of how blood is processed very useful and applicable. For example, I didn’t know that fresh frozen plasma (FFP) requires 20 minutes to thaw, which means that I need to order certain products ahead of time. Also, now I will know to put red blood cells back in the fridge until they are transfused or make sure the platelets are rocking and not standing for long period of times. This is all critical information, which obviously has important clinical implications.”

Tseday (CBR): Can you usually prepare ahead of time if a patient needs transfusions during surgery?

Kristen: “Yes, we can predict if a patient is going to need a transfusion from their lab results. But things can change quickly in the operating room and also on the ward. Patients may need blood urgently, so having a blood bank here, in the hospital, is critical. We have quick access to either matched or unmatched blood.”

Tseday (CBR): In your experience, which blood product is transfused most often in the operating room?

Kristen: “We often end up transfusing red blood cells but we also encounter patients requiring different types of blood products, such as platelets, IVIG etc. This adds another layer of complexity: knowing when to transfuse, which product to use, and for which patients.”

Tseday (CBR): How fast can you get transfusion products from the blood bank to transfuse patients?

Kristen: “We can transfuse pretty quickly – in approximately 5 minutes, particularly at the big centers, like Vancouver General Hospital, St. Paul’s Hospital or Royal Columbian Hospital. This is how we are able to manage patients with massive hemorrhages. Being able to communicate with the blood bank in the hospital can help speed things up.”

Overall, the main take-away from this curriculum is that it is possible to narrow the transfusion knowledge gap among physicians and residents one camp at a time. As Evan put it, “[Transfusion Camp] is practice changing” and will have far-reaching consequences for residents’ and physicians’ practices and, ultimately, to improve patient outcomes.

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