Transfusion Transmitted Injuries Section

Current Activities

Transfusion Transmitted Injuries Surveillance System (TTISS)

TTISS evolved from a pilot project in 1999-2002 involving four participating provinces – British Columbia, Québec, Prince Edward Island, Nova Scotia – and has now become the national surveillance system for capturing moderate and serious adverse transfusion events reported in Canada. In 2004-2005, nine Provinces and two Territories participated in the TTISS.  In 2002, 56 hospitals participated in TTISS, and by 2004, the project had expanded to include 291 reporting hospitals. The proportion of hospital sites reporting at present represents 70% of red cell transfusion occurring in Canada per year.

TTISS is supported by input from front line health care workers, the National TTISS Working Group and the National Working Party for Data Review for improvement of surveillance activities. TTISS collaborates with Canadian Blood Services (CBS), Héma-Québec (HQ), and the Marketed Health Products Directorate (MHPD) of Health Canada for reconciliation of all data collected in order to ensure complete and accurate reporting. TTISS strives to produce quality data and strictly adheres to the definitions for the classification of reactions, in agreement with CBS and HQ. Data are disseminated regularly to stakeholders through TTISS Program Reports.

TTISS continues to evolve, change and improve. Future initiatives include upgrading the TTISS database to a web-based system which will incorporate a module for more in-depth reporting of transfusion-related errors.  Also, the Public Health Agency of Canada, in collaboration with stakeholders, has developed a standardized Guideline for investigation of suspected transfusion transmitted bacterial contamination which was released in January 2008 on the Canada Communicable Disease Report (CCDR) website.

Transfusion Error Reporting System

In early 2005, the Transfusion Error Surveillance System (TESS) was initiated as a pilot project in four provinces in Canada. The TESS Pilot Project was designed to capture errors in the transfusion chain for the administration of blood, blood components and plasma derivatives. TESS is a non-punitive, anonymous, web-based error reporting system that captures actual events (i.e., events that may or may not result in adverse consequences for the patient) as well as “near-miss” events (i.e., events that have the potential to cause harm if not detected).

Managed by the Public Health Agency of Canada, the TESS Pilot Project provides participating institutions and their respective provincial/territorial blood coordinating offices with benchmarking data for process improvement. The Public Health Agency of Canada disseminates the results of analysis to its stakeholders through regular reports, conferences and stakeholder meetings.

An objective of the TESS Pilot Project is to lay the groundwork for a national transfusion error reporting system that can be integrated with the Transfusion Transmitted Injuries Surveillance System (TTISS). The two systems will help improve blood transfusion-related patient safety. The pilot is expected to end in the spring of 2008 and participation of additional institutions is anticipated.  Plans for the future expansion of TESS are still under development.

Blood-Borne Pathogens Surveillance System in Hemophilia Patients

The Public Health Agency of Canada has funded the Association of Hemophilia Clinic Directors of Canada to

1. support the expansion of the Canadian Hemophilia Registry (CHR), so that clinical data from an existing national database, known as the Canadian Hemophilia Assessment and Resource Management information System (CHARMS), can be integrated with the CHR, and
2. establish blood-borne pathogens surveillance for patients with bleeding disorders through a comprehensive and serial collection of patients' serum and DNA samples for testing of known and emerging blood-borne diseases.

The National Working Party for Data Review (NWPDR)

The National Working Party for Data Review (NWPDR) is comprised of members selected for their scientific, medical or epidemiological expertise. This group reviews and evaluates data concerning the safety of transfusion of blood/blood products and transplantation of cells, tissues and organs.  The Working Party provides guidance to the Public Health Agency of Canada on emerging issues related to serious adverse events associated with the use of these products.  There are approximately 13 members in the NWPDR, including PHAC representation.