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Canadian Blood Services SPECIAL FEATURE unrelated transplants for Canadian patients Canadian Blood Services: through its adult stem cell registry and its cord blood bank.10 More than just blood Did you know that for Canadian patients in need of a hematopoietic stem cell transplant the chance of finding an unrelated stem cell donor Five things to know about Canadian Blood Services that may be match is 80% to 90% for Caucasians, but falls relevant to your patients. to lower than 15% in non-Caucasians?11 This reflects the lack of ethnic diversity in the stem E.M. Wong, MD cell registry [Figure 1], not only in Canada but worldwide. Unlike blood donation, allogeneic stem cell transplantation requires more strin- anadian Blood Services is a critical products to include both adult and cord blood gent cell matching due to human leukocyte part of Canada’s health care system. stem cells, plasma sufficiency, and organ/tis- 1,3 antigen (HLA) typing, which is determined by As physicians, we often use blood sue donation and transplantation. Canadian racial background and ethnicity. Efforts are be- Cproducts for our patients but rarely reflect on Blood Services highlighted 20 years of growth ing made to increase the biological diversity of the breadth of activities that Canadian Blood and maturity with a new logo and tagline (Can- the Canadian Blood Services stem cell registry Services oversees and the selfless volunteer do- ada’s Lifeline) to better reflect this broader by registering more potential adult donors to nations made by Canadians. mandate as it continues to help patients in need. better reflect the current makeup of Canada’s population. 20 years and counting Blood donations Potential donors (healthy people between Canadian Blood Services recently celebrated 20 Although more than half of Canadians are eli- 4,5 17 and 35 years of age) can register online years in operation. The organization was formed gible to donate blood, only 1 in 25 does. Last by completing a health questionnaire and be on 28 September 1998 as an arm’s-length or- year more than 410 000 donors visited clinics HLA-typed after providing a buccal swab to ganization to manage Canada’s blood supply in across the country, including British Colum- join the 400 000 Canadians already on the response to the Krever inquiry into the blood bia’s five permanent collection sites and the registry.12 system after thousands of people received in- numerous mobile clinics operated around the 1,2 The Canadian Blood Services cord blood fected blood products in the 1980s. During province. The minimum age to donate blood bank was established in 2015, and one of its the past 20 years, the role of Canadian Blood at Canadian Blood Services is 17,6 but there is 6,7 collection centres is at BC Women’s Hospital in Services has expanded from blood and blood no maximum age. Canada’s oldest donor, a Vancouver. The other three collection centres are 95-year-old woman from Port Coquitlam, was in Edmonton, Ottawa, and Brampton. Rather celebrated last year.8 Dr Wong is a family physician with than being discarded as medical waste after the Iron deficiency is not uncommon among a focus in elder care. As a Canadian natural process of delivery, cord blood stem cells frequent blood donors, and Canadian Blood Blood Services volunteer for the past 10 can be banked for an extended period. Cord Services implemented changes in 2016 to re- years, she organizes public awareness blood stem cells are lifesaving for patients in duce this risk. The interdonation interval for campaigns on how to “give life” by need of stem cell transplant and, because of the female whole blood donors was increased to 84 donating blood or cord blood, or by less rigorous requirement for HLA matching days from 56 days, and the minimum hemoglo- registering as a potential adult stem cell due to the immaturity of the fetal blood stem bin requirement for male whole blood donors or organ/tissue donor. Her childhood cells, they provide some advantages over adult was increased to 130 g/L from 125 g/L. Plans 13 experience of being a blood recipient and stem cell transplantations. The ethnic diversity include selective ferritin testing for frequent her husband’s experience of not being of the cord blood bank is broader than that of donors who are at highest risk of developing able to find a suitable stem cell donor for the adult registry with more mixed-race units iron deficiency.9 his aplastic anemia, as well as learning [Figure 2]. Currently there are more than 3000 about others’ struggles, inspired her to cord blood units listed in the Canadian Blood give back. She is truly humbled by and Stem cell donations and Services bank and available for transplant, and grateful for the many volunteers who transplantation 21 have been distributed and transplanted to Canadian Blood Services operates a stem cell selflessly donate to Canadian Blood date. Informed consent for cord blood donation program that provides hematopoietic stem cells Services. must be obtained before the donor is in active for transplantation. Last year alone, Canadi- labor, ideally as part of her prenatal care with an Blood Services facilitated more than 400 14 This article has been peer reviewed. her primary caregiver. 62 BC MEDICAL JOURNAL VOL. 62 NO. 2 | MARCH 2020 Caucasian 66.91% SPECIAL FEATURE Chinese 7.32% South Asian 6.64% Other Multiple ethnicity 3.36% 4.99% Unknown 1.49% Black- Southeast Asian 1.62% African Jewish- Métis Black-Caribbean 0.26% Arab 1.41% Ashkenazi 0.37% 0.32% First Nations 1.06% 0.38% Central Asian 0.18% Hispanic 1.04% North Asian 0.12% Northeast Asian 0.49% Jewish-Sephardic 0.07% 4.18% Pacic Islander 0.02% Inuit 0.01% Caucasian Filipino Black-Other 66.91% 1.07% 0.90% Number of registrants: 454 482 FIGURE 1. Ethnic composition of adult stem cell registry (provided by Canadian Blood Services, September 2019). Organs and tissues: Donations and transplantation Ethnicity of 3403 cord blood units listed Canadian Blood Services helps coordinate or- Target: gan and tissue donation and transplantation • 60/40, Non-Caucasian/Caucasian in partnership with provincial organ donation Actual, up to and including 30 September 2019: organizations like BC Transplant. The Kidney • 61/39, Non-Caucasian/Caucasian Paired Donation (KPD) program, launched in • Includes 22 shipped to date 2009, is an example of interprovincial health systems working together to forge success be- yond provincial borders and improve access Unknown, 0.03% Arab, 3.53% Other, 0.03% Asian-Central, 0.26% to transplants for patients. The success of this Asian-North, 0.09% Asian-Northeast, 0.15% program can be attributed to the selflessness of those who have stepped forward to be liv- Multiple ethnicity, 26.60% Asian-South, 16.02% ing organ donors. KPD is operated as part of the Canadian Transplant Registry, a national Asian-Southeast, 1.03% web-based computer program operated by Ca- Pacic Islander, 0.12% Black-African, 3.03% nadian Blood Services and used to link the Jewish-Sephardic, 0.00% Jewish-Ashkenazi, 0.15% Black-Caribbean, 1.82% national potential recipient wait list with actual Hispanic, 1.20% Black-Other, 0.18% organ donors. Métis, 0.03% Working with partners across the organ and Inuit, 0.06% tissue donation and transplantation community, First Nations, 0.26% Canadian Blood Services also develops leading Filipino, 3.09% practices, supports professional education and Chinese, 3.26% public awareness activities, and collaborates on Caucasian, 39.05% new ways to share data on the performance of the donation and transplantation system in Canada.1 Continued on page 64 FIGURE 2. Ethnic composition of cord blood bank (provided by Canadian Blood Services, September 2019). BC MEDICAL JOURNAL VOL. 62 NO. 2 | MARCH 2020 63 Multiple ethnicity 3.36% SPECIAL FEATURE .blood.ca/en/transfusion/clinical-guide/vein-vein Since volunteer donations are critical to its Plasma -summary-blood-system-canada. Canadian Blood Services operates a national continued operations, physicians should also 4. Government of Canada. Blood, organ and tissue do- formulary for plasma protein products, includ- consider their role in educating the public about nation. Accessed 14 October 2019.www.canada.ca/ ing immune globulins, clotting factor concen- Canadian Blood Services. Not only do existing en/public-health/services/healthy-living/blood-organ patients need its services daily, some day phy- -tissue-donation.html. trates, and albumin to name a few. Canadian 5. Goldman M, Drews S, Devine D. Clinical guide to trans- Blood Services is embarking on a project to sicians and their families and friends could be fusion. Chapter 6. Donor selection, donor testing and n significantly increase the amount of plasma those patients as well. pathogen reduction. Accessed 19 August 2019.https:// that can be collected from unpaid donors. This profedu.blood.ca/en/transfusion/guide-clinique/do Competing interests nor-selection-donor-testing-and-pathogen-reduction. plasma can be directed to the production of None declared. 6. Canadian Blood Services. ABCs of eligibility. Accessed 19 plasma protein products such as immune globu- August 2019. https://blood.ca/en/blood/am-i-eligible/ lins to improve plasma sufficiency in Canada. abcs-eligibility. Acknowledgments In August 2019, Canadian Blood Services 7. Goldman M, O’Brien SF. Our older population: Donors Dr Tanya Petraszko, Canadian Blood Services as well as recipients? ISBT Sci Ser 2017;12:401-404. announced plans to open a proof-of-concept 15 associate medical director for Western Canada 8. CBC News. Canada’s oldest blood donor, ‘Granny Bea,’ source plasma collection site in Kelowna. still giving at 95.
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