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Transfusion Reaction Reporting

Donna Berta RN BScN, Clinical Project Coordinator – Nursing, ORBCoN
Hemovigilance has been described as surveillance measures spanning the entire transfusion process from blood collection to blood recipient follow-up. Information on adverse transfusion effects is compiled to limit re-occurrence. The goal of reporting and evaluating adverse events is to improve transfusion safety.

Canada’s national hemovigilance system, Transfusion Transmitted Injuries Surveillance System (TTISS), was implemented by the Centre for Communicable Disease and Infection Control (CCDIC) of the Public Health Agency of Canada (PHAC) in 2001. Each province and territory report their transfusion reactions to TTISS. 

In Ontario, the Ministry of Health commissions the McMaster Centre for Transfusion Research of McMaster University to coordinate the province’s TTISS actions (TTISS-ON). Participation is voluntary, but all Ontario hospitals have signed on to report moderate to severe transfusion reactions to blood components (red blood cells, platelets, plasma, cryoprecipitate) and plasma protein and related products (PPRP). 

Blood component serious or unexpected transfusion reactions (posing a significant risk to patient safety) and those pertaining to the safety of the blood itself must be reported to Health Canada’s Canada Vigilance Program directly or via the manufacturer (Canadian Blood Services or Héma-Québec) in addition to TTISS-ON. Effective December 16, 2019 (as per Vanessa’s Law), PPRP serious adverse reactions must be reported directly to Health Canada’s Canada Vigilance Program as well as to the manufacturer of the product. Refer to the TTISS-ON website for their interactive Ontario Guide for Reporting Transfusion Reactions to identify the reporting requirements for each transfusion reaction.

A sentinel site model (where 29 Ontario hospitals have committed to report all transfusion reactions [minor (febrile non-hemolytic, delayed serologic, and allergic) reactions in addition to major, moderate to severe, transfusion reactions] is an integral component of the TTISS-ON program. These 29 Ontario hospitals represent approximately 35% of all blood components transfused in Ontario. This sentinel site transfusion reaction data along with Canadian Blood Services (CBS) disposition data are used to calculate the Ontario incidence or frequency of transfusion reactions by type and by blood component. Sentinel site data for the 2020 calendar year are displayed in Figure 1 and 2 and Table 1. 

At annual hospital site visits, ORBCoN and CBS provide this data along with hospital specific data (based on transfusion reactions reported by that hospital) to highlight transfusion patient safety. Transfusion Medicine Services have reaction investigating and reporting accountabilities. Accordingly, transfusion prescribers and transfusionists are accountable to recognize and report transfusion reactions.  Hospital specific data reports (graphs and tables) generated from TTISS-ON and CBS data should be reviewed by Transfusion and Quality committees and shared with front line care providers to support hemovigilance. 
For more information about report generation resources, contact Joanne Duncan, TTISS-ON Coordinator (
Figure 1: 2020, Sentinel Sites, Minor (febrile non-hemolytic, delayed serologic, and allergic) Reactions 
Figure 2: 2020, Sentinel Sites, Major (moderate to severe) Reactions 
Table 1: 2020, Sentinel Sites: Transfusion Reaction Type per Blood Component and Incidence of Major, Minor, Any Reaction per Blood Component
Number of Units Transfused 113,696 21,657 16,705 152,058
   Red Blood Cells   Platelets  Plasma Total
Transfusion Reaction Type        
Acute Hemolytic 1     1
Bacterial Infection   2   2
Delayed Hemolytic 15     15
Hypotensive 4 1   5
Other nonspecific pain 2     2
Other results of Investigation 8 5   13
Possible TRALI 1 1 1 3
Severe Allergic/Anaphylactic/Anaphylactoid 2 7 1 10
TACO 34 6 1 41
TAD   1 1 2
TRALI 1     1
Delayed Serological 105 1   106
Febrile Non-Hemolytic 165 55 2 222
Minor Allergic 31 91 14 136
Total 369 170 20 559
Incidence of Major Reaction 1 in 1,672 1 in 941 1 in 4,176 1 in 1,600
Incidence of Minor Reaction 1 in 377 1 in 147 1 in 1,044 1 in 328
Incidence of Any Reaction 1 in 308 1 in 127 1 in 835 1 in 272

Ontario Transfusion Transmitted Injuries Surveillance System (TTISS-ON) is gratefully acknowledged for the data provided.

Canadian Blood Services (CBS) A guide to reporting adverse transfusion reactions [Internet]. [Ottawa], CBS; 2020 [cited 2022 Mar 7]. Available from:

International Society of Blood Transfusion (ISBT). Haemovigilance [Internet]. [Amsterdam, the Netherlands], ISBT; 2022 [cited 2022 Mar 7]. Available from:

Ontario Transfusion Transmitted Injuries Surveillance System (TTISS-ON). Report an adverse reaction [Internet]. [Hamilton], TTISS-ON; 2022 [cited 2022 Mar 7]. Available from:


Canadian Society For Transfusion Medicine (CSTM) Conference 2022- May 26-29th

Troy Thompson, Program Manager ORBCoN and 2022 CSTM Conference Co-Chair


The CSTM Conference for 2022 will be located at the Westin Harbour Castle Hotel in Toronto ON.  The theme for the 2022 conference is Adapt, Transform, Personalize.  The scientific program offers educational sessions for all healthcare professionals working in or with an interest in Transfusion Medicine.  
The keynote speaker for this year’s conference is Jessica Holmes who has been a perennial favourite on Royal Canadian Air Farce for 15 years, and has brought the house down opening for giants such as Ellen DeGeneres, Russell Peters, Jerry Seinfeld, and Oprah Winfrey.

Her hilarious take on life’s challenges as well as her unique knack for impersonating celebrities will have audiences in stitches. Her customized emcee and entertainment presentations — which include motivation and wellness — are always a hit. 
Networking Opportunities
The CSTM conference provides registrants with ample opportunity for networking and socializing and will once again host an Exhibitor area and a President’s reception.  In addition, you are invited to submit abstracts for poster and/or oral presentation at the conference to highlight your individual/facility’s efforts in Transfusion Medicine and helping to connect Canada's Transfusion Community!

The conference venue, the Westin Harbour Castle, with its two 34-storey waterfront towers, offers dreamy views of both Lake Ontario and the entire city. It is the quintessential urban convention resort located in the revived waterfront district, the hotel offers direct access to some of Toronto's most noteworthy sites, including the Rogers Centre, Scotiabank Arena, CN Tower, high-end shopping and delicious restaurants. The hotel is located near local subway stations and bus stops for easy travel throughout downtown Toronto and is only a short taxi ride from both Pearson and Toronto Island Airports.

For more information and to register for the 2022 CSTM Conference please visit

Advertisement posters highlighting the 2022 CSTM Conference are available on the conference webpage; please help to promote the conference by printing and posting at your facilities!

Discounted Early Bird registration closes after April 29, 2022, be sure to register soon!
On behalf of the 2022 CSTM Conference co-chairs- Dr. Katerina Pavenski and myself and the CSTM Conference Organizing Committee we invite you to join us at the conference in May.  We look forward to an inspiring and thought provoking conference!
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Celebrating National Medical Laboratory Week 

Medical laboratories are at the centre of healthcare! Although you might not see them, #LabISEssential. On behalf of ORBCoN Happy National Medical Laboratory Week to all medical laboratory professionals for everything you do!
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Register: CSTM 2022 Annual Conference

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Register: Perinatal Consensus Conference

Perinatal Consensus Conference. Choosing wisely when performing antenatal and postnatal transfusion tests. 1. Discuss routine and specialized transfusion tests to be ordered prenatally including genotyping for patients with weak D. 2. "Choose Wisely" when performing transfusion tests at the time of delivery 3. Define hemolytic disease of the newborn. 4. Explain which clinical situations warrant testing of cord blood
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Featured Resource: IVIG Infusion Guide

The IVIG Infusion Guide (updated, version 3.0) Includes IVIG brand and patient weight based infusion rate tables. 1) Provides healthcare practitioners involved in the infusion of IVIG with evidence informed, best practice guidance 2)The informtion can be incorporated into hospital specific policies and procedures 3) The material is limited to IVIG infusion and is not applicable to infusion of subcutaneous immune globulin
Click Here Find More

Coming Soon: Transfusion Medicine Education Web Conference Archive Video

The 17th annual Transfusion Medicine Education Web Conference was held April 8th 2022. This event showcased dealing with different transfusion requirements for different types of patients with a massive bleed. If you missed the event it will be archived on the Transfusion Ontario website for viewing. Watch for it on in the coming week. We woud like to extend our thanks to the organizers and the speakers for another great symposium. See you all next year!

Upcoming Event: University of Toronto Transfusion Medicine Rounds

University of Toronto Monthly TM Rounds

April 28th, 2022 @ 12:00 pm – 1:00 pm

Transfusion-related acute lung injury - a breathtaking syndrome  presented by Dr. Alexander Vlaar

Click Here To Register
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