Prof Erica Wood
The first integrated national database of blood usage in Australia is being set up following a successful pilot program overseen by the Transfusion Research Unit at Monash University, Melbourne.
The National Transfusion Dataset (NTD) aims to collect information about where, when, and how blood products are used across all clinical settings, and have the ability to link with clinical outcomes, its developers say.
The database will integrate data from numerous currently unlinked sources including ambulance services, hospital records, blood donor services, disease registries and pathology providers.
“The dataset will be an invaluable resource towards a comprehensive understanding of how and why blood products are used, numbers and characteristics of patients transfused in health services, the clinical outcomes after transfusion; and provide support to policy development and research,” according to the unit’s Blood Synergy program.
It says the national dataset will build on the success of the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR) set up in 2011 to collect transfusion data on patients experiencing major haemorrhage and receiving five or more units of blood within four hours. The registry linking 41 hospitals has captured data on more than 10,000 cases of critical bleeding.
This was extended to a pilot Transfusion Database (TD) project in 2019 that collated data on all (not just massive) transfusions on more 8,000 patients from pilot sites at the Alfred Hospital in Melbourne, Flinders Medical Centre in Adelaide, and Wimmera Health in Horsham.
Now with funding from the Australian Research Data Commons, the Blood Synergy program team are expanding this registry to capture data on all transfusion episodes, beyond major events.
“The NTD will integrate and expand these databases to provide new data on transfusion practice including blood utilisation, clinical management and the vital closing of the haemovigilance loop,” it says.
Professor Erica Wood, Head of the Transfusion Research Unit, says one of the major challenges is securely linking up all the relevant records. For example, Lifeblood maintain records of blood donations, processing and product distribution to health services, while pre-hospital data on blood product usage is held by ambulance and retrieval services.
In the hospital setting, pathology departments manage data on blood units received and issued, along with patient blood group and compatibility testing records, and information on any transfusion reactions, while clinical information is held in EMR systems.
And many clinical registries capture and analyse data on patients with blood disorders and other conditions, some of whom need transfusions of many types of blood products.
“Currently these datasets are not ‘joined up’ to see a full picture of transfusion practice from donor to product to patient,” says Professor Wood.
“Having these data available will be extremely helpful to hospitals and pathology services, our national blood service, governments who fund these services, and everyone in the community to see how blood is used in Australia, and how its use can be improved”.
“As the dataset is built, it will also be securely linked with data from several national registries to capture even more clinical information relevant to analysing transfusion practice and outcomes.”
Transfusion Dataset project leader Dr Kim Huynh says the team face a huge challenge in harmonising the data items and processes and ensuring everything is captured but there are no double-ups or conflicting information.
“We’re being very careful, in order to deliver what should be a fantastic resource,” she said.
“A key part of this is trying to find patterns: What patient characteristics predict high-level clinical need for blood? How common are each of those groups of people? What side-effects are experienced, and by whom? How cost-effective are our current systems? By having a clearer picture, we can inform clinical guidelines, help improve logistics and reduce wastage, and streamline practice nationally.”
The project is already underway at the Alfred Hospital, Flinders Medical Centre and Ambulance Victoria, with The Royal Melbourne Hospital and Royal Darwin Hospital waiting in the wings.
There are now 60 hospital sites enrolled on the Massive Transfusion Registry, and the team plan to enrol them as new sites to the National Transfusion Dataset over the next several years.
“We’ve got a lot of experience working alongside peak national bodies like the National Blood Authority as well as Departments of Health, so it will be great to have their involvement and support when we start sharing our findings.”