Improving transfusion practice through serology education

Understanding blood compatibility is critical to ensuring safe transfusions, but in some cases, identifying compatible blood types for a patient can be challenging. That’s because blood can be typed according to 38 different blood group systems and hundreds of different blood cell antigens within these systems—not just the familiar ABO and Rh types—and knowing if a patient has antibodies to these antigens is crucial to their transfusion care.

Data collected by the Public Health Agency of Canada from 2011–2015 show that adverse reactions to receiving a blood transfusion, triggered when a patient’s antibodies destroy donated red bloods (called a hemolytic reaction), do occur, although they are uncommon because of antibody testing performed before transfusion. Acute hemolytic reactions—a life-threatening condition—occurred at a rate of one case for every 94,656 units of blood components transfused, and delayed hemolytic reactions, which tend to be mild, occurred at a rate of one case for every 37,270 units of blood components transfused.

For doctors training to become specialists in treating patients with blood disorders (called hematologists), understanding the complexities of antibody-antigen reactions (called serology) is essential. But access to training in serology varies across the country, which can create significant differences in knowledge, as demonstrated by the findings of a survey led by Dr. Matthew Yan. “When it came to antibodies, the knowledge and experiences among the hematology trainees we surveyed was varied,” said Dr. Yan, a transfusion medicine doctor at the Fraser Health Authority in British Columbia and medical officer at Canadian Blood Services

Dr. Yan and colleagues took on the task of developing a tool that could help standardize serology education and fill the learning gaps. With funding from Canadian Blood Services’ BloodTechnet Award Program, they created LearnSerology.ca, an online curriculum with six modules, including a novel interactive module for completing an antibody investigation panel.

“We know that LearnSerology.ca is an effective learning tool, and in some ways is superior to traditional immunohematology teaching for Canadian hematology residents,” says Dr. Valérie Arsenault, pediatric hematologist and transfusion medicine specialist at CHU Sainte-Justine in Montreal and a collaborator on LearnSerology.ca. At the recent AABB annual meeting, Dr. Arsenault presented the results of a study that examined how effective LearnSerology.ca was as a learning tool. The upshot? Compared to non-exposed trainees, trainees exposed to the website performed significantly better in a serology exam on questions related to understanding and interpreting an antibody panel and tended to score better on the exam overall.

What makes Learnserology.ca different from other educational resources on this topic is that it is designed to complement an in-person curriculum with content that can be learned at an individual’s own pace on their computer or smartphone. The website is currently being used at the University of Toronto to support training of hematology residents, in addition to a serology curriculum they learn in-person throughout their training. Although it was developed with physician trainees in mind, the website is also being used by medical laboratory technologists.

Early indicators of the website’s popularity suggest people all over the world are looking for this kind of information. Dr. Jacob Pendergrast, a transfusion medicine specialist at Toronto General Hospital who contributed content for LearnSerology.ca, says in 2020, the website has already logged 10,000 unique visits, including 9% from Canada, from 126 countries. “That really surprised us because there hasn’t been much promotion, but people are finding it through search engine queries or word of mouth,” he says.

According to Dr. Arsenault, the BloodTech Net Award Program was crucial to the development of the website. “It gave us the means to create this amazing interactive educational platform for hematology and pathology residents as well as medical laboratory technologists around the world,” says Dr. Arsenault. “By teaching knowledge and skills in serology, LearnSerology.ca has the potential to make future hematologists better at providing transfusion care to patients and, ultimately, can increase patient safety.”

Canadian Blood Services invests in the development of innovative education projects in transfusion, cellular therapy and organ and tissue transplantation through the BloodTechNet Award Program. Until November 15, 2020, Canadian Blood Services is accepting applications for this funding opportunity. For more information, including the competition guidelines and application form, please visit the BloodTechNet Award Program page.

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The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.