Dr Chris Hogan is a consultant haematologist and brings to the NBA long-term sub-specialist expertise and experience in transfusion medicine, from both the clinical and the laboratory perspectives. He retains his part-time position as consultant haematologist at Royal Melbourne Hospital. Dr Hogan is also a member of the Education Committee of the Australian and New Zealand Society of Blood Transfusion. He began working as the NBA’s first Principal Medical Officer in August 2008.
This is both an exciting and a challenging time to be working in the blood sector. The clinical and resource environment is complex and rapidly changing. Demand for specialised blood products such as intravenous immunoglobulin is increasing. The need for strong relationships between production, supply and the patient interface is even greater nowadays because of the increased sophistication of disease treatment programs, important niche areas of expert sub-specialist practice, and the climate of finite resources.
Together with these clinical demands, the need for systematic and critical practice review through usage audits and registry data is now a standard. Data gathering and management and data warehousing are themes running through the NBA’s approach to meeting these challenges as we go forward. Properly balancing the management of clinical safety, efficacy and sufficiency of the supply of blood and blood products requires major data and data management resources.
During 2008–09 the NBA progressed a major project to revise the National Health and Medical Research Council’s Clinical Practice Guidelines on the use of blood components. Peri-operative, critical bleeding, paediatric and neonatal, medical and obstetric guidelines will be produced as part of a suite of clinical, scenario-based product use and practice standards and recommendations. The NBA’s development of the National Blood Supply Contingency Plan, now endorsed by health ministers, was a significant step forward. There is now related activity on the part of the states and territories, hospitals and pathology providers to flesh out the more local details of the plan and response. This work has been relevant in the context of the emergence of the pandemic (H1N1) 2009 and the potential threat this poses for our health system, our volunteer blood donor base, and the blood supply. The rise in the incidence of dengue fever in Queensland and internationally, the outbreak of chikungunya virus infection in northern Italy, and increasing concerns about West Nile virus and variant Creutzfeldt–Jacob disease all serve to heighten the need to maintain vigilance about new and emerging threats to our blood supply and to develop strategic and robust plans to manage such circumstances, together with our colleagues in the Australian Red Cross Blood Service and other parts of the health sector.
The NBA has now set up an enduring national haemovigilance structure, the Haemovigilance Advisory Committee. This structure will enable the development of a national haemovigilance data set and contribute to blood and transfusion safety reviews and initiatives. In part the committee builds on foundation work achieved through jurisdictional initiatives such as Blood Matters, Blood Safe and Blood Watch. Australia will soon be in a position to share its national haemovigilance data with the newly founded International Haemovigilance Network.
The new Criteria for the Clinical Use of Intravenous Immunoglobulin in Australia were released in March 2008 and the NBA is in the process of reviewing patterns of IVIg issue and use against the criteria. This will in turn support clinical practice review and supply and demand planning. It is interesting to note that international data on IVIg use patterns in Human Development Index countries similar to Australia show significant variation in per capita IVIg annual use and I look forward to researching this further.
I particularly thank Dr Turner and all the NBA team for the support they gave me as I took up my new role and for their commitment and hard work this year in a demanding and increasingly complex blood sector. I sincerely thank my clinical colleagues in the health sector who have demonstrated their commitment to and interest in working with me and other NBA staff on a number of important initiatives during the reporting year.
Dr Chris Hogan
Principal Medical Officer
National Blood Authority