A blood donor clinic at a shopping mall in Calgary in March, 2020. CBS spent nearly two-thirds of its budget on 'plasma protein and related products' last year.Jeff McIntosh/The Canadian Press
Canadian Blood Services is known as the operator of Canada’s blood collection and distribution system outside of Quebec. The government-funded charity runs a network of donation sites where donors roll up their sleeves and it provides the logistics to get life-saving blood transfusions to hospitals across the country.
But its financial statements reveal that it spends most of its money on a service most Canadians aren’t familiar with; buying and dispensing Canada’s supply of pharmaceutical products derived from human plasma.
CBS spent more than $1-billion last year – nearly two-thirds of its budget – on “plasma protein and related products,” which it distributes to hospitals in a pharmacare-like program. That spending was up 10 per cent over the previous year, and double what it spent a decade before.
The rapid growth in demand for these drugs is also behind the expanding Canadian footprint of Spanish pharmaceutical company Grifols, which runs the only network of for-profit, pay-for-plasma collection centres in Canada.
Grifols has recently received attention for the deaths of two people after they visited the company’s locations in Winnipeg. Health Canada says it has not identified a link between the acts of donation and the deaths.
Plasma products are unusual in the pharmaceutical industry, because they are the only large-scale medicines derived directly from the human body.
Plasma is a straw-coloured, protein-rich fluid found in blood that can either be separated from conventional whole blood donations, or donated directly through the use of specialized machines.
When CBS announced an unprecedented partnership with Grifols in 2022 to collect and process plasma, the agency said it was necessary to work with a major commercial partner to meet the constantly growing demand for a product called immunoglobulin (IG).
“The main product that we focus on all the time is immunoglobulin,” CBS chief executive officer Graham Sher said at a public board meeting in December. “It’s not the only one in the formulary, but it is the one that drives the size and the cost of the formulary,” referring to the range of products supplied by CBS.
Of the 317,000 litres of plasma that CBS collected in 2024-25, just 4,000 litres were needed for transfusions. The rest were used for drug manufacturing.
Health Canada reviewing deaths of two people who donated plasma at private centres in Winnipeg
Plasma collected in Canada through Grifols’ 17 collection centres and through CBS’s donation centres are sent by truck to a Grifols’ manufacturing facility in North Carolina. The plasma is converted into a paste through a process called fractionation and the finished products are shipped back to Canada. (Grifols is also using some of the paste derived from its Canadian donations to manufacture a different product called albumin at a plant in Montreal, which the company is exporting to other countries, principally China. Grifols says in public investor documents it hopes to also produce immunoglobulin in Montreal by 2028.)
IG is most commonly given intravenously to patients with immune disorders. The fastest category of new users are those who have acquired immune deficiencies because of another cause, such as cancer patients going through treatment.
According to CBS, as of December, about a third of the IG used in Canada was derived from Canadian donations. Nearly all the rest came from U.S. donors.
Use of IG has gone up globally, but Canada remains one of the highest users of it. CBS projects demand to rise a further 50 per cent over the next five years.
Peter Jaworski, a teaching professor at Georgetown University in Washington and founder of the Georgetown Blood and Plasma Research Group, said aging demographics has a big role to play in demand in high-income countries such as Canada.
“One of the biggest drivers of immunoglobulin use is a good news story, CAR-T cell treatment and other new cancer treatments,” he said. “They make us immunodeficient. And so we replace cancer with immunodeficiency, which is a bargain everyone should take.”
Other jurisdictions have tried to bring more scrutiny to the use of IG.
In Britain, where IG use is a third of Canada’s, the National Health Service has tight guidelines for physicians on appropriate use of the drug, which it has updated as recently as last March. (The country also lifted a long-standing ban on collecting plasma for use in producing IG in 2021.)
Back in Canada, a movement by physicians called Choosing Wisely has been advocating for reducing unnecessary tests and treatments, backed by research.
The group’s hematologists have made 12 recommendations, of which the top three are about reducing use of IG. The recommendations say there is not enough evidence to back up the drug’s use in some cases, can cause unnecessary side effects and costs between $60,000 and $100,000 per patient per year.
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“We recognize this has a big financial impact on our healthcare system,” said Mohammad Rafaei, a hematologist at Niagara Health and the lead of Choosing Wisely.
Dr. Rafaei said the group is looking at doing more research into IG use. Choosing Wisely says its work on more appropriate use of whole blood, which it has done in co-ordination with CBS and Héma-Québec – its counterpart in the province – is saving 17,000 litres of blood and $23-million per year.