How long do you hold units in crossmatched status?

[kirkaw]

Greetings,

How long do you hold red cell units in a crossmatched status? For the life of the specimen? For 24 hours? Also, do you crossmatch the same unit on multiple patients?

Thanks!

[tbostock]

It depends: if for an OR case, if their Hgb is stable the next day, or they go home, we take the units down. If the patient has an antibody, we keep the crossmatch up for the life of the specimen, and then put it in a "hold" status until the patient is discharged.

Yes, especially for short dated units, we will crossmatch for multiple patients...first come, first served.

[David Saikin]

Policy for preop xms is to hold til day after surgery.  Will hold rt xm for up to 3 days.

Usually do not do mult xms on a unit.

 

Dave

[BankerGirl]

We do pretty much the same as Terri.  There are only three times we crossmatch units: 1. we have a give order, 2. the pt has an antibody or history, or 3. the OR requests blood in the cooler, usually for CVOR cases.  Love, Love, Love that Electronic Crossmatch, even if the name is a misnomer.

[Malcolm Needs ☆]

We do pretty much the same as Terri.  There are only three times we crossmatch units: 1. we have a give order, 2. the pt has an antibody or history, or 3. the OR requests blood in the cooler, usually for CVOR cases.  Love, Love, Love that Electronic Crossmatch, even if the name is a misnomer.

 

As a professional pedant, I just LOVE that bit about the misnomer BankerGirl!!!!!!!!!!!!!!!!!

[Auntie-D]

Love, Love, Love that Electronic Crossmatch, even if the name is a misnomer.

 

Me too! Although we call it 'electronic issue' and reserve the term 'electronic crossmatch' to units that have been crossmatched on the analyser, rather than manually.

[aafrin]

We usually keep x-matched units for a day further from the day on which it was requested. Rest as Terri, and YES we do x-match units to multiple patients - First in First out (FIFO) to avoid outdate

[Dr. Pepper]

Thanks to CVOABOC (computerized-verification-of-ABO-compatibility), our number of crossmatches has dropped down a lot. We do pretty much like Bankergirl does, and hold them like Dave does. We rarely double crossmatch - but then, we rarely crossmatch ahead of time unless it's serologic.

 

I wonder how comfortable the rest of the medical world would be if they realized what we sometimes do, or don't do, to get that "COMPATIBLE" unit of blood: adsorptions, neutralizations, flat out ignoring positive reactions at IS, or, in most cases, not even getting a test tube wet! Ignorance surely is bliss.

[Auntie-D]

Thanks to CVOABOC (computerized-verification-of-ABO-compatibility)

 

It doesn't really roll off the tongue does it? We just call it Electronic Issue - EI

Edited July 1, 2015 by Auntie-D

[Dr. Pepper]

It doesn't really roll off the tongue does it? We just call it Electronic Issue - EI

 

Kind of stops around the V. I was just being a little silly. We do call it electronic crossmatch, although I teach that it is really CVOABOC.

[mollyredone]

Most of our surgical crossmatches are for ortho, and are rarely used. We still haven't gotten to electronic XM due to other computer upgrades, but we XM long dated units for surgical patients. That way we are not tying up our short-dated when they probably won't be needed anyway.

[BankerGirl]

As a professional pedant, I just LOVE that bit about the misnomer BankerGirl!!!!!!!!!!!!!!!!!

 

I added that just for you, Malcolm, I really did.

[Malcolm Needs ☆]

It worked, and it worked beautifully!!!!!!!!!!!!!          

[SMILLER]

Ahem...

My linguistic research reveals that a "misnomer"  is when a word is used that is "not proper or inappropriate".  Since and electronic crossmatch involves something electronic (the computer system) and a crossmatch (in the sense that the computer performs it, not the tech), then the tem is both proper and appropriate.

 

So the use of the word "misnomer", to describe the electronic crossmatch, is a misnomer.

 

(sorry, could not resist)

 

Scott

[Malcolm Needs ☆]

You should have resisted Scott!

 

The computer selects the units, but in no sense does it perform a crossmatch.  It is, therefore, an electronic issue, not an electronic crossmatch, which, incidentally, remains a MISNOMER!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

               

[SMILLER]

Of course what this means is that my use of the term misnomer for the use of the term misnomer was, itself, a misnomer.

 

Clinical Lab Science is SO confusing!

 

Scott

[Malcolm Needs ☆]

Of course what this means is that my use of the term misnomer for the use of the term misnomer was, itself, a misnomer.

 

Clinical Lab Science is SO confusing!

 

Scott

LOVE IT!!!!!!!!!!!!!!!!!!!!         

[kirkaw]

Back on topic, people! One of the Red Cross medical directors spoke to our transfusion committee and suggested that it is not efficient use of inventory to keep units crossmatched for the entire (72 hour) life of the sample. The idea is that if blood is not going to be transfused, why crossmatch it all? The proper order in this situation would be a type and screen.

 

Agree or disagree? Please tell me why.

[goodchild]

I completely agree.

[Malcolm Needs ☆]

Sorry kirkaw, I agree on both counts.

 

Reasons:

 

1)  I should, by now, have learned not to hijack other peoples' topics.     

 

2)  If the patient is unlikely to require a transfusion, we should go back to the idea of the "group and screen", as proposed by Boral and Henry (Boral LI, Henry JB.  The type and screen:  A safe alternative and supplement in selected surgical procedures.  Transfusion 1977; 17: 163-168.), which was specifically designed to stop the waste of blood being cross-matched when there was little chance that it would actually be transfused; especially with the vast improvements that have been made in the sensitivity of the detection of atypical alloantibodies (although we may well have gone too far in this respect, in as much as I am quite convinced that we are now detecting too many clinically insignificant atypical alloantibodies).  This odes, however, mean that we can provide "safe blood" (if this actually exists) very, very quickly when required, if no atypical alloantibodies are detected, and can provide antigen negative blood (as a standby) for the rare occasions when blood is required for a procedure that does not normally require blood.      

[AMcCord]

We currently hold crossmatched units and double tag like Terri does, however.................our medical director and I have suggested moving to Type and Screen unless a transfusion has been ordered. We are wrapping this into our move into blood management policies and order simplification. We have the support of the CMO and the senior hospitalist so we are hopeful that we'll get to implement it - with active support and pep talks for the medical staff from those gentlemen.

[AuntiS]

I can tell you what we do here...

 

For any preoperative patients, we follow the Maximum Surgical Blood Order list and XM whatever is required (if required or only a GS) for the type of surgery.  We hold them for a maximum of 48 hours - but in reality is usually less time because we take them down the morning after their day of surgery.

 

For any patient with an antibody, we automatically crossmatch 2 units so that there is no delay in providing compatible blood, if needed.

 

I cannot WAIT to go to computer crossmatch (issue?? so that we don't have ANY blood sitting on shelves for patient's with no antibody history!

 

s

[MERRYPATH]

Again I work evening shift...my viewpoint is that most units are returned unused from ORs so I generally release the majority of returned units. If they are antibody units we have a shelf where we keep antigen typed units so unless the patients go to a critical care unit I will release the units. In our system they can quickly be reset up and re tagged based on the current xm if needed. On the days prior to ORs the day staff searches the list of pending OR for people with antibody histories coming for the next day ORs and we give the list to the attending who will let us know if any units should be available...just in case. We used to automatically do 2 units ahead on all antibody patients in OR...actually at one point in my career even if they were IN house. But that went the way of Irradiating all of a few stations RBCs just in case they made a mistake requesting Irradiated units...we don't do that any more either. Someone checks the antigen typed unit shelf to monitor outdates for those units and they go to general inventory at some point. I am personally reluctant to use any outdating antigen typed RBC on the suspicion that as soon as I use the unit I will need the unit...kind of a superstition. If they are outdating imminently I will use them and knock wood.

PatO

Edited July 3, 2015 by MERRYPATH

[John C. Staley]

I agree totally.  Waste of time and resources.

[KatarinaN]

For the topic..

 

We have electronic crossmatch/issue (we call it Type & Screen and we also LOVE it) so we do the serological cross match for patients who have antibodies and are not valid for Type&Screen. We hold the bags for five days - as long as their X is valid and then put them back to our stock. We do not double tag units.

 

Edit: We can have so called zero-orders. But in that case, if patient is antibody positive, we automatically also do two units for the patient.

Edited July 6, 2015 by KatarinaN