2ND TYPE FOR O PTS IN ELECTRONIC XM

[mollyredone]

I thought I had read on the forum somewhere that patients that type O with the first type don't need a second type for electronic crossmatch.  Is this true?  I don't know if I can override that in Meditech.  Or do you need to do an IS XM?  I know that if you don't have a 2nd type on other blood types, you can do an IS XM and give O blood.  I want to make sure I am getting everything set up for going live with EXM.  We have the EXM attached to the IS XM in Meditech.

Thanks in advance.

[Dansket]

46 minutes ago, mollyredone said:

I thought I had read on the forum somewhere that patients that type O with the first type don't need a second type for electronic crossmatch.  Is this true?  I don't know if I can override that in Meditech.  Or do you need to do an IS XM?  I know that if you don't have a 2nd type on other blood types, you can do an IS XM and give O blood.  

Electronic crossmatch requires 2 ABO types on file regardless of the initial ABO typing. Patients who don't qualify for the electronic crossmatch may be serologically crossmatched with ABO identical or ABO compatible RBC's regardless of the initial ABO typing.

Meditech will prompt you that patient does not qualify for electronic crossmatch if no second ABO on file. I am not aware that you can override this requirement in Meditech regardless the patient's initial ABO typing.

 

[mollyredone]

I think I was getting that confused with the general idea of having two separate types on a patient, but needing just one on O types.  I tried it in test for EXM and it definitely won't let you override that!

Thanks Dansket!

[Carrie Easley]

Not sure about Meditech, but SoftBank requires it on all types.  It reflexes the ISXM if needed.  We have a hard stop that will only allow issue of O packed cells if only one type one record.  

[Mabel Adams]

2 types are always required for EXM although one can be historic.  We require a 2nd specimen for non O patients but allow a repeat type of the same specimen if the initial type is group O. This is our policy, not EXM requirements. These different blood types have different codes in our computer so they don't bill.  The 2nd type that we do on group O patients lives only in the BB system, not the lab system. The one in the lab system creates an order for the phleb to draw a second specimen if we can't find one in the lab already. Of course, Meditech doesn't really have separate tests that can live only in BB as I recall.

[SMILLER]

Someone remind me why, if an initial typing is O, that it is thought to be unnecessary to retype with another specimen (for facilities who normally would draw another specimen for the re-type).

 

Thanks, Scott

[mcgouc]

You would only be giving group O cells. Of course, you could give the incorrect plasma type if only one ABO.  Since I had so many generalists rotating through Blood Bank, we just kept the same policy of requiring a second sample for the second ABO for all patients. 

[Dansket]

17 hours ago, SMILLER said:

Someone remind me why, if an initial typing is O, that it is thought to be unnecessary to retype with another specimen (for facilities who normally would draw another specimen for the re-type).

 

Thanks, Scott

It depends.  If your goal is accuracy in ABO typing then draw a second specimen.  If your goal is patient safety, then it isn't necessary to type a second specimen because you routinely will select group O donor units and they will always be compatible. At my facility, 55% of patients with no previous ABO on file type as group O. 

[tcoyle]

FDA Guidance for Computer Crossmatch states you should either perform or maintain a record of a second test, confirming the recipients ABO/Rh.  Please see page 8. 

AABB standard 5.16.2.2 (30th edition) states that two determinations of the recipients ABO group...one on a current sample and the second by one of the following methods...

FDAEXM_Guidance.pdf

[mollyredone]

On 1/12/2017 at 6:23 AM, tcoyle said:

 

FDA Guidance for Computer Crossmatch states you should either perform or maintain a record of a second test, confirming the recipients ABO/Rh.  Please see page 8. 

AABB standard 5.16.2.2 (30th edition) states that two determinations of the recipients ABO group...one on a current sample and the second by one of the following methods...

FDAEXM_Guidance.pdf

 

Terri,  I realized my confusion right after I posted it.  I have the FDA guidance as well as the AABB one.  We are getting closer to going live!

[lmunger]

We are considering implementing computer XMs with our new Cerner Blood Bank system. I am under the impression that the retype for an electronic crossmatch must include a backtype retype? We currently don't perform backtype testing on any of  our patient retypes, which are performed in tube.

[Dansket]

2 hours ago, lmunger said:

We are considering implementing computer XMs with our new Cerner Blood Bank system. I am under the impression that the retype for an electronic crossmatch must include a backtype retype? We currently don't perform backtype testing on any of  our patient retypes, which are performed in tube.

Yes, if you are AABB accredited, then you must do an ABO determination (as defined in 5.14.1) on the initial blood sample and an ABO determination (as defined in 5.14.1) on the 'retype specimen'.  FDA, CAP and other accrediting agencies do not prescribe how the 'retype' must be done.

[SMILLER]

Right.  You could just retype the same specimen, then.

Scott

[gagpinks]

In UK now we have 2 sample policy. If you don't have 2 valid sample give O Red cell and AB plasma and A neg platelet until second sample is available. We don't retype same sample just in case ,it is Wrong blood in  tube. Same criteria for EXM: 2 valid sample processed on analyser (both forward and reverse grouping )without manual editing  with negative antibody screen. 

[Maureen]

Before we implemented electronic crossmatch we changed our retype protocol. We perform a full front and back type when we perform a patient Retype.