Leaderboard

My greatest apology for leaving you all hanging. We've been so incredibly busy and short-staffed that I could not even think about anything else but trying to finish up my daily duties. Anyway, seems that the patient also had an impella device that had to be "adjusted" and I believe that corrected the hemolysis. I'm only reading the responses today (2 weeks later)☹️so hats off to you all who thought mechanical causes. I would have not thought that the device would be that far-off to cause the gross hemolysis we saw. We do see slight hemolysis with impella devices but not like this one. I guess never say never. Thank you all for your responses.

Your policy (to draw and test your own specimen) is the strictest interpretation of the standards (and one that most blood banks likely follow), but I do believe you'll find systems that share MRNs, share LIS, share policy & procedure (may even share technical staff) that will use pretransfusion results performed in blood bank A to transfuse the patient at location B by technical staff in blood bank B and are doing so within AABB and CAP standards. All that is to say, I don't think you'll find a standard that explicitly says you have to draw and test your own specimen at your own physical location. We come to that conclusion because of all the other standards.

Definitely!

I actually didn't have to google the answer for this one! I knew that Landsteiner discovered ABO typing at the beginning of the 20th century :)

In our facilities, it also has to do with the Cost Center. Even if they transfer with the same MRN/FIN, our "Mother" hospital cuts off the band and repeats testing.

(Slightly paraphrased from the Guidance to the 34th Edition of AABB Standards for Blood Banks and Transfusion Services) AABB Standard 5.14.8 requires that there be 2 determinations of a recipients ABO group..... the first determination must be on a current sample and the second determination may be determined by one of the following methods: 1) comparison with previous records 2) testing a second sample collected at a time different from the first sample 3) retesting the same sample if the patient identification was verified at the time of sample collection using an electronic identification system. CAP standards (12/2024) Changes to Standards clarifies the requirement even further: "In the transfusion medicine checklist, TRM.40300 Historical Record Check says ABO, Rh, and antibody screen test results must be compared with results of the same tests recorded previously to detect discrepancies and identify patients requiring specially selected units. “New language was added to this existing requirement to clarify what is acceptable ABO and Rh historical records,” says Matthew Karafin, MD, MS, chair of the CAP Transfusion, Apheresis, and Cellular Therapy Committee and clinical professor of transfusion medicine services at the University of North Carolina at Chapel Hill. The revised requirement now says the acceptable ABO and Rh historical records for transfusion purposes are only those generated or entered by laboratory personnel into the health system’s laboratory information system and performed by an accredited lab or certified by the relevant government agency in its jurisdiction. “We learned that assessors have encountered facilities that were using blood types from other institutions, such as from Epic Care Everywhere,” Dr. Karafin says. “Moreover, we were made aware that blood typing information from these other institutions was sometimes being added by non-blood bank personnel, so we had concerns about the reliability of this information.” For patient safety, the CAP wants to ensure that the ABO and Rh used for transfusion are the ones that laboratory personnel have entered into an LIS. This “implies that a transfusion service reviewed the information and was responsible for its data entry,” Dr. Karafin says."

I don't think there is a requirement to share between hospitals, only that a search of previous records was performed for ABO/Rh and antibody screen. The lab needs to define how they will perform the search. The reasoning that labs use 2 types is a. to limit mistransfusion events and b. to use electronic crossmatch. You don't need 2 types is you aren't using electronic crossmatch and if you use other ways to reduce mistransfusion risks- you can always use immediate spin to allocate type specific blood. To use a type from another hospital, personally, I would want the testing/results to show up in my LIS automatically, and know that my lab and the other lab follow the same policies for patient ID, labeling, testing, etc. TRM.40300 Historical Record Check TRM.40670 ABO Group and Rh(D) Type Verification TRM.30550 Misidentification and Mistransfusion Risk Monitoring TRM.30575 Mistransfusion Risk Reduction

I think this is the key: Is initial testing at that ED is under one patient identifier/armband and the testing at your facility under a completely different patient identifier/armband? It's less about the testing, more about the patient identification. From CAP: TRM.40230 Specimen Labeling for Pretransfusion Testing Phase II All blood samples used for pretransfusion testing are labeled at the time of specimen collection in the presence of the patient with: 1. Patient's first and last name 2. Unique identification number 3. Date of collection 4. A method to identify the individual collecting the specimen. NOTE: Blood specimens collected for pretransfusion testing must be positively and completely identified and labeled before leaving the patient. Acceptable practices for positive identification of patient and blood specimen labels must be defined in the procedure manual and may include visual inspection and/or an electronic system to read the identifying information contained in bar codes or radio-frequency identification (RFID) microchips or the patient's wristband. Acceptable practices for generating specimen labels must be defined in the procedure manual (refer to GEN.40490) and may include electronic devices utilizing information encoded in bar codes or RFID microchips. There must be a dependable method to identify the individual who collected the blood specimen, such as initials or another identifier on the tube, or an electronic record. Evidence of Compliance ✓ Properly labeled blood specimens AND ✓ Records identifying the individual collecting pretransfusion testing specimens

We have seen this phenomenon from time to time, albeit rarely. We use R1wR1 red cells with all of our antibody identifications, purely because it is always cell 1 in the panel! We also, however, use two R1R1 panel cells and an r'r panel cell. I'm not too sure why we get the odd sample that reacts like that, because the C antigen on the R1wR1 panel cell is not that much weaker than the C antigen on the R1R1 panel cells, and certainly no weaker than that on the r'r panel cells. Remember that the "w" of "Cw" stands for "Willis", and not "weak", as it was named after the donor who caused the immunisation to the antigen in the first example of anti-Cw described (something I forgot a few years back in an article I wrote, much to my embarrassment, if that is any solace to you) and that RH8 (RHCw) is allelic to both RH9 (RHCx) and RH51 (MAR), and not to either RH2 (RHC) or RH4 (RHc). Therefore, any weakening must be due to steric hinderance, or something similar. :confuse::confuse: