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If AABB accredited is there a minimum expectation from the AABB as to the Blood Bank topics discussed at the AMR? We have our AMR coming up shortly and are also starting our accreditation process with the AABB. I want to ensure we have covered all bases. Thanks

I am working on implementing a new blood bank system which has a very poor Crossmatch/Blood issue process, I'm looking for some examples to give to our IT department as to how other systems manage this process because I think they think I'm wanting something that is top level functionality when I see it as a basic requirement. Please can you give a brief outline of your LIS Crossmatch/Issue processes for me. Thanks

When you say you have them all listed, do you mean you have them listed as individual product codes, I'e the product description but under one main category heading? or you have a category for each class or product. For example a category for packed RBC's with all the possible product's within this description, then a separate category for apheresis RBC's with all the possible products listed under this category, a seperate category for irradiated RBC's with all the possible products listed under this, then a different category for apeheresis irradiated RBC's and so on so forth, rather than just calling them all PRBC's then listing the individual product descriptions under the one category for PRBC's. If you say the Dr's only see the 4 main category's this implies all PRBC's individual codes are listed together under the one main PRBC category? This is the way I'm used to it been. Thanks

I'm in the process of setting up a new LIS for our lab, the current settings in the system have 100's of component categories for example, Packed Red Cell's, Packed Red Cell's Leuko Depleted, Packed Red Cells Irradiated and so on all as individual categories. In the UK we always used to just used to stick to 4 main categories, PRBC, FFP, CRYO, PLT'S and some times Whole Blood if it was ever used. My issue with having lots of different categories is that all of these are presented to the Dr's at the time of ordering and they are unlikely to understand all the different product categories and know which one they should be selecting etc, so my gut instinct is to stick to the major types of product as the specific product type is in the description anyway defined by product code and there is little benefit to each one having its own category. Just curious what the usual setup is in the US? As we are going for AABB accreditation I want to set it up in a way that they would expect to see it. Thanks

In the past we always used to test the second group with just a forward group but when the requirement for 2 samples came out in 2012 most labs changed to doing two full's groups on the first 2 samples, then forward only on any subsequent samples. 4.3.1. ABO grouping. i. A full ABO group comprises a forward group and a reverse group; the forward group should be performed using monoclonal anti-A and anti-B blood grouping reagents, and the reverse group using A1 and B reagent red cells. ii. A full group must be performed on all samples from first time patients, with the exception of neonates, where the reverse group is unlikely to be helpful, as any ABO antibodies are likely to be maternal in origin. iii. Consideration can be given to omitting the reverse group on subsequent samples, where secure, fully interfaced automation is used and a risk assessment has been undertaken to ensure that the forward group is not compromised. The risk assessment should include the possibility that the first sample may have been taken from the wrong patient, an event estimated to occur at a rate of 1:2000 samples (Dzik et al., 2003; Murphy et al., 2004). iv. The following should apply before consideration is given to omitting the reverse group: • There should be no manual intervention or manual editing of results; • The current cell group must be identical with the historical record; • There must be at least one valid historical record where testing included a reverse group. The historical group should have been performed in a fully automated system, in control of the LIMS or analyser, with nomanual edits; however, further aspects of validity should be locally defined, with consideration given to where and when the group was performed and recorded. v. The risks involved with omitting the reverse group decrease with the number of matching historical records. Where there is only one historical record, the first sample could have been taken from the wrong patient, and a grouping anomaly in the subsequent sample could be overlooked without a reverse group, e.g. mixed field reactions (potentially indicating an ABO incompatible transfusion) are sometimes not detected or are misinterpreted.

I think the point is in an emergency situation where you don't have time to either get the second sample or if you have the second sample and have identified a discrepancy then you should use group O until it is resolved. What other option do you have? If it is not an emergency then of cause a third sample would be required to resolve where the error occurred as well as looking at any other patients on the same ward bled at a similar time to see if there are any other patients involved in the mix up. But I agree with your point that it should be all patients that have a second sample, we required 2 samples regardless of their blood groups.

Current UK guidelines stipulate "Unless secure electronic patient identification systems are in place, a second sample should be requested for confirmation of the ABO group of a first time patient prior to transfusion, where this does not impede the delivery of urgent red cells or other components." As per the recommendation only ABO type is required to be repeated, repeat antibody screen is not required. In any case of urgent blood request group O blood is usually used if the 2nd sample is not available. When this recommendation came in in 2012 it did cause a lot of discussions regarding the increased use of group O blood at the time.

When we did plasma exchange and had a single SAHARA we used to have to start thawing overnight to get it ready in advance, they claim 6 bag capacity but in reality I found it was hard to fit 6 in. One site I worked at that was a major trauma center and did heart and lung transplants and ECMO had 2 for this reason.

I have used the Sarstedt SAHARA III for many years and they are very good, with regards to limitations I am not aware of any as such, they use dry heat to thaw the plasma and I don't ever remember one breaking down in the 3 different labs I have used them in. Maintenance is limited to wiping down the unit every week and cleaning out when you get a burst bag but they have a tray in the bottom to catch any leakage, I would take one any day over any water bath options. My current lab has an Helmer, I find it very slow compared to the SAHARA.

Are BPL still going? I gave up on them in the end, so many supply issues over the years, the only real advantage of BPL over the other suppliers was the fact they did a 250iu then they stopped producing that to concentrate on the 500 and 1500's. Plus the fact it was a lot cheaper than the CSL product.

Worth noting not all preparations can be given IV, it depends on the filtration methods used. One of the main suppliers in the UK (BPL) could only be used IM, Rhophylac by CSL Behring can be administered IV.

http://grifols.com/documents/10192/4198468/brochure-mdmulticard-en/fc571fca-f5e0-4b8c-97de-502b9a75f947

Hi Malcolm I was aiming my comment at blood centers in other countries where PRBC's may be the only option, I don't believe we can order whole blood from our center here in the UAE and reconstituting PRBC's is the only option we have. I wish every blood service was a capable as NHSBT.

I remember when I was in the UK a rep showing me a device they have for such a purpose, would have either been from Immucore or Ortho but cannot say for definite which one. If I remember correctly he said they were aimed at countries that require bedside checking of ABO prior to transfusion so there must be some countries out there where this is a requirement and there is a market for it. The device he showed me looked very much like the Diamed malaria strip test, a Elisa in a clear plastic case that gave bands for the positive reactions.

When investigating grouping errors when antibodies with wide thermal range are present such as Anti-M reacting at RT and 37. What lengths do you go to to confirm the reverse group, for example if the screening cells are incorrectly positive I,e group B forward group reacting in the B cells and confirmed Anti-M reacting at room temp, do you just assume the Anti-M is responsible for the false positive reaction or do you go out of your way to find M negative group B-cells to confirm negative reaction in the back group. I go with the latter but all my staff seem to think I'm mad asking them to confirm this, just interested to see others approaches. Thanks

If you PM me your e-mail address I would be happy to share our SOP with you. We don't wash the red cells though we only remove the supernatant then reconstitute with FFP.

Hi Malcolm, according to the red book whole blood is used in the UK for exchange TX with removal of some plasma to increase the HCT. Is this not the reason why reconstituted PRBC are not been used as the end product is the same? But for labs that don't have access to whole blood reconstitution would be required to remove the additives and correct the HCT.

When performing double exchange is the additive solution and anticoagulants not an issue? Plus removal of any potential residual AB antibodies if using group O unit with non group O patient? This was always my understanding of the justification for reconstituting.

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No you can buy inline filters for post storage leukocyte reduction, our blood supplier does not offer leukocyte reduction of platelets unless they bare apheresis units but they are not always available so we sometimes have to resort to using these filters. https://www.terumobct.com/imugard "MUGARD III-PL for Platelets The IMUGARD III-PL filter is a hard-housing filter designed to remove leukocytes and microaggregates from platelet preparations. Each filter system is equipped with a spike, clamps and tubing. The filter housing material is semitransparent to make monitoring the filtration process easier. Available in lab and bedside versions, the IMUGARD III-PL features a bypass line on the lab version to remove air from the transfer bag. The bedside version features a drip chamber and a roller clamp below the filter to adjust flow to the patient. Filters platelet concentrate for volumes equivalent to platelets produced from six Buffy Coats Offers greater than 90 percent platelet recovery" The efficiency is reported to be not as good as pre storage with these but this is not an option we always have. My issue is currently we are giving the filters to the nurses to do at the bedside which I don't feel is the best option and I would like to bring it into the lab, mainly because of training as its much harder to train all the nurses to do it properly than it is for the lab and of cause the lab can QC the process which would be impossible at the time of administration.

Are there any sites that receive platelets non Leukocyte reduced and then perform the leukocyte reduction on site? If so do you do this in the laboratory prior to issue to the wards, or do you provide the nurses with the filter for them to perform at the bedside? Thanks

But what temp do you consider acceptable for return? what evidence did you use to validate this? If you state it must still be at 1oC to 6oC, you may be throwing units away that are still fit for use. As CAP are asking for a validation then it needs to be evidence based, opting for 1oC to 6oC would be the easy option but I dont want to be throwing away units that we can still use. Are there any standards from AABB regarding this? I have a copy in the post but not sure it will come before our CAP inspection next month. Thanks Steve

But what is the acceptable temperature limit for a 30 minute excursion? If it was in a validated transport box with a logger inside that remained between 1oC and 6oC then it wont be considered to have left cold storage hence the 30 minute rule wouldn't apply. We have transport boxes validated for 8 hours that we send to OR. So that fact that a limit to "30 minutes rule" exists suggests that the unit does not need to be kept at cold storage temperatures, but what would be acceptable? temperature for the unit to reach for 30 minutes? For example UK guidelines state that a unit of PRBC can be used with temperature excursion of up to 10oC for up to 5 hours. Some interesting info in this document for the UKBTS reviewing the evidence of various studies, https://www.transfusionguidelines.org/document-library/documents/change-notifcation-no-33-2016/download-file/Change Notification No 33 2016 - Removal of red cells from a controlled temp.pdf Ramirez-Arcos and colleagues from the Canadian Blood Service reported on two studies using red cells in SAGM. In the first study, a single five hour exposure to room temperature showed no immediately significant effects on the in vitro quality of the red cells, although six days after the exposure ATP and K+ levels were significantly lower than in unexposed controls[22]. In the second study, units were exposed to room temperature for 30 minutes on each of five separate days, and no significant effects on in vitro red cell quality markers were reported[23]. Steve

I have always used total number of outgoing RBC's for that month, used + wasted. The issue with using the number received is that some months you may receive a large quantity for that month but due to expiry they wont expire till the following month where your received stock may be less than the month before hence this will skew the figures giving a higher % waste for this month. Using total outgoing RBC's gives a better indication of the waste against use for each particular month. My previous lab had a stats program built in that was based on MHRA and UK BSMS requirements and this always reported waste as a % of total outgoing RBC's. Steve

Just found this from the BBTS; https://www.bbts.org.uk/downloads/bbts2016/presentations/15.00_wed_qs_3_kate_aplin_bbts_2016.pdf/