Dansket

You are correct. However, in a facility with a very low volume of transfusion <1000 units annually, we elected to standardize the criteria for collection of pretransfusion blood samples, i.e., collecting a blood sample within 3 days of the intended date of transfusion for both red cell and non-red cell transfusions.

My working definition of a current blood sample is a blood sample that was obtained from the patient within 3 days of the intended date of transfusion.

Agreed 5.15.5 is not relevant to rosi0017 post. AABB Standards 30th Edition 5.14, "Pretransfusion tests for allogeneic transfusion shall include ABO group and Rh type. In addition, for Whole Blood, Red Blood Cell, and Granulocyte components, pretransfusion testing for unexpected antibodies to red cell antigens shall be performed." I don't have access to the 31st Edition, is this wording above identical? Components selected for transfusion to a patient, if not labeled Autologous must, by definition, be allogeneic. It seems that the only difference between requirements for non-red cell components and red cell components as stated in 5.14 is that pretransfusion testing for unexpected antibodies (an antibody screen) to red cell antigens is explicitly required for red cell components only. Therefore, pretransfusion testing for ABO and Rh on a current patient blood sample is required for both non-red cell and red cell components.

We use Alba-QC-Chek for Daily and Day of Use QC on ProVue. We put new lot of Alba-QC-Chek into use on Mondays. If inspector asks for evidence of lot to lot comparision, we would show them Sunday's QC test results on old lot of Alba-QC-Chek and Monday's QC test results on new lot of Alba-QC-Chek. It is extremely rare for Daily QC to fail on ProVue.

1. See AABB Standard 5.27 Urgent Requirement for Blood and Blood components, page 43 in the 30th edition. 2. No, if completed type on armbanded sample is not group O, we continue to issue Group O until completion of the 2nd confirmatory type.

See 30th Edition of the AABB standards page 37, 5.15.5. This may have changed in the 31st Edition.

Not at all. Bags lay flat in the drawer (without racks or dividers). It all depends on the number of bags you put in the drawer.

It curious that the CAP requires that the Rh type be verified by repeat testing, but the AABB requires verification of the ABO group only. Also, the two Checklist Requirements appear to contradict each other in that TRM.30575 mentions "...Verifying the ABO group of the intended recipient ..." while TRM.40670 states "The recipient's ABO group and Rh(D) type has ben verified"... Hopefully, the FDA will adopt the more stringent requirements of the CAP or the AABB, so that ABO verification by repeat testing of the recipient will be required of all US hospitals, not just those who are CAP/AABB accredited.

Do the UK guidelines state how the second sample should be tested for ABO? If so, which tests are required? In the US, for the second ABO when Computer Crossmatch is done, the AABB currently requires both red cells and plasma/serum be tested and the CAP does not specify required testing for ABO Confirmation (red cells and plasma/serum, red cells only or plasma/serum only).

You have ignored my question regarding repeat antibody screen on second blood sample in accordance with your statement above, "...or an antibody is missed because the "real" patient is group O with, say, an anti-K …" How would this scenario be detected unless you repeated the antibody screen on the second blood sample, in that in the UK and US, only testing for ABO is required? Gel cards are available in the US that contain only anti-A,B or anti-A and anti-B. These gel cards are used routinely to confirm the ABO type of donor units received by the Transfusion Service. Gel cards containing anti-A,B are used to confirm donor units labeled group O and gel cards containing anti-A and anti-B are used to confirm donor units labeled group A, group B and group AB.

Your post suggests that patients who initially type group O should be tested a second time for not only ABO, but also Rh and Antibody Screen. I assume you would include the same testing (ABO, Rh and Antibody Screen) for non-Group O patients. I disagree. Does anyone (US and UK) in this forum repeat the Antibody screen on the same sample or a newly collected blood sample? Repeat the Rh? The concept of a second ABO typing did not emerge until after the "Computer Crossmatch" became an alternative method (to the serological crossmatch) approved by the FDA in the late 1990’s. Repeat testing of the same sample or a newly collected blood sample for Rh and Antibody screen was not required by the FDA, AABB or the CAP. A second ABO typing is intended to be a serological alternative to the Immediate-spin Crossmatch to confirm the patient's ABO determination when a "Computer Crossmatch" is done. This creates a process that is similar to that done for donor units, i.e., blood type determination by donor center and blood type confirmation by the Transfusion Service. In the absence of a "Computer Crossmatch", a serological Immediate-spin Crossmatch is required to detect ABO incompatibility between donor and recipient and most patients are transfused based on a single ABO determination without any repeat testing for Rh or Antibody Screen.

Testing the same specimen twice may detect some internal testing errors, but will not detect WBIT (Wrong Blood In Tube). You need to gather some data to show how many patients would be impacted by collecting a second blood sample. Ask these questions, "How many patient admits annually?", "How many patient admits required blood bank testing?" (at my facility the calculated percentage was 11%), "How many patient samples type as Group O?" (at my facility the calculated percentage was 55% and we don't draw a second blood sample on these patients), "Of the non-Group O patients, how many had an independently collected blood sample in Hematology that could be used for the second ABO blood sample" (in our facility that was calculated to be 16%). So for every 1000 patients admitted annually, 100 (I'm using 10% for sake of simple calculations) would require blood bank testing of whom 45 (100-55) would be non-group O, 7 (45 x 0.16) would have a blood sample in hematology, leaving 38 (45 - 7) or 3.8% (38/1000) patients requiring a second sample to be collected. Using this kind of data will give you a much better grasp of the impact of routine performance of a second ABO determination on all patients for whom a Type and Screen or a Type and Crossmatch is ordered.

We discontinued storing RBC units upright in holders years ago. You can observe "hemolysis or other changes in appearance" regardless of storage position, flat or upright.

Check with your blood supplier. During transport (up to 8-12 hours), platelets are not agitated.

Does the blood bank armband have a unique identifying number/letter code? If so, require that the person collecting the 2nd sample write the blood bank armband number/letter code on the specimen container label. Then match the code in the blood bank upon receipt of the 2nd sample.