Dansket

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.

Are you saying that because the ABO Determination test is self-validating, that those test results can also be interpreted as ‘negative’ QC for the reagent red blood cells and the reagent antisera? Extending that logic, then why can’t those same test results also be interpreted as Positive QC for both sets of reagents! Please help me to understand. Is there any precedent in laboratory medicine for a test to be considered self-qc'ing (I know this isn't a valid word) and therefore not requiring separate positive and negative controls?

There was a prominent trauma surgeon who said, "Patients die from the blood they don't get, not the blood they do get".

Could the Daily/Day of Use QC for the ABO Plasma Grouping Cells ( A1 and B ) be considered a positive and negative control for the saline crossmatch? In both cases these tests use patient serum/plasma added to donor red cells, the only difference being that the ABO Plasma Grouping cells are stored in solution designed to maintain agglutinability while the donor cells are stored in a solution designed to maintain oxygen transport.

Nursing is required to call Blood Bank and also to order Request to Investigate Suspected Adverse Reaction to Blood Transfusion in their computer. The computer request is sent to Meditech (Lab and BB computer) to order Transfusion Reaction Investigation. Blood sample is collected ( and blood container with Transfusion form) and routed to BB for DAT and Visual Inspection. Clerical Check is done comparing information on blood container label, transfusion form and pretransfusion blood sample for any discrepancies. This process is documented as the STAT Investigation. An EXTENDED Investigation (repeat Type and Screen, Crossmatch, chemistries, etc.) is done only if clerical discrepancies, serological discrepancies or Visual Inspection are noted.

The discrepancies found (typically Type and Screen requests) are not necessarily newborns but are usually adults who were reported to be Rh Negative or Rh Positive (years ago) who currently test differently. We will request a second independent venipuncture, test that blood sample accordingly to resolve the discrepancy, and report the results with comments as appropriate.

No, but we do find discrepancies in the computer database that goes back to 1999.

If the newborn rbcs are agglutinated in the Weak D test and are unagglutinated in the Weak D Control test, our computer interprets and reports these test results as Rh Positive.

We report the newborn to be Rh Indeterminate, with a comment that the newborn is treated as if Rh Positive for purposes of determining the mother's RhIg candidacy. Additionally, the newborn may be tested in 4-6 months to determine the baby's true Rh type.

Which scientific paper(s) does your SOP cite to support your practice of adding a second drop of anti-D to a negative (no agglutination) Anti-D test? Which scientific paper(s) does your SOP cite so support your practice of interpreting 1+ agglutination in the Anti-D test as Rh Negative? HFAP in the Healthcare Facility Accreditation Program that has the same deemed status with CMMS as does Joint Commission.

I believe the FDA is the ultimate authority in the US. CAP, HFAP, Joint Commission and State regulators all act as surrogates for the FDA and are subservient to them.

Please read the following from CAP (US accreditation program) announcing 2018 revisions to the Transfusion Medicine Checklist, "Also clarified in the 2018 checklist is that the use of molecular-based screening assays alone for ABO and Rh(D) blood type assignment is unacceptable for transfusion or transplantation. “We still do not know completely everything about ABO and Rh molecular typing,” Dr. Gandhi says, which is why TRM.40550, “Forward/Reverse Typing,” now says an FDA-cleared or -approved serological method must be used. ABO/Rh typing for transplant or transfusion has to be done “by an FDA-approved method, and right now that’s only serology,” Dr. Gandhi says. “We use molecular-based testing for a lot of blood bank phenotyping now,” Dr. Park says, “but it is not acceptable and it’s just not the right testing and methodology for ABO and Rh.” ABO and Rh typing by molecular methods is complicated and not without risk, she says, adding, “Serology is very simple, so go with the simple one that works well.” So, again I ask US Blood Bankers, "How do you justify interpreting the presence of agglutination in the Anti-D test as Rh Negative?" Which scientific articles do you cite in your SOP?