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Posts posted by Dansket
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2 hours ago, David Saikin said:
I don't see how that standard answers the question. What I see in AABB standards is 5.14 and 5.14.5 (31st edition): allogeneic transfusion requires at least a current specimen type (if there is a historical record). If red cells are being transfused then an antibody screen is also required. This is identical to the 30th edition.
We only require this once/admission for non-red cell components.
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.
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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.
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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.
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1 hour ago, rosi0017 said:
Besides anecdotal reasoning to obtain a current admission sample, is there a requirement or standard addressing non-cellular products and historical vs current sample requirements prior to transfusion?
See 30th Edition of the AABB standards page 37, 5.15.5. This may have changed in the 31st Edition.
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1 hour ago, Ward_X said:
Do racks even exist that allow units to be laid flat? Without any sort of holder, I feel like they could easily slide off each other, off shelves, and rub condensation onto other labels; overall make it fairly difficult to leaf through.
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.
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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"...
15 hours ago, sgoertzen said:CAP Checklist Requirements:
TRM.30575 Misidentification Risk
The facility has a system to reduce the risk of mistransfusion for non-emergent red cell transfusions.
... (1) Verifying the ABO group of the intended recipient on a second sample collected at a separate ...
TRM.40670 ABO Group and Rh(D) Type Verification
The recipient's ABO group and Rh(D) type has been verified by repeat testing of the same sample, a different sample, or agreement with a historical type in the laboratory's records.
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.
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8 hours ago, srichar3 said:
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.
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).
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On 6/8/2019 at 1:36 AM, Malcolm Needs said:
Sorry, but to my mind, these patients should also be typed twice. Yes, they can be given group O blood (almost always safely), but what if it is a WBIT, and the D typing is wrong because of it, or an antibody is missed because the "real" patient is group O with, say, an anti-K, while the other patient bled is group O, with no antibodies present. In addition, and incredibly rarely, what if the "real" patient is an Oh, while the patient bled is an ordinary group O.
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?
2 hours ago, Malcolm Needs said:As the vast majority of hospitals (and Reference Laboratories) in the UK use column agglutination technology and automation, it is almost impossible to perform a second ABO without either a second D type or wasting a column or more than one column.
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.
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15 hours ago, Malcolm Needs said:
Sorry, but to my mind, these patients should also be typed twice. Yes, they can be given group O blood (almost always safely), but what if it is a WBIT, and the D typing is wrong because of it, or an antibody is missed because the "real" patient is group O with, say, an anti-K, while the other patient bled is group O, with no antibodies present. In addition, and incredibly rarely, what if the "real" patient is an Oh, while the patient bled is an ordinary group O.
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.
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3 hours ago, SMILLER said:
We do not test a different specimen. Currently regulators in the US only require a second ABO test (in order to release "electronic crossmatched" units). We test the same specimen twice, unless we have a previous record.
However, we DO use a BB armband specific for BB specimen draws and transfusions. The phlebotomist applies it and it must be used when ordering, issuing and transfusing blood products.
Scott
Testing the same specimen twice may detect some internal testing errors, but will not detect WBIT (Wrong Blood In Tube).
4 hours ago, Sue Arata said:The hospital is reluctant to require a second specimen to be drawn for fear of lower patient satisfaction scores.
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.
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4 hours ago, SMILLER said:
I think you could define the"test" as an ABO/Rh (or even just ABO). In which case the test's negative QC would include that done for the forward typing. So that CFR 493.1256 (d) (3) (ii) would be satisfied.
Scott
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?
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22 hours ago, applejw said:
If you are in a Massive Transfusion situation and the patient is bleeding so profusely that you run out of available (aka thawed or liquid) ABO compatible plasma - the only available plasma is Group O. You have a specimen and the patient is Group A. What would you do?
There was a prominent trauma surgeon who said, "Patients die from the blood they don't get, not the blood they do get".
- jayinsat, applejw, Malcolm Needs and 2 others
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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.
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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.
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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.
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No, but we do find discrepancies in the computer database that goes back to 1999.
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52 minutes ago, Ensis01 said:
If your patient is negative at IS and positive using IAT what is recorded in the LIS and how do you deal with resulting questions?
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.
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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.
- tkakin, John C. Staley, Patty and 4 others
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48 minutes ago, slsmith said:
We use Ortho Anti-D and their insert says agglutination is interpreted as positive. It also states one drop of
Anti-D is used. But our procedure is add 1 drop of Anti-D and if the reaction is negative we add another drop of Anti-D and if the agglutination is 1+ or less the interpretation is negative. We do not send for genomics testing unless the physician requests, which has happened in the past when the patient had a history of Rh positive from another institution. Never have we been cited from CAP or AABB which are the accreditation agencies we use. Who is HFAP anyway?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.
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16 minutes ago, Ensis01 said:
At the risk of opening a can of worms; who does accredit the accrediting agencies WRT blood bank? It seems the higher up the government system you go the less serology they know (let alone the growing molecular implications) but they must ratify/audit each agency?! If the agencies are therefore effectively self regulatory how do they form agreements within itself, other agencies, define who the experts are, come to agreements and then implement the results?
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.
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5 hours ago, Malcolm Needs said:
Fine, but I would ask, in that case, from where, or from whom, do the accrediting communities gather their information to make their rules, or do they make them up themselves? Surely, they have to listen to the experts in the field, most of whom are the authors on these two papers?
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?
Non cellular component transfusion and historical ABO/Rh
in Transfusion Services
Posted
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.