Dansket

We are using Meditech C/S version 5.64. Currently, we test the uncentrifuged blood sample with anti-A,B on receipt for patients with no ABO/Rh on file. Our Type and Screen (a G-type test) includes a T-type test for entering the result of the anti-A,B serological tube test and BT (a B type test) for ABO/Rh interpretion. A test CONFIRM is configured in Meditech to include results entry for anti-A, anti-B, anti-D and BTU (a B-type test) for the ABO/Rh interpretation. Based on the result entered for the anti-A,B test, either the test CONFIRMO or the test CONFIRM is automatically reflexed when the result is saved and filed. The test CONFIRM is ordered on a new specimen (second venipuncture) to be collected from the patient. That second blood sample is tested with an A/B/D gel card (anti-A, anti-B and anti-D). The results are entered in Meditech and serve as the second ABO/Rh blood type on the patient, satisfying the Meditech requirements for the computer crossmatch. So we have two B-Type tests in our Meditech system, BT and BTU. BTU is also used for donor unit ABO/Rh confirmation tests.

Plain saline has nothing for the red cells to feed on. See page 874-875 of the 16ed of the AABB Technical Manual under heading Method 1-6. Preparing a 3% Red Cell Suspension. See note at the bottom left of page 875.

I agree with David, but a bit more stringent. Red cells stored in saline at 4C are good for 24 hours maximum.

Use your crossmatch data for past 12-48 months to make your case. How many patients with a negative antibody screen had incompatible crossmatches? Due to unexpected antibody? Due to ABO incompatibility?

There are no standards that I'm aware of that would address your issue. Your decision is driven by your internal policies and procedures. In our case, if a patient is known to qualifiy for electronic crossmatch we don't need or physically handle the specimen, just add the order to the existing current Type and Screen in the computer and crossmatch away!

In this scenario, RN has arrived in Blood Bank with a properly-completed MD-signed facility request form for uncrossmatched red blood cells. User keys patient identifier into your transfusion services computer system and displays the patient demographics onscreen. User notices that the patient has a history of clinically significant antibody. At this point, what is your facility’s policy/procedure/practice/response to receipt of a valid request signed by a physician for uncrossmatched red blood cells for a patient with a history of clinically significant antibody?