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Since this is a accreditation agency group I would like to get an opinion on the requirement of the transfusion service's requirement to re-type the donor units.  I do not know if this has been previously studied or written about in the past.  Just thinking outside the box...

If a donor center were to re-type the unit after the unit had been labeled and the unit tagged as such for the re-typed would the transfusion service be required to re-type the unit?

You can't make an argument that you do not trust the donor center since you do not repeat HIV or etc. testing, and those tests are quite important.

You cannot make an argument that you have found mis-typed units, because, that is the past, not after the proposed change in testing at the donor center; what is that per-cent?

You cannot make an argument that the techs at the transfusion center never make a mistake; what is that per-cent?

You cannot make a financial argument if there was a significant issue with the unit after transfusion the patient would sue everyone anyway.

You can't say because it is a regulation, since those can be changed and that is what this is about.

You can't make the argument that all rbc transfusions are fatal, because they are not.

I might make techs uncomfortable about the change, but techs were uncomfortable when we went to LISS from albumin or physical crossmatch vs electronic crossmatch.

What are your thoughts?

 

 

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My only thought is, "What is the motivation for such a change?"  The retesting will still have to be done and you will pay for it one way or another so what, exactly are you hoping to accomplish??  A little convenience for the transfusion staff?  

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19 hours ago, John C. Staley said:

My only thought is, "What is the motivation for such a change?"  The retesting will still have to be done and you will pay for it one way or another so what, exactly are you hoping to accomplish??  A little convenience for the transfusion staff?  

I think that is the point = remove the requirement for the hospitals to perform the Retyping.  Motivation? I agree that it is a waste of time and resources. 

The labeling facility has already tested the unit and rechecked it how many times?  How many discrepancies have you found in your career?  In over 40 years of mine, I have never seen a discrepancy.  That's not of the units I have personally rechecked, it's of the 100s of thousands of units I have overseen. 

And, please correct me if I'm wrong, I don't think they do this recheck in the hospitals in the UK, maybe all of Europe?  Help me out here with that.  What is their kill rate because of mislabeled units?

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2 hours ago, Joanne P. Scannell said:

And, please correct me if I'm wrong, I don't think they do this recheck in the hospitals in the UK, maybe all of Europe?  Help me out here with that.  What is their kill rate because of mislabeled units?

Certainly the blood supplied by the NHSBT that what is on the label on the outside is GUARANTEED to be what is actually in the bag, and so no retyping is required.  I THINK the same applies in Scotland, Wales and Northern Ireland, although am happy to be corrected.

As all such "kills" would be reported to our regulatory authorities, and published in the annual Serious Hazards of Transfusion (SHOT) Report, I can say for certain that no "kills" have been reported for many, many years!

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We retype the units as they come in because like CSP0102, I have personally found units mislabeled at the blood center, so better safe than sorry I like to say.

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When I was a very young tech, our supervisor had us carry every Rh negative result through "Du" as it was called then.  I also had an O Neg labeled unit test O "Du" positive.

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1 hour ago, BankerGirl said:

When I was a very young tech, our supervisor had us carry every Rh negative result through "Du" as it was called then.  I also had an O Neg labeled unit test O "Du" positive.

There is no such thing as anti-Du.  Therefore, there cannot be blood that is Du positive.

Some individuals who have a normal RHD gene express a weaken D antigen because of the "Ceppellini effect" of having either a RHCE*Ce or a RHCE*CE gene in the trans position (see Ceppellini R, Dunn LC, Turri M.  An interaction between alleles at the Rh locus in man which weakens the reactivity of the Rh0 factor (Du).  Proc nat Acad Sci, Wash 1955; 41: 283-288), but such individuals are still not Du positive.

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It's an interesting idea - one motivated I suspect to provide a more attractive product to the hospital?  But retyping in the hospital also theoretically covers any errors in donor entry into the hospital LIS.  

sandra

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19 hours ago, Malcolm Needs said:

There is no such thing as anti-Du.  Therefore, there cannot be blood that is Du positive.

I realize what you say is correct Malcolm, but that is what my supervisor called it and that is the way it was reported back in then.:P

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During my 40'ish years, we have had 3 discrepancies, all were reportedly group B, but typed as an A subgroup B.

Interestingly, we had one recently.  The Vision called the anti-A reaction negative, but 3 techs called it weakly positive.

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The requirement to perform a donor retype also plays into whether or not the LIS is used for electronic compatibility testing.

AABB 5.16.2.4  The system contains logic to alert the user to discrepancies between the donor ABO group and Rh type on the unit label and those determined by blood group confirmatory tests and to ABO incompatibility between the recipient and the donor unit. *

*FDA Guidance for Industry: Computer Crossmatch"

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On ‎06‎/‎24‎/‎2020 at 9:17 AM, Judes said:

During my 40'ish years, we have had 3 discrepancies, all were reportedly group B, but typed as an A subgroup B.

Interestingly, we had one recently.  The Vision called the anti-A reaction negative, but 3 techs called it weakly positive.

We had one of those decades ago before monoclonals.  Typed a unit as B+.  Transfused to a B patient.  Next time we saw the donor we were trying out monoclonals.  anti-A rx was 2+.  AsubB.  We checked the transfusion on the B patient.  H&H stayed up, no evidence of rbc destruction upon chart review.  My techs were freaking out. 

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I was also thinking about 'why not drop the unit retesting' after all of the donor centers went to computerized donor labeling/retesting and I hadn't seen a labeling error in years (you did use to see a very few go by) and then realized that with so many places going to computerized "compatible unit release" - the retesting done by the receiving facility is the only chance they get to check that the RBCs in the unit do indeed match the label on the bag.  Without, at least, an Immediate Spin crossmatch check of the unit vs. the pt - there would be NO other physical check done if unit retesting was dropped.  So there we go, the inspection agencies will want the unit recheck for forever!  If the UK's figures were studied and accepted by the FDA/CMS/AABB, etc. - we might eventually see a change, but it probably won't be soon.  (my 2 cents :winkrazz:)

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It definitely would be convenient to not have to retype. The whole process of receiving, saving and squeezing  segment is quite time consuming.  I usually do like 4 units per minute before any testing. Our blood bank can go through a hundred units everyday. 

 

We do not retype for licensed antigen typing from blood supplier... It was in discussion with our compliance last week that if a CAP/accredited transfusion service perform the typing, we do not necessary to retype during blood transfer. But those transfusion service had to be in our LIS system.
 

While there have been no ABO discrepancy in all the thousands of unit I retype, there has been quite a few Rh discrepancy over the years. Especially for those weak D donor.

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