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Donor re-typing


mrmic
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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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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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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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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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  • 2 weeks later...
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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  • 2 weeks later...
On 6/24/2020 at 7:10 AM, BankerGirl said:

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

And it is a whole lot easier to say. 

By the way, the U stands for Underwood; this is the name of one of the early patients identified with a partial D.

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I work at a blood center and I can tell you that though super rare, mislabeling does happen. Not sub-groups, or variants, but actual wrong blood in the wrong bag situations.  I have only seen a very small number of these and they always involve the most unbelievable, bizarre, "were they TRYING to mess up" situations. These situations usually result in 2 first time donors having their blood drawn into a bag labeled with one number and the tubes labeled another number, now both bags have the wrong blood/label.  First time donors do not have history to catch these discrepancies. I would never suggest the confirmation step at the hospital be removed, especially with electronic XM so prevalent now.  I guess it's been at least 6 or 7 years since we had one of these. 

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4 hours ago, sbraden said:

I work at a blood center and I can tell you that though super rare, mislabeling does happen. Not sub-groups, or variants, but actual wrong blood in the wrong bag situations.  I have only seen a very small number of these and they always involve the most unbelievable, bizarre, "were they TRYING to mess up" situations. These situations usually result in 2 first time donors having their blood drawn into a bag labeled with one number and the tubes labeled another number, now both bags have the wrong blood/label.  First time donors do not have history to catch these discrepancies. I would never suggest the confirmation step at the hospital be removed, especially with electronic XM so prevalent now.  I guess it's been at least 6 or 7 years since we had one of these. 

I've been active in blood banking for a while, and I've seen just a few of these.  Most of the ones I have seen involved two units being swapped.  The first one I remember was an AB unit that was labelled as an O.  The unit had come in as part of a shipment for our neonatal stock;  when we retyped it, we found that it was actually an AB.  

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  • 6 months later...

Wow! Thanks for the responses.  Motivation is always patient care, always. I've worked at both Transfusion Services and Donor Centers. As a staff tech to management.  

There are multiple steps along the process of collecting blood from the donor to infusion of blood to the patient.  Some steps involve human participation.  As humans, we are not perfect.  For the labs, automation and computer software has helped us with specific steps where we may make an error, but not all steps, not yet at least. And we still can't stop a doctor or nurse by-passing protocol and just giving it to the wrong patient however.

As far as I know, blood products are not re-typed at the donor center after they have been labeled at the donor center.  This has been historically done at the transfusion service.  If the unit is not used, sent back to the donor center, re-sent to another hospital, it is normally re-typed again.  Same if it is a transfer from one hospital to another separately owned hospital.

Technologists are the same trustworthiness at every facility as within each facility. So if the red cell unit was re-typed at the Donor Center and labeled as such that it was re-typed, why would the Transfusion Service need to re-typed the unit?  That liability would belong to the Donor Center just like all the tests performed on the donation at the Donor Center.

The costs of the lab tests for donation is not the major factor of the donation charge.  There would be no reason to adjust pricing of the unit if it was a system wide change.  

The clinical significance of the affect of transfusing very weak A&B subgroups does not appear to be a major issue.

The topic was brought up as a "Think outside the box" discussion for this select group of participants.  Not a right or wrong proposal.

Again, thanks for comments and discussion.  

 

 

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