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Greetings all - 

We are having an AABB inspection, and a curious question has come up. The inspector is accustomed to KBs being read by blood bank personnel, so any issuance of RhIg (more than the typical vial) is based ona  result coming out of blood bank, and acted on by blood bank.  However, in our lab, KBs are read by heme, and it's now created some confusion around which lab section 'owns' the competencies. Our heme lab uses a slightly different format for competencies (a problem in and of itself, but not the issue at hand), and the inspector is a bit discomfited by this.

I have only worked in two hospitals, and in both, KB was read by heme but actedf on by BB. and this question simply hasnt come up during inspections previously.

so as an informal survey, I am just curious - which lab section reads and results your KBs? 

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During the majority of my professional life, Blood Bank has read the Kleihauer tests.  I have NEVER understood why this should be so.  It was INCREDIBLY rare to come across a case that was not, to all intents and purposes, negative (or certainly required no more than the "typical vial", as you say).  This meant that those working full time in Blood Bank were most UNLIKELY to be competent in accurately counting a minority of cells on a smear under the microscope.

On the other hand, the Haematology Laboratory staff were used to looking at slides to accurately assess, for example, reticulocytes and, come to that, malaria slides.  I always thought, therefore, that their staff would be much more competent at looking at Kleihauer slides (this, of course, was before reticulocyte counts were performed by automation), but I still think that those who are used to performing a particular test should be the ones who actually perform the tests on a routine basis, particularly in these modern times when the "measurement of uncertainty" is such a popular reason to give "a fizzer".

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Sounds to me like an inspector who is "uncomfortable" because it's not how they do it.  I recommend a nod and smile and a comment such as, "We'll look into it."  As long as who is doing it, are trained and competency is documented it should not matter which department is doing it.  To rephrase what Malcolm said, the procedure is more in haematology's wheel house. (It's kind of fun spelling words with more letters than necessary!)

:coffeecup:

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We no longer have L/D but when we did, Heme performed all KB and would enter the patient results in the computer system. We would base our number of RhIG injections based on the result and the package insert.

As far as PT, the BB would get it first and perform the Fetal Screen. We would enter our results on the forms and then give the PT to heme to perform the KB. That way we both performed the portion of the PT we actually did in our departments. Since heme did the majority of the work, the department lead would enter the results into the CAP website. 

I agree with John. Some inspectors think if you don't do it the way they have been doing it,  you are doing it wrong. There are lots of roads to the same destination, but some are better paved.

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KBs are performed in our Hematology Department.  This test is not uncommon as it is run for more reasons than just to figure out RhIG dosage.  I believe, because of this and their more acute training/experience in microscopy, this is the best place for this test to be done.

Competency for KB belongs to the section who is performing the test no matter what anyone else uses those results for.

The only 'competency' determination that I believe is necessary for the Blood Bank is to assure that the BB Tech who is processing RhIG orders knows how to acquire the KB result and how to calculate the dosage using that result.

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In our hospital, KBs are performed in the haematology department. If positive, the amount of mls bleed is calculated and documented. The RhIG is then given out by pharmacy based on the package insert information and after discussion with the doctor. Would an AABB inspector even look at this process in our hospital as Blood Bank is not involved at all?

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I'm so jealous - all these labs where the KB is performed in hematology!  Here ours are done in the BB.  To be fair, we are a core lab, so the staff performing the test are the same.  I would just rather not own the test and all the competency that comes with it :D

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On 5/20/2021 at 10:45 AM, Kelly Guenthner said:

We share the CAP proficiency kit; BB takes ownership of monitoring/submitting (because we're bossy like that :P)

If you're sharing the CAP PT, I presume you are under the same CLIA number?  Our BB has its own CLIA, sharing for us is a no no.

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The hematology department does the KB. There is a built in table when the KB is resulted that states how many vials of rhogam is indicated, which is doted out by pharmacy. Only BB involvement is if they did a fetal screen which turns out positive they give hematology the sample, the KB is automatically reflexed based on a positive result.

Hem and BB share the PT testing. The leads work together on who is assign the samples , review the results and submit to CAP. The only "trouble" we ever got in was on what medical director signed the attestation form. The site medical director was signing it but according to CAP it should of been the BB medical director.  Not an issue anymore as now it is the same person.

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Our KB test is considered a Miscellaneous Hematology test and we have designated readers who perform the CAP surveys to prove competency since we get so few of them. Some of the techs are generalists who float into the blood bank and some are Heme techs. As long as your SOP spells out whose responsibility it is to read the slides, the department should not matter. Competency is required though.

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The inspector should not be uncomfortable w the way you are doing it.  It is perfectly acceptable to have KB done in Heme and RhIg distributed by Blood Bank.  If for some reason you get cited -it is also acceptable to rebut.  I would just say that this is the way it is done.  There is no standard that says the BB has to perform or read KBs, just that there has to be a mechanism to determine the dose of RhIg.  Would the inspector have a problem if you numerated using flow?  That's not usually done in BB either. Never be afraid to stand up for your operation.  There are inspectors/assessors who should not be performing those tasks.  Worse case scenario is that you would have to comply. 
 

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thanks for all the responses! looks like most folks, like us, have the KBs read in hematology. And the inspector was OK with it; i think he'd just been looking at our BB personnel competency forms, but when he asked for the KB staff competencies he didnt like the (slightly different) format that our heme dept uses. He was a very seasoned inspector, so when he said BB, not heme, most often reads KBs, I just got curious if our institution is really an outlier in that respect. Seems not!! thanks!

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