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Segments post-crossmatch


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Curious if anyone has ever heard of retaining the open segment (in a capped tube) post crossmatch. The justification given is to ensure the segment used for crossmatch is the segment used in workup, should a transfusion reaction be suspected. I have only ever pulled an unopened segment (either upon receipt of unit or prior to issue depending on the facility) but never heard of this other option. Please help me! If this in an antiquated process, please explain the origin or if it is of value, help me with some references. Look forward to the dialogue.

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When I worked for NHSBT RCI we kept the cells used for XM in Cellstab (containing preservative) for about a week.

All our serology was performed manually so we had already taken an aliquot of cells which had been washed in saline before making suspensions. (Usually in Dil2 or BioVue's equivalent)

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We keep the opened segment used for the crossmatch instead of pulling segs on receipt or issue of units.  I've done that at other facilities - seemed like just another thing to store and then toss.  When a TRX is called it's easy to pull the sample with the segs used (rubber banded to sample), do the clerical check (match up the segment DIN and the seg # with #'s on the returned bag) and then get a couple more drops out of the seg for testing.   Have never run out of cells and can "confirm" the right seg was used for the crossmatch.  

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I am curious to know if there is a correlation between the number of serological cross matches done and those blood banks that keep opened segments. I can see that for small facilities that do relatively few cross matches with generalist techs it makes sense to keep everything. I also see for large facilities it would take up too much space. I have done both practices (different facilities). 

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Years ago, we kept the segment used for the crossmatch in a covered tube rubber banded to the patient’s specimen.  When we went to the electronic issue, we switched to pulling an extra segment when we received units.  It was bulky keeping the segs with the patient specimens. Plus, we did a lot of add on crossmatches and had to keep all the specimens organized and spaced in case we needed to rubber band more segments to the tube.  It was about 600 beds with a busy OR. In the decades we kept the crossmatched segments, we never found one time where a crossmatched segment did not match a segment from a unit involved in a transfusion reaction.  When we started pulling and keeping an extra segment on receipt, I thought we might miss keeping some segments, but we never had a problem finding a seg for a work-up.  Our specimen refrigerator looked a lot neater and specimens took up less room. You could check your reaction work-ups to see if there has ever been an error found when doing the reaction work-up. If not, you could demonstrate the extra time and supplies involved in keeping the crossmatched segments was not justified. .  

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