Jump to content

Repeat of donor Antigen typing


Byfaith
Go to solution Solved by Ensis01,

Recommended Posts

At my hospital the policy is to double check all antigen negative units, whether found by screening our inventory or ordered from our Reference lab.  This was instituted many years ago after a mix up was discovered.  At the time, there were no bar codes on the units to label tubes with and our computer system was limited.  We would like to drop this policy, with an optional recheck depending on the techs comfort level - say they screened many units for several antigens and were multitasking as well.  Wondering if anyone else does this double check as a routine?  Also, do you recheck units ordered from the Reference lab - does it make a difference if they are antigen typed or historical?

Link to comment
Share on other sites

12 hours ago, Byfaith said:

with an optional recheck depending on the techs comfort level - say they screened many units for several antigens and were multitasking as well.

Lots of users on this Forum are in the same place and I'm sure they have some good advice on how to approach this issue. However, I would be cautious of implementing an optional process that potentially calls into question the quality of previous work.

Link to comment
Share on other sites

We don't recheck antigen typings here in our hospital in Canada. The typings that have been performed at Canadian Blood Services, are embedded in the barcode on the bag, with all negatives printed on the End User Label. Every unit is antigen typed for K so if it isn't printed on the bag the unit is K Pos. Antigen typings we do are all linked to the unit through barcode. The reason of, "We were typing a lot of units and may have mixed them up", is not acceptable in a blood bank setting. Go work in a different department if you can't organize yourself. Anyway, there is also a full gel or whatever you use crossmatch at the end of that phenotyping, as long as the antibody is reacting, an anomaly could be discovered there. You have to have a little faith that people before you are doing their job properly, or you can cause yourself a lot of undue stress.

Edited by NicolePCanada
Link to comment
Share on other sites

We do not recheck ag typing. One and done. If our supplier sends us antigen neg units, they are either typed in the moment by the supplier or labeled as "historically negative" which means the donor has been typed twice by the supplier and will not be typed again. As @NicolePCanada said, you're still going to do the AHG XM, so no need to cause undue stress. Also agree fervently with @exlimey that you should not make something like this optional. 

Link to comment
Share on other sites

It would be highly unusual for hospitals in the UK to retest antigenicity (at least, those supplied by the NHSBT).

Some years ago, one of the Consultant Doctors in the NHSBT (I forget who, to my shame) wrote an open letter to all the hospitals guaranteeing that any blood groups on the bags are correct.  In every case, the bags/donors are typed for ABO, D, C, E, c, e and K at least twice, BUT, on top of that very few of the hospitals, unless they are large teaching hospitals, can afford to keep sufficient CE-marked grouping reagents for all of the common blood groups.  They would certainly not carry antibodies against such antibodies as anti-Vel, anti-Lan, anti-Kpb, anti-Jsb, anti-Fy3, anti-Inb etc, or the genotyping for V-, VS-, etc, so it is a bit of a non-question in a way, because we have a huge admix of ethnicities in and around London, Manchester, Birmingham, etc meaning we see a fair smattering of antibodies against these specificities.

Link to comment
Share on other sites

  • Solution

If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised.

If you receive labeled antigen negative units from your reference lab then believe their process and the label.

Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.

 

Link to comment
Share on other sites

21 hours ago, MAGNUM said:

We do not retype any antigen typings that come from the reference laboratory.

20 hours ago, jshepherd said:

We do not recheck ag typing. 

12 hours ago, Ensis01 said:

then believe their process and the label.

Apologies in advance to the above for using their comments as examples.

Just to stir-up a little controversy.......if we trust our Government-regulated/approved blood suppliers to have quality systems, get the correct answer and label accurately, why are in-coming Red Cell Units re-typed for ABO/Rh ?

And....go......

Link to comment
Share on other sites

We do not perform repeat antigen typing on units sent from the reference lab. If it says historical antigen type, we are OK with that. We enter the extra Ag typing into the computer when we receive the unit.

We do not waste the time and antisera to retype units the techs type here at our BB. If I did that then why not go back and repeat everything else they did. The units would be AHG XM and should catch it if the antigen is showing up. If a tech did mislabel an Ag, they would be written up when it was found for causing patient harm.

We once had a sickle cell frequent flier with an anti-E. Her antibody couldn't be detected after several years. Then she came in a few weeks later with a roaring 4+ ant-E. My first thought was we has mistyped a unit we had given her. After investigating, it seems she went to a wedding out of state and while she was there, she popped into a hospital to get juiced up. She neglected to tell them she had an antibody, even though we give out antibody cards. They didn't see the anti-E so just transfused her. That is the closest we have ever come to thinking we mistyped someone.

I agree with Exlimey about repeating the ABO/Rh. I have worked for over 40 years and not once have I ever had a mistyped unit or even heard about a mistyped unit. I am guessing blood centers probably have multiple people type each unit to prevent labeling with the wrong type. It has always seemed like a waste of time to me. But it is a rule and we follow rules. 

Link to comment
Share on other sites

3 hours ago, exlimey said:

Apologies in advance to the above for using their comments as examples.

Just to stir-up a little controversy.......if we trust our Government-regulated/approved blood suppliers to have quality systems, get the correct answer and label accurately, why are in-coming Red Cell Units re-typed for ABO/Rh ?

And....go......

Exactly!! The answer is because the FDA says we have to..... :( I have never seen a mistyped unit from any blood supplier in 17 years. ABO or ag typing. 

Link to comment
Share on other sites

15 hours ago, Ensis01 said:

Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.

I know that tech!  She left a day blood bank position for a graveyard generalist position so she would not have to use the new automated instrument because if she didn't do the testing it was probably wrong.

:coffeecup:

Link to comment
Share on other sites

5 hours ago, applejw said:

Just last month, we had a unit from our supplier labeled as O+ but retype showed that it was AB+.  I personally don't mind re-typing units so that we can do an electronic crossmatch.

WOW ! Just, wow. I really wasn't expecting to hear this. I can't imagine the multitude of failures involved in such an event. Of course.....if one was mislabeled (or mistyped), there's probably an equally badly mislabeled partner out there somewhere.

Link to comment
Share on other sites

On 12/19/2022 at 7:14 PM, Ensis01 said:

If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised.

If you receive labeled antigen negative units from your reference lab then believe their process and the label.

Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.

 

In our case it would be not totally trusting your own work and asking a second tech to double check with a new segment.

Link to comment
Share on other sites

6 hours ago, Byfaith said:

In our case it would be not totally trusting your own work and asking a second tech to double check with a new segment.

The policy at all places I have worked; to find antigen negative units in our inventory requires testing two different segments sequentially (not parallel). First segment is a screen and second is confirmation. 

Link to comment
Share on other sites

  • 3 weeks later...
On 12/19/2022 at 2:19 PM, Malcolm Needs said:

It would be highly unusual for hospitals in the UK to retest antigenicity (at least, those supplied by the NHSBT).

Some years ago, one of the Consultant Doctors in the NHSBT (I forget who, to my shame) wrote an open letter to all the hospitals guaranteeing that any blood groups on the bags are correct.  In every case, the bags/donors are typed for ABO, D, C, E, c, e and K at least twice, BUT, on top of that very few of the hospitals, unless they are large teaching hospitals, can afford to keep sufficient CE-marked grouping reagents for all of the common blood groups.  They would certainly not carry antibodies against such antibodies as anti-Vel, anti-Lan, anti-Kpb, anti-Jsb, anti-Fy3, anti-Inb etc, or the genotyping for V-, VS-, etc, so it is a bit of a non-question in a way, because we have a huge admix of ethnicities in and around London, Manchester, Birmingham, etc meaning we see a fair smattering of antibodies against these specificities.

I would never trust an AHG XM to always "catch" an incorrectly antigen typed unit.  

Link to comment
Share on other sites

9 hours ago, Toph said:

I would never trust an AHG XM to always "catch" an incorrectly antigen typed unit.  

How do you get hold of the extremely rare antibody specificities I mentioned (such as anti-Vel) to regroup units sent from, possibly, frozen blood banks, that they have typed as Vel Negative before the unit is sent out?

Link to comment
Share on other sites

On 12/20/2022 at 4:36 AM, exlimey said:

Apologies in advance to the above for using their comments as examples.

Just to stir-up a little controversy.......if we trust our Government-regulated/approved blood suppliers to have quality systems, get the correct answer and label accurately, why are in-coming Red Cell Units re-typed for ABO/Rh ?

And....go......

Forty years ago, we occasionally received a mislabeled unit, but I have seen only one since ARC started using more barcodes and related quality practices.  That unit was labeled O neg but retyped as O pos.  We finally had to return the unit to ARC, and they spiked it to test the contents which were O neg.  I think it was early in the Adsol years and we used to get a pedi unit that was CPDA-1 or maybe it had something to do with leukoreduction.  When it was collected, the person making segments was in the habit of cutting off the tubing and discarding it but needed to keep it on the CPDA-1 unit for making segments. He quickly realized his error, fished the discarded tubing out of the waste bin and reattached it to the unit, I think with a clamp.  Of course, he did not grab the tubing from the correct unit.

Link to comment
Share on other sites

13 hours ago, Mabel Adams said:

Forty years ago, we occasionally received a mislabeled unit, but I have seen only one since ARC started using more barcodes and related quality practices.  That unit was labeled O neg but retyped as O pos.  We finally had to return the unit to ARC, and they spiked it to test the contents which were O neg.  I think it was early in the Adsol years and we used to get a pedi unit that was CPDA-1 or maybe it had something to do with leukoreduction.  When it was collected, the person making segments was in the habit of cutting off the tubing and discarding it but needed to keep it on the CPDA-1 unit for making segments. He quickly realized his error, fished the discarded tubing out of the waste bin and reattached it to the unit, I think with a clamp.  Of course, he did not grab the tubing from the correct unit.

Wow. That's bizarre.

The routine retest of incoming materials detected the "transplanted" segments, only because of an Rh difference. If the transplants just happened to be the same ABO/Rh as the host - fairly good odds for an O+ to another O+, for example, it would be undetectable. I wonder how many times that's happened ? No way to know, I suppose.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.