Second ABO/Rh tests prior to transfusion

[John C. Staley]

We are considering requiring a second/confirmation ABO/Rh type on patients who have no previous records. We will be requiring a second sample for the testing. My question is for those of you who do something like this. Do you charge for this testing or do you just write it off as a cost of doing business? :?:

Thanks

John

[Melanie]

We do a quick ABO/Rh on the sample that was already tested to verify result and computer entry prior to transfusion. A second sample is not required and we eat the cost of the testing.

[luhubert]

We do just a forward type on the same red cells but make another suspension from the original tube. We record the results in the computer but the test is a "No Charge" test.

This extra typing assures us that the blood banker typing the specimen didn't make a mistake but it doesn't assure us that the blood is from the patient listed on the label.

We do try to have a different person perform the type but when only one person is working, they check themselves.

[Dawn]

We require a second ABO/Rh for all new patients. We use the same tube. Currently we do not bill for this testing. But we are moving to electronic crossmatch and will lose the revenue we previously earned from immediate spin crossmatches. So we will begin to bill for this second ABO/Rh.

[tmaldona]

We require a second speicmen be drawn if there is no history and if the current sample type is not O. We will use a specimen in the lab that was drawn at a different time (ex. CBC drawn earlier in the day). We do not currently charge for the test.

[ChrisH]

We require a 2nd ABO on all patients with no history. We do not require a 2nd sample, but that another tech to the testing (if possible). We also do not charge for the additional testing.

[Myella]

We require a second sample for ABO confirmation if the patient's initial type is other than group O before we can issue blood. It is ordered separately, so I believe the patient is billed for it.

[sandy]

We order & perform at no charge.

[CCard]

It depends on your computer system, and the billing interface. Some systems will allow a second identical ABO/Rh test to be performed on the same accession # but will not bill the second test. Others do not and a second accession # must be created for the same sample, and either permit the billing or not. When considering a future BBIS, one should take this into consideration.

[mtheriault]

We perform a forward typing on samples that are converted from Type and Screen to Crossmatch to confirm blood type. We do not charge for this check.

[Blupo]

There must be 2 ABORh types from different samples on all patients requiring a transfusion. The only exceptions are patient who type as O (+ or -) or if they are in the OR. The blood bank calls the floor for the second sample. We will not accepted 2 samples received in the BB at the same time as 2 separate samples. This policy has been in effect for some time in the largest site and has prevent many errors especially from July to Oct when all the new "kids" arrive.

When we retest the second sample we have the option of having a different name for the test and it does not charge the patient.

[LAESPE]

We require a second sample drawn at different times from the original clot used for type, screen, crossmatch and if there is no ABO/Rh blood type record on file. We also do this in blood types A,B,AB and not the O patients. We dont charge the patient for this.

[radwan1411]

Or blood bank Module BestCare does it like this,, 

The physician will place an order , the order request goes to something called ( Transfusion order screen ) and at the same time system issue a panel of tests for that patient this panel has ( blood group + Antibody Screen + AC+ 2nd sample + X-Match ) once the 1st sample is arrived all the tests will be done to it except for XM & 2ND sample will be left empty ) once the nurse call for preparation or informing that this patient OR is tomorrow the staff always check the result Screen if the X-M TEST + 2ND is empty they as for a second sample once that sample arrive the result of XM + 2ND is updated with the blood Group of the patient ) 

 

2nd sample is like a test placed with the panel and is there only as an evidence of recieving and for tracking and u can monitor time with it and who done like every other test and has no charge code 

[Mr Wayne Govender]

It's standard practice in UK that on first presentation a full group and antibody screen is done. Should blood or products be required it's mandatory that a second sample is taken for the forward group only and antibody screen. NHS patients aren't charged for this but there's a surcharge for privately insured patients.

[Sonya Martinez]

We created a no charge, blood bank only test called ABO2 which contains an ABO and Rh.  We have been trying a long time to get all the surgical clinics to order an ABORh the day they schedule surgery and then have the patient come back 1-3 days prior to the surgery for their type and screen.  However, with COVID and the required testing TAT being no more than 48 hours before surgery and most clinics doing telemedicine this has been problematic.  We do require a second sample, collected at a different time, and we use other specimens collected for other lab testing like CBCs, Coag, etc.  We will perform gel or LISS crossmatches on those patient's without a second type using only type O RBCs and will only use electronic crossmatch if they have 2 ABORh results.  Because we're a children's hospital we also give only type AB plasma containing products if we don't have ABO confirmation (the ABO2).  We still get pushback from surgeons about this but when we can't get AB platelets they will comply.  

[AMcCord]

For patients with no previous history we add a test called ABO/Rh confirm to the patient's order. There is no charge code associated with the test. The test is a tube front and back type. We require either 2 methods (Echo + tube confirm) or 2 techs if the Echo is down. We also use only one specimen. Patient ID is electronic and we issue blood products using a barrier method.

[Darren]

I have a calculation built in Meditech that if the patient has no BB history then it will automatically add a second type to the order. Forward type only. Currently we just run it on the same tube.

[Malcolm Needs ★]

19 minutes ago, Darren said:

I have a calculation built in Meditech that if the patient has no BB history then it will automatically add a second type to the order. Forward type only. Currently we just run it on the same tube.

And if the blood in the tube was taken from the wrong patient?

[exlimey]

16 hours ago, Malcolm Needs said:

And if the blood in the tube was taken from the wrong patient?

Ahhh.....the unanswerable question. My personal favorite: Even if the first and second tubes were collected from different patients, there's still a good chance they'll still match ABO group (~40% group O, ~40% group A, etc.). If one were a gambler, those would be good odds.  But, that being said, I still think two tubes are better than one.

[John C. Staley]

Somebody was sure digging through the archives to find this one!  Glad to see.  This was probably one of my first posts.

To be honest, I don't remember if we ever went with the second type but I imagine we did knowing the corporate QA team at the time.  I do believe that anything short of a second draw is little more than smoke and mirrors to show compliance with some mandate.

Edited May 4 by John C. Staley

[lalamb]

We require another sample of a different collection event, prior to transfusion.

Believe this is in the new AABB standards.

The computer automatically orders a no charge forward and reverse retype, if the pt has "No Hx".

 

We actually found a mislabeled BB specimen, once. Discovered when tech did the rpt on a diff sample and got a diff aborh.....

 

 

[exlimey]

8 hours ago, lalamb said:

Believe this is in the new AABB standards.

If indeed two samples are mandated by standards, AABB or otherwise (I'm not doubting your information, lalamb), it would seem that from some of the responses here, many labs are going to have to re-tool their processes, including building such practices into their computer systems.

[L.C.H.]

we require two types before issuing type-specific blood, and has to be two different samples from two different sticks. we bill for both.  

[AuntiS]

Here in Canada, the same sample can be retested IF the sample was collected using positive patient identification.

So, here in our lab, we are super lucky because we have MLA who perform phlebotomy on 95% of the patients (some are nurse collected in the ED and ICU).  Our MLA use positive patient identification technology (Mobilab).  We allow for the retesting of those samples.  Anyone else needs a new sample - which we order for lab collection, thus avoiding the workarounds where a second sample is drawn at the same time as the first but tucked away until needed.

We also allow the previous ABO to be from another lab.  We have access to blood bank results from area hospitals.  If the blood group from our hospital matches another hospital we don't need the restest.

sandra

[John C. Staley]

51 minutes ago, AuntiS said:

We also allow the previous ABO to be from another lab.  We have access to blood bank results from area hospitals.  If the blood group from our hospital matches another hospital we don't need the restest.

Wow, just wow.  I can't even imagine a blood banker in the US considering this as acceptable.  Our usual assumption has always been, if we didn't do it then it's probably wrong.  Our paranoia runs deep and swift.  Now, before anyone gets too upset with me please know that I was one of you for 35 years so I can play the what if game with the best of you.  I'm just noting what I observed over many years.  If anyone in the US is actually accepting the results from other facilities at face value and acting on them, please let me know, I would love to be wrong.