Second blood type for electronic XM

[bmarotto]

For those of you doing electronic crossmatch, if you get a patient that does not have a blood type on file and you do a 2nd blood type the same day to qualify the patient for electronic crossmatch, do you charge for the second blood type? Now that we can charge for electronic crossmatches I am thinking there should not be a charge for the 2nd type. We have never charged for it but we are doing file build for a new computer system so I thought I would ask what others are doing.

[Lcsmrz]

We perform a second blood type immediately if no history exists, preferably by a second tech. And we charge for it -- cheaper than the IS crossmatches !!

[John C. Staley]

I'm curious, I assume that when you say "immediately" you mean on the same sample. If this is performed by the same tech, what are you gaining besides a little artificial comfort or simply complying with a requirement for 2 types? I fail to see how this adds any safety which is obviously the goal.

Personally, my feeling is that if it is not a second sample drawn at a different time you gain very little if any added safety. I realize that it is quite a burden to obtain a second sample. We looked into it quite extensively. If you really want to add a significant layer of safety anything short of a second sample from a different draw is of little to no value.

[CABMT]

We require a second type be done by a second technologist to qualify for electronic crossmatch.

[Lcsmrz]

While we prefer a second tech & second sample, neither is always available, esp on the midnight shift and on weekends. When unavoidable, we require everything but the sample be discarded and a completely new setup for retyping, with reID of everything. A vast majority of requests has a second tech perform the retypes, but on the same sample.

And we are a 100% nurse-draw facility. It seems hard enough to get one properly-labeled tube from them! Interestingly, we require a heelstick to confirm the blood type of our NICU babies, yet always give Onegs.

We're not being very consistent, but this is the way our "downtown" flagship facility works ... we're required to follow along.

[rcurrie]

If you think about it, the IS crossmatch is simply another ABO (reverse only, with donor cells as the reagent cells). We allow the same tech who performed the initial ABO to do an IS crossmatch. So, I see no fault with Larry's reasoning to allow the same tech to repeat the ABO/Rh when there is only one tech available, given the constraints in place. We don't allow this at my institution, however. Rather, if only one tech is on duty, they just have to do an ISXM.

BC

[bevydawn]

I agree that doing an IS crossmatch is of no more benefit than the same tech retyping the same tube of blood, but because of the verbage in TRM.40670 "Repeat testing of the same sample may be inadequate unless the sample has been drawn using a mechanical barrier system or digital bedside patient identification system" we require that if there is no previous type, then the patient must have an IS crossmatch until a second specimen can be obtained. We do use a digital bedside patient ID system, but unfortunately, right now, it is impossible to use it 100% of the time. If a second specimen is drawn, then we have a test order code for an additoanl type that won't charge the patient so we do not have to worry about crediting.

[rcurrie]

Doing an IS crossmatch on the same specimen adds no value other than to detect tech error in interpreting the ABO result. That is the only reason for doing the ISXM. It has nothing to do with bedside patient ID. If the blood is not truly from the patient, an ISXM does no good whatsoever. If you are worried about patient ID, then your only recourse if you don't have a patient history or a second draw is to give type O blood.

BC

[bevydawn]

Well, I must say you're preaching to the choir on this topic...I argued with my "people" for months on their so-called logic and according to our current practices, you can see who won that battle. They just cite TRM.40670 as their case for having us do it that way, no matter how pointless it is.

[Julie]

We require a second tech to repeat ABO/Rh in tube (our initial testing is in gel). Lacking the availability of a second tech, we IS or IgG XM group O RBCs.

[Lisa W.]

We require a second draw to confirm with patient's with no history. In emergent cases we allow the nurse or phleb to get a second "witness" to confirm patient ID. However, we have some departments that use this easier way not in emergent cases. Our computer (SoftBank) requires 2 different samples typed to allow electronic crossmatching. Otherwise we have to do an IS XM, which does nothing if the wrong patient was stuck.

[Lisa W.]

If the wrong person is drawn initially, what is the point of an Immediate Spin XM? Still testing the wrong patient! We draw 2 samples if there is no history, or require 2 signatures in emergent cases.

[sgoertzen]

Our policy is that we allow retyping the same specimen as the 2nd typing for only group O's and neonates < 4 mo. (who will get O blood regardless of type).

If the patient is over 4 mo. and is A, or B or AB, a new specimen must be used for the 2nd typing that was collected at a separate time. If they refuse to collect us a 2nd specimen (we are a pediatric hospital), then they get group O blood until a 2nd specimen is obtained. They rarely refuse (unless it is an emergency) since they prefer type specific.

Our computer (MediTech) checks to see if the patient has 2 verified blood typings on file for the patient, a negative Ab screen history, and also a fresh negative Ab screen (< 72 hours old) to trigger the electronic crossmatch. We are currently charging for the 2nd typing, but not for the electronic crossmatch. We may want to rethink that and switch it, since we could charge multiple times for multiple units electronically crossmatched, whereas we can only charge once for the type recheck.