Type problems

[bevydawn]

I am just curious how other facilities would have handled this situation which we had just a couple days ago...

A patient presented with what was an apparant cold auto-agglutinin. No matter what we tried we could not get anything to work, including his type. His DAT was also 4+ positive with poly and C3. We finally sent his specimen to our reference lab. They worked him up and were finally able to get a type (B pos) and determine that he had a probable auto anti-I with no underlying alloantibodies. Initially the physician requested 2 units to be transfused so the reference lab crossmatched 2 units of B pos to him and found them compatible using allogenic adsorbed serum. My concern came with our laboratory policy that states if WE are unable to obtain a valid type on a patient we are only to transfuse type O units. When I said this to the tech at the reference lab after learning she had crossmatched B units, she stated that one of the reasons we sent this specimen was to resolve the type issues we were having. I understood what she was saying, but posed the question to our medical director who agreed with me. Luckily the physician decided transfusion was not in this patient's best interest so we never had to go any further with finding compatible units. Would you rely on your reference lab's type? I realize we rely on them for antibody issues, but for me, a type just seems different.

[Seveets]

Before the reference lab came up with a type we would give out O in an emergency but now that you know the true type, I believe we would give out the B pos units that the reference lab had set up.

Curious what the front type of the patient was when you did it.

[Lcsmrz]

If the reference lab tags the Bpos units compatible, I would give them. If not, your SOP reigns.

Our reference lab calls them "screened compatible," but does not tag them as compatible, leaving the decision and the liability to us. We sign them out on the clinician's signature, so he verifies the addition risk.