Retesting of Reference Lab Results

[PBryant]

Our current policy states that crossmatches and antigen typing will be repeated on all sendout reference samples if the DAT is negative and "absorbed" serum was not used for original testing. I can possibly understand checking the antigen types but why the crossmatch? Is this a standard practice at blood banks using reference lab services? Is this a liability issue? Why would the reference lab results not be the test of record?

[Likewine99]

At our institution we do not repeat the antigen types on the donor units. Our Reference Lab is AABB, CLIA, CAP accredited and our SOP states that the antigen test is the test of record. The Ref Lab is NOT accredited to do transfusion testing so we do the XM on the units prior to transfusion.

Another reason for not repeating the ag type on the donor unit is cost of reagent and tech time. Most, if not all of our patients receiving antigen neg blood are inpatients and there would not be any additional reimbusement to the hospital if we charged to repeat the antigen test since we are paid at the inpatient DRG rate.

Hope this helps and doesn't confuse.

[OPUS104]

Isn't outside Ag retesting required by JCAHO? I haven't worked in a hosp. in years,,,,, but have been told this is true by some of our hospitals. They have told us if they have the antisera there.... they are required to confirm our Ag testing.

We do not send units to our hospital labeled crossmatched. We actually have a sticker ( big bright red one!) that says uncrossmatched blood on each unit we send out from a work-up. The samples we get are not banded samples. Do you send your banded sample to the ref. lab? What do you use to crossmatch any units if you need more with in 72 hrs? We would never take on the extra liability that the sample went thru (and the unit would return thru) ump-teen hands and end up correct. But we are bigh fat chickens...... different strokes and all that stuff

[Julie]

Having worked in both (Ref. Lab & Transfusion Service), some of the antigen negative red cells provided by the ref lab are based on historical data. Also, we did not return any adsorbed sera to the requesting hospital. The hospital should confirm antigen neg. status (just as with ABO and Rh negative requirements) and if necessary when adsorbed isn't available, transfuse "least incompatible". Document the reference lab results in the patient record.

[PBryant]

At our institution we do not repeat the antigen types on the donor units. Our Reference Lab is AABB, CLIA, CAP accredited and our SOP states that the antigen test is the test of record. The Ref Lab is NOT accredited to do transfusion testing so we do the XM on the units prior to transfusion.

Another reason for not repeating the ag type on the donor unit is cost of reagent and tech time. Most, if not all of our patients receiving antigen neg blood are inpatients and there would not be any additional reimbusement to the hospital if we charged to repeat the antigen test since we are paid at the inpatient DRG rate.

Hope this helps and doesn't confuse.

Yes, very helpful. I had not considered the accreditation aspect.....good point. I think we will probably continue to confirm the antigen type though. Error in antigen typing has been found amoung our own staff and if I recall correctly one of my coworkers stated that they have found an error once in a reference tested unit.

[PBryant]

Isn't outside Ag retesting required by JCAHO? I haven't worked in a hosp. in years,,,,, but have been told this is true by some of our hospitals. They have told us if they have the antisera there.... they are required to confirm our Ag testing.

We do not send units to our hospital labeled crossmatched. We actually have a sticker ( big bright red one!) that says uncrossmatched blood on each unit we send out from a work-up. The samples we get are not banded samples. Do you send your banded sample to the ref. lab? What do you use to crossmatch any units if you need more with in 72 hrs? We would never take on the extra liability that the sample went thru (and the unit would return thru) ump-teen hands and end up correct. But we are bigh fat chickens...... different strokes and all that stuff

We have, in special circumstances, sent the banded sample. We keep a portion of the sample(s) sent for repeat and/or additional xm testing.

[PBryant]

Having worked in both (Ref. Lab & Transfusion Service), some of the antigen negative red cells provided by the ref lab are based on historical data. Also, we did not return any adsorbed sera to the requesting hospital. The hospital should confirm antigen neg. status (just as with ABO and Rh negative requirements) and if necessary when adsorbed isn't available, transfuse "least incompatible". Document the reference lab results in the patient record.

We do not get any of the adsorbed sample returned and so our policy states we do not repeat the xm for DAT positive patients in which adsorbed plasma was used by the reference lab for xm. So sometimes we accept the xm and sometimes we don't. In all cases we confirm ABO,Rh and antigen type (if we have the typing reagent available).

[Eagle Eye]

We confirm antigen typing at our institution if we have antisera.

[John C. Staley]

We do not cofirm the antigen testing coming from our blood supplier. I have never seen a JCAHO requirement for this or any other agency for that matter.

[Sara B]

We are a small hospital and do not retest, since we only carry Anti-D! We send a banded specimen to our reference lab and they perform the crossmatch. We do not repeat their crossmatch, either. As was stated above, they are certified by AABB, FDA, CAP and perform anitbody ids and crossmatches for many small, critical-access hospitals.

I know bloodbank is an area where we recheck and recheck things, but at what point do you stop repeating? I would hope in the instance of incorrect results that a QI report was filed with the reference lab.

[bbbirder]

We confirm when we have the anti-sera. Our blood center usually ships units based on historical typing, not current. If we request, they will do testing.

We do most of our own absorbing, so we always to the XM.

Linda F

[AMcCord]

We reconfirm antigen typing when the units come in for the reasons everyone has listed. We do send a properly ID'd specimen to our reference lab, they won't accept anything that is not properly labeled - good for them, in my opinion. If we send a specimen and request suitable units, the report comes back not as crossmatch compatible (or whatever is appropriate for the circumstance) but as 'pre-selected for compatibility'. A note on the report states that all components must be crossmatched at the transfusing facility, their results do not act as the test of record for the crossmatch, etc, etc.

Since we stock a lot of antisera and usually only send out recently transfused warm autos and oddball/illmannered antibodies, we sometimes send segments of units we have crossmatched and that appear compatible or least incompatible. Once we get the reference report faxed to us, we are usually ready to transfuse without much, if any, additional testing. Most importantly, we don't have to wait for units to ship which reduces the possibility our specimen has expired and speeds up getting the product to the patient. Since we are 150 miles from our blood supplier/reference lab, this can really speed up the process. If the reference lab used adsorbed serum for the compatibility 'screen', we report out our crossmatch as incompatible (which it surely was for us) and release only the least incompatible.

[MARINA]

We are a large cancer treatment hospital. We only send out warms. We do not re-antigen type units. I would be interested in seeing JCAHO requirement to reantigen type units from our reference lab. We did reantigen type units years ago and stopped this practice because of time, cost and redundancy.

[Mary]

We also have the clinican sign a release form for transfusion of blood which is incompatible by "in vitro" testing. Sometimes that changes their mind!

[Sara B]

Our reference center does perform a complete crossmatch, state the units are compatible, and their tech signs a transfusion tag.

Now if we do have units in-house that are compatible, we will send pigtails for antigen testing. If the antigen testing is negative for the identified antibody, the reference lab faxes all of the results. We then tag the unit and include the reference lab results in the patient's records.