Issuing Group O To Patients With Unconfirmed Blood Type

[jhaig]

This may have been covered in one of the many threads about obtaining a second blood type on a new specimen, etc. - but - our policy on retypes requires that a second specimen be used if there is one available. If there's not one that has already been drawn in the lab, then a second aliquot of the previously tested specimen is used. I want to change this policy to include only transfusing group O red cells until a second specimen is drawn and the blood type can be confirmed (on patients without a historical blood type already in the computer system). I don't trust either phlebotomy or the nursing staff to draw another specimen to confirm a blood type. I think they would try to draw two specimens at the same time and hold one back. Maybe it's me, but I'm going on past experience.

So - I need some information on switching back to a patient's original blood type after they have received group O cells. Say a B-Pos patient receives 2 units of group O then has another specimen drawn to confirm the B-pos blood type. Is there a time frame for giving the patient B-pos?

We don't have this situation come up very often. Usually a patient getting blood at our facility either has a previous blood type or has a specimen that has been previously drawn over in hematology, and of course we give O-neg. in emergencies. I want to protect patients getting routine transfusions.

[bluetrout]

Exactly when is the second specimen supposed to be collected? Who is going to collect the second specimen if you don't trust the phlebs and nurses? You said you are not talking about emergencies but routine transfusions. If it is not an emergency then why wouldn't you have time to obtain a second specimen?

[John C. Staley]

For adults, when we transfuse type O blood because we don't know the patient's type we will switch to the patient's type immediately upon obtaining the patients type. Why wait?

[Franklyn]

Our practice mirrors Mr. Staleys - but if that patient has an antibody and is a big bleeder we will ween them off the non-antibody tested O units to antigen negative units at a rate determined by blood loss, blood need and availability of the blood. That is a real Zebra, though, and might only happen once every few years.

[csjuarez]

I want to change this policy to include only transfusing group O red cells until a second specimen is drawn and the blood type can be confirmed (on patients without a historical blood type already in the computer system).

I hope that your blood supply is better than mine! Though it's a logical move to use only type O red cells until the patient's type can be confirmed with a second specimen, I know my inventory won't support that.

As far as converting back to the patient's type once the type O units have been transfused, we join the others with doing so as soon as the type is known. However, if the patient is found to be Rh negative and has received emergency issue of Rh positive blood, we will continue to give Rh positive type compatible until the patient is stablilized.

[Mary]

I think we need to be careful with doing following our protocols EVERY time, whatever those may be. I been been involved in several legal litigations and they stressed the "Standard of Care" issue (did this patient receive the same care that all other patients do, etc.) If the blood supply, location of the patient, quality of the veins, age, etc. all start to be "valid" exceptions, I wouldn't want to have to defend what was done, if it didn't follow protocol. If these types of exceptions are written into the policy, I feel that it doesn't treat all patients the same. Maybe I am being too fussy, but I never want to go through a deposition again (and we were not even to blame!)

[dcharland]

We switch to the patients type as soon as we get it. We tried having a second specimen drawn for new patients. And what you said happened to us, nurses were drawing 2 samples and pocketing the second one in case we needed a second blood type. We stopped that process and started using the typenex band system and require just one specimen.

As far as switching the patient if the type is RH neg, if it's a male and is actively bleeding we will keep him on O pos until the crisis stops. After that we will go to Rh negative units for the 1-2 unit at a time transfusions.