Rh-control for AB, Rh-positive patients repeat testing

[NICKJ1]

I have a co-worker that repeatedly has an issue with including an Rh-control (i.e. 6% albumin) with AB,Rh-positive patients once it has been established on two different samples.

My standpoint considering regulatory guidelines and product insert information is that when the ABO/Rh must be re-established on specimens used for transfusion purposes the Rh-control for AB, Rh-positive patients must be included to reflect the current serologial status of the patient. I would appreciate all input on how this testing aspect is perceived at other transfusion services. Thanks, Nick.

Edited May 28, 2008 by NICKJ1
LEFT OUT ENDING

[Lcsmrz]

What does the reagent product insert say, and more importantly, what does your SOP say?

Mine says we run a cell control whenever the patient is ABpos, regardless of how many times it was tested previously.

[rcollins]

Our SOP also says Rh control must be run everytime with AB pos patients. Depending on your computer system, you may be able to set it up so the interp cannot be made without the appropriate result in the Rh control spot.

[John C. Staley]

If we have two documented negative controls on an AB pos patient the control is no longer required.

[Mabel Adams]

We do it every time based on the KISS principle. Then new techs and generalists don't have one more set of exceptions to remember. It is quick, easy and cheap.

Complement him on his higher understanding of serologic principles then tell him to do it anyway just to keep things simple and consistent.

Put that brain to use thinking about something that can make better use of his intelligence! I bet he would be good at making suggestions of ways to improve processes--changes that could be written into SOPs that everyone would follow consistently. Changes that would make more difference to the end product than tilting at this windmill.

Sorry, got going a bit, didn't I?

[LAS]

As do we for the same reason.

[jhaig]

Exactly. Pick your battles and spend your precious energy on something else. We run a control by our SOP and by AABB guidelines. You still want to have a current representation of the patient's serological status. How do you know for sure the patient is not developing CAD or multiple myeloma or something else that could cause autoagglutination?

I've dealt with this situation before where the tech seems to have intimate knowledge about blood banking which doesn't agree with written procedures. Document anything this tech does that goes against your current written policies. Don't make it a witch hunt, but keep a record just in case.