Confirming ABO Type prior to transfusion

[AMcCord]

We've been having a long discussion on a number of threads about what we are doing about ABO confirmation prior to transfusion. I'm having that discussion with our lab manager and we have reached an impasse. He wants to know - in numbers - how the majority are dealing with this problem. I'd like to see a poll to determine what the prevalent method is:

1. Retype the same specimen (same or different tech)?

2. Retype a specimen drawn at a different time specifically for blood bank?

3. Retype a specimen from another lab section that was drawn at a different time - meets blood bank labeling requirements?

4. Retype a specimen from another lab section that was drawn at a different time - has NO specific blood bank labeling requirement?

Thanks in advance for your input!

[Seveets]

If no history we retype the same specimen with a different tech and different reagent (gel and tube). BUT all blood bank patients are identified by two people at the time of draw and both people initial the tube.

[L106]

If no history, we retype the same specimen. Our policy is that the retype may be done by a different tech OR by different methodology (ie: automation and tube.)

We do not require two people to identify the patient at the time of draw.

Donna Brandis Ehler, MT/SBB

[David Saikin]

I guess we are assuming that there is no history on this patient. The CAP standard demands a process by which you are certain that you are transfusing the patient the specimen was obtained from . . . it no longer demands a 2nd type but a validated process.

[jhaig]

I guess we are assuming that there is no history on this patient. The CAP standard demands a process by which you are certain that you are transfusing the patient the specimen was obtained from . . . it no longer demands a 2nd type but a validated process.

I'm a little confused here. CAP standard TRM.30575 clearly states that "documenting the ABO group of the intended recipient on a second sample collected at a separate phlebotomy (including documentation in the institution's historical record)" is one of the options that should be considered when confirming the ABO of a patient without a previous ABO history. Why is CAP no longer demanding a 2nd type?

We draw a separate specimen if the patient has no verified ABO in our computer. If there is a specimen we can use from a previous draw, we will use that. If a redraw can't be obtained before transfusion is needed, then we will give group O until another tube can be drawn.

You can retype a specimen with all of the different reagents, techs, or methods you want, but if it's not the right patient, it's still wrong.

I don't say this to be catty or anything, but this topic continues to give me a staggering headache.

[rrcc1974]

It sounds like CAP is moving away from offering options.

[John C. Staley]

You need one more choice, None of the Above.

We don't do any of them. Our plan is for barcoded armbands and computer interfaces which is currently in the planning and development stages.

[BBK710]

We've been having a long discussion on a number of threads about what we are doing about ABO confirmation prior to transfusion. I'm having that discussion with our lab manager and we have reached an impasse. He wants to know - in numbers - how the majority are dealing with this problem. I'd like to see a poll to determine what the prevalent method is:

1. Retype the same specimen (same or different tech)?

2. Retype a specimen drawn at a different time specifically for blood bank?

3. Retype a specimen from another lab section that was drawn at a different time - meets blood bank labeling requirements?

4. Retype a specimen from another lab section that was drawn at a different time - has NO specific blood bank labeling requirement?

Thanks in advance for your input!

I didn't vote because we use a combination of the above options. If we have a sample in the lab (usually a cbc) labeled to meet blood bank requirements we will use that specimen for confirmation. If there is no specimen we have a sample drawn to confirm the blood type. If none of these are possible we will transfuse with type O until a second sample can be obtained. That doesn't happen often, and usually we have a sample in the lab so redraws are limited.

[David Saikin]

I think that the standard TRM.30575 is no longer being used. I did a CAP inspection 2 weeks ago and it is not in the checklist which CAP sent to me.

[Bill Sinn]

TRM. 30575 was still on the checklist with which we were recently inspected. We were cited as deficient because, while we were doing a 2nd ABO/Rh on a 2nd sample (separate phlebotomy), we did NOT do this for Group O patients. We would transfuse Group O's with group O blood anyway!

In answer to the original survey question ofthis thread, #4, 2nd sample does NOT need to satisfy all blood bank criteria for ID, labeling, ets.

[L106]

Bill is correct. The current CAP Checklist item TRM.30575 has been revised to read as follows:

"Does the facility have a plan to implement a system to reduce the risk of mistransfusion for non-emergent red cell transfusions?"

They go on in their "Comments" note to describe several examples of various things you can do to achieve this. (Currently, this item is a Phase I deficiency.)

Donna Brandis Ehler, MT/SBB

[rrcc1974]

**NEW** 10/31/2006

**REVISED** 09/27/2007

TRM.30575 Phase I N/A YES NO

Does the facility have a plan to implement a system to reduce the risk of mistransfusion for nonemergent

red cell transfusions?

Among options that

might be considered are: (1) Documenting the ABO group of the intended recipient on a second

sample collected at a separate phlebotomy (including documentation in the institution’s historical

record); (2) Utilizing a mechanical barrier system or an electronic identification verification system

that ensures that the patient from whom the pretransfusion specimen was collected is the same patient

who is about to be transfused. The use of a second manual banding system, while currently

acceptable, is probably not as effective as the above two options.

The second manual banding system has worked for us for the 30 years I have been in Transfusion Medicine. When wireless is implemented, we will go that route.

[jhaig]

How about a retyping policy on patients receiving non-red cell products (FFP, Platelets, Rhogam, Cryo)? Is there a need to re-draw patients without a historical blood type if they are receiving any of these products?

[Eoin]

We've been having a long discussion on a number of threads about what we are doing about ABO confirmation prior to transfusion. I'm having that discussion with our lab manager and we have reached an impasse. He wants to know - in numbers - how the majority are dealing with this problem. I'd like to see a poll to determine what the prevalent method is:

1. Retype the same specimen (same or different tech)?

2. Retype a specimen drawn at a different time specifically for blood bank?

3. Retype a specimen from another lab section that was drawn at a different time - meets blood bank labeling requirements?

4. Retype a specimen from another lab section that was drawn at a different time - has NO specific blood bank labeling requirement?

Thanks in advance for your input!

Same sample, but back to the primary tube by a different Scientist.

On call - back to the primary sample, using a different technique AND separated in space and time.

[TJCOOK]

We use a combination of the options. If we have no prior history on the patient we require a second tech to perform a blood type verification on the primary specimen before releasing the patient's blood type. If there are orders for RBCs then we require a second specimen collected at a different time. We always try to get a specimen from the clinical lab, labeled appropriately, instead of having the patient re-stuck. If the blood is needed before completing the patient's blood type on a second specimen we issue group "O" bloods

[stephtu]

We use a second sample collected at a different time to confirm type "no previous records" unless they type as O. If we can not get a second sample before blood is needed, we issue type O. This does not happen often.

[FHFM]

If there is no historical blood type, we confirm ABO/Rh with another specimen in the lab as long as it was drawn at a different time.

[Patty]

We type verify on a second sample if no history. All our lab samples must have 2 identifiers on the label so we feel it meets BB requirements to use a previously drawn CBC sample if available. We also do not require O patients to be verified with a repeat type. Did you challange your deficiency with CAP? I am interested in their response as I do not feel you should have been cited.

Edited June 27, 2008 by Patty
Clerical

[dalene]

We retype a specimen drawn at a different time specifically for blood bank. We receive a lot of mislabeled samples drawn by nursing. We also require the second sample to be drawn by a different nurse.

[Michaele]

When we get a crossmatch order, a blood bank technologist collects a specimen. If there is no prior history on the patient, we repeat the type on that sample.

[cmiller]

We perform retypes on a separate sample if there is no previous history. If a correctly labeled (name/MR#) from a previous sample is available (usually CBC) we will use it as the retype. If not, we recollect. If we can't get a retype before transfusion we transfuse group O rbcs.

We require a "current" ABO/RH for other products (FFP, platelets or cryo), but not a second draw to confirm. (By current we mean duirng the current admission.)

The whole arguement for retyping the same sample (even if by different tech or method) doesn't allow the opportunity to catch the mistake of a mislabeled sample/wrong person drawn. This to mean seems to be the point of greatest risk for their being a mistake. So by redrawing a second sample, or using a separate sample we not only catch mislabeling mistakes but also a mistyping mistake that could be made a tech.

[Philip Thornton]

To Bill Sinn: Cited? I think you should contest that. CAP clearly states that 'Other approaches capable of reducing the risk of mistransfusion may be used.' The intent is to reduce the fatalities due to mis-transfusion from misidentification of the intended recipient. Giving type "O" units to any patient type especially type "O" patients fulfills the above intent. The only way you should have been cited is if your procedure stated that all first time ABO patients would be subject to a second ABO type (which would include type "O" recipients) thus causing a deviation from your stated procedure. Edited June 28, 2008 by Philip Thornton

[mda]

If the patient is new to us, we check type the ABO(forward only) of the patient using the same sample but different Tech and second set of reagents.

[elvallot]

Our phlebotomists use handheld scanners that read barcode on the patients armband. Blood bank requests for type and screen or crossmatch are generated by the computer from patient information on LIS which includes a medical record number that is unique to the patient. These requests also have barcodes that match patient information. In the event that a request does not match a patient the phlebotomist is flagged to a discrepancy. If patient information is correct a sample is drawn. Additonally we assign a BB number that again is unique to this patient. We do not retype the patient before crossmatch. We do compare any historical type to current sample. However in the event that a type and screen is ordered and after testing a crossmatch order is added, whether a new technologist or same technologist is doing the testing, when retrieving the sample the sample must again be matched to request checking all patient information and a retype is then done. This applies to any additional testing on a previously drawn sample. Should a patient type not match historical type then an investion is initiated.

[bpkelly]

We use several methods depending on what is available. If we have historical information, that serves as a second check. If there is a properly labeled specimen in the main lab that was drawn at another time we use that. If neither of those options work, we have a second sample drawn specifically for us. We have been doing this for 3 years and it works like a charm.