emergency issue blood and electronic crossmatching

[suhu]

Curious as to what other electronic crossmatchers are doing regarding subsequent crossmatching of issued emergency blood (no type and cross at time of issue).

Our procedure is still the same as prior to implementing the electronic crossmatch. We pull segments from the units we issue, and when we receive the subsequent Type and Cross specimen, we perform a serologic crossmatch.

If a subsequent type and cross qualifies the patient for electronic crossmatching, is this really necessary? If I document a review of each issued unit that confirms it as Group O (review of the units' computer records such as the re-type), would it be sufficient to append a comment to each unit, something like "Group O confirmed, qualified for electronic crossmatch"?

[rcurrie]

I believe your procedure is correct. Since the units issued did not qualify for an electronic crossmatch at the time they were issued, then you must perform a serologic crossmatch.

BC

[John C. Staley]

I beg to differ.

At the time of crossmatch they do qualitfy for an electronic crossmatch so that should be acceptable. At that point what would a serologic crossmatch give you that an electronic would not??

:fingerscr

[bmarotto]

I agree with John that nothing is to be gained but I know our computer system (Softbank) interprets the qualification point to be the time of issue, not the time of crossmatch. It turns out not to be an issue for us since we automatically do an IS crossmatch and put the tubes in to incubate when we issue uncrossmatched blood. This is to expedite things should there be an antibody. We would at least know if the issued units were compatible or not and attempt to retrieve any incompatible units.

[Joanne P. Scannell]

I think we are muddying up the waters here.

Electronic crossmatch is, for all intents and purposes, a 'no crossmatch' situation in our minds.

We determine whether we can 'no crossmatch' for various conditions.

1. Rules regarding testing ... eg. no clinically significant antibodies, double ABO/Rh, ... set by the regulatory agencies and hardwired into some of our computer systems.

2. Rules regarding situation ... eg. massive transfusion ... set by the individual institution

The first one is 'easy'.

The second one, as stated in all these emails, varies. So, the techs make the determination 'at the time'. Patient may qualify today but not tomorrow by reason #2.

Following that line of thinking, since the tech is responsible for the determination, he/she allocates the unit and puts 'ND' (=Not Done) in for the test result with the interpretation as 'CMPBT = Compatible by Blood Type'. This way, the records are clear.

[suhu]

JP--your method is what I would like to do, but the concern we have, althogh not logical in terms of electronic crossmatching , is complying with CAP TRM .40770

"Completion of compatiblilty testing for units released uncrossmatched must be documented".

does adding your comment CMPBT" comply with the CAP requirement to complete compatilbity testing on issued emergency units?

[Joanne P. Scannell]

Uncrossmatched vs 'Uncrossmatched' ... same term, different functional meanings ...

1. Uncrossmatched for purposes of Emergency Release ... yes, the physical crossmatch must be done and recorded. So, when we perform that function, we go back and enter the test results. If need be (and I haven't had an inspector ask for this yet), the actual time of all entries by techs can be visualized in the computer system.

2. Uncrossmatched because we are going 'electronic' (eg. CMBT) for the reason we have already issued enough units (ie. massive transfusion policy) or if you are performing 'electronic crossmatches' routinely, no physical crossmatch is ever done ... ergo, it stays CMBT forever.

3. Another use of CMBT is when we have a strong cold agglutinin ... but that's another story!

[John C. Staley]

Again I beg to differ!

Electronic Crossmatch is still a crossmatch. The units are considered just as crossmatch compatible as any units having gone through a serologic crossmatch be it IS or AHG!

If you are routinely utilizing an electronic crossmatch and upon testing an emergency release patient they qualify for an electronic crossmatch then a post release electronic crossmatch of the units emergency released will be acceptable.

[csjuarez]

We also use the electronic crossmatch for units issued by Emergency Release. We pull a segment at the time of issue in case the serological results require serological crossmatching, but if the antibody screen is negative and we've performed the two required types, we will perform the electronic crossmatch just as we would if they hadn't already been issued. I don't see that a serological crossmatch would be required under those circumstances or that it would add any information or safety to the process.

[reidhospbb]

Our process for "proving" compatibility of emergency released units follows the same logic that we use when performing any crossmatch. If it meets the criteria for an electronic crossmatch it is performed and verified as an electronic crossmatch. If it doesn't meet the criteria, we perform a serologic crossmatch. I feel the intent of the regulation is to assure that the unit is completely and thoroughly tested exactly like a normally crossmatched unit would be. They don't want any steps skipped just because the unit is already transfused.

[Joanne P. Scannell]

Again I beg to differ!

Electronic Crossmatch is still a crossmatch. The units are considered just as crossmatch compatible as any units having gone through a serologic crossmatch be it IS or AHG!

If you are routinely utilizing an electronic crossmatch and upon testing an emergency release patient they qualify for an electronic crossmatch then a post release electronic crossmatch of the units emergency released will be acceptable.

Ummm, isn't that what we have all been saying?

[John C. Staley]

Uncrossmatched vs 'Uncrossmatched' ... same term, different functional meanings ...

1. Uncrossmatched for purposes of Emergency Release ... yes, the physical crossmatch must be done and recorded. So, when we perform that function, we go back and enter the test results. If need be (and I haven't had an inspector ask for this yet), the actual time of all entries by techs can be visualized in the computer system.

2. Uncrossmatched because we are going 'electronic' (eg. CMBT) for the reason we have already issued enough units (ie. massive transfusion policy) or if you are performing 'electronic crossmatches' routinely, no physical crossmatch is ever done ... ergo, it stays CMBT forever.

3. Another use of CMBT is when we have a strong cold agglutinin ... but that's another story!

I read this post to mean that you do not consider an electronic crossmatch as a "real" crossmatch. If I misinterpreted I apologize.

[kcayson]

I agree with reidhospbb. If the type and screen qualifies the patient to receive electronic crossmatches, there is no need to perform a serological just because it was emergency released. The only difference is the type and screen was done after the units were already released to the patient. The serological work should be the same as if the crossmatch was done before.

[Joanne P. Scannell]

I agree with reidhospbb. If the type and screen qualifies the patient to receive electronic crossmatches, there is no need to perform a serological just because it was emergency released. The only difference is the type and screen was done after the units were already released to the patient. The serological work should be the same as if the crossmatch was done before.

No one is saying that an 'electronic' crossmatch (for whatever reason) need be converted to a serological/physical crossmatch just because it went out EMR ...

And we are all saying the SAME thing here! ie. If qualifies for 'electronic' ... it stays as is. If it's serological, need to do the serological testing and record those results.

Ok, enough?

[suhu]

thank you everyone for your input.

I do have one more question. If the emergency patient subsequently qualifies for electronic crossmatch, how exactly do you the electronic crossmatches on the already issued units?

Do you bring each of them back into inventory, re-allocate them to the patient, "electronically" crossmatch them, and then re-issue them as clerical reissues or something to that effect? Seems very cumbersome. We are a busy level one trauma center in a depressed city, sometimes issue 10 or more emergency units before we get a specimen.

Can I just add a comment to each unit, like ABO confirmed, if I later perform a computer record check to confirm they are group O?

[John C. Staley]

I would think that how you do this will be dictated mostly by the computer system you use and how creative you can be.

:pcproblem

[Joanne P. Scannell]

As I wrote earlier, if the patient qualifies for 'electronic' crossmatch for whatever reason, we leave the result in the computer as 'CMBT' (Compatible by Blood Type) ... ie. no backpeddling is necessary.

Yes, our comment CMBT qualifies, it IS the interpretationof a crossmatch. We are not on official electronic crossmatches yet BUT we do stop crossmatching after the 12th unit during a trauma.

[JOANBALONE]

In our hospital, it all depends on when and how the units were issued. If units were issued before the patient was entered into the system or before a sample was received in the blood bank we wait until TAS testing is complete, allocate the units, electronic crossmatch them and then back issue them with the time the units actually went out the door. We include a comment such as "xmatch completed after issue" Units issued under a current blood bank sample accession number in which TAS testing is incomplete are issued with the code EREL. After TAS testing is complete and the sample qualifies for electronic crossmatch we then put in a code for the crossmatch result basically saying that the units are compatible, i.e. the tech over rides the electronic crossmatch. Any future units allocated under that accession number will then qualify for electronic crossmatch.

Edited April 6, 2009 by JOANBALONE
spelling error