Pre-Op Type/Screens and Crossmatches

[rjjosvai]

Would like some direction from other facilities around the county as to how long you before surgery you collect - perform and set up units on Out patient surgery patients? In our local are it varies from 72 hours to three weeks at different hospitals. This is for a patient who have not been trasnfused in last three months, been pregnant and with a history on no antibodies.

[Mary**]

Ours are drawn up to a week ahead of time, but we don't do the testing until 2 days before surgery.

[clmergen]

We draw up to 14 days ahead. We do the Type and Screens same day as draw but set up the crossmatches the day before surgery.

[KKidd]

We collect samples up to 7 days prior to surgery and generally test the day before. One thing you want to consider, what does the product insert for your anti-sera say regarding the appropriate specimen. THa could influence when you test.

[jlemmons]

We draw and test the specimens up to six days prior to surgery. Our biggest problem has been the armbands. We have our pre-op surgery people call us the day of surgery to verify that the armband that they are putting on the patient (It was placed with the paperwork on the day of draw) is the same and the one we have on our units and paperwork. This seems to work well and we don't seem to have any problems. Of course, if they have been transfused in the last three months or are pregnant, this procedure doesn't work so we must only draw 3 days prior.

[Brenda K Hutson]

We will draw up to 10 days ahead of time, but will actually extend it to 3 days past the intended use date (not to exceed 10 days). We figure the most likely date of transfusion will be the date of surgery (or intended use date) so this is in staying with the requirement to test for antibodies every 3 days (on patients being transfused). Otherwise, we would have to keep track of exactly what day they do get the first transfusion, then decide how long we can extend the specimen; too much work and rarely necessary.

I worked another place that extended 30 days. I have a couple of issues with that. First, the Type and Screen was not always done when the specimen arrived (and per Manufacturer's Inserts, there are definitely guidelines for the age of the specimen for various testing). They did electronic crossmatch so that was not a concern, but one thing I do think about where I work, is the fact that while we do the Type and Screen on the day of draw, we may not perform the crossmatch until the day before surgery; I have to admit I have had some reservations about using a specimen that may be 6, 7, 8 days old to perform a crossmatch.

Brenda

[David Saikin]

How do you folks that delay testing for more than 3 days pass inspection?

[tbostock]

How do you folks that delay testing for more than 3 days pass inspection?

Not to mention the practical: if the patient has multiple antibodies, wouldn't you want to know that ASAP instead of the day before surgery?

[Brenda K Hutson]

We don't delay the Type and Screen aspect; only the crossmatch at times if surgery is several days away (rather than tie up our blood). Not sure about places that do delay. To me, the primary issue of waiting to do the testing would be not meeting the instructions of the Manufacturer's Inserts. In addition, yes, you would certainly want to know "sooner rather than later" if a patient has antibodies. From a regulatory standpoint, since you are only extending specimens on patients who have not been pregnant and/or transfused in the past 3 months, you are performing the screen prior to surgery and wouldn't expect any new antibodies between that time and surgery. However, I think places doing that would be taking a big risk with "disappearing" antibodies (i.e. Kidd).

Other regulatory issues you are thinking of?? Perhaps something not coming to my mind at the moment?

Brenda Hutson, CLS(ASCP)SBB

[Malcolm Needs ☆]

Not to mention the practical: if the patient has multiple antibodies, wouldn't you want to know that ASAP instead of the day before surgery?

Yes Terri; I couldn't agree with you more.

The other thing is that, hospitals that only discover multiple antibodies (or a single antibody directed against a high frequency antigen) are the ones that send in a sample to the Reference Laboratory a few hours before the planned surgery (often an inadequate sample) and then moan if we don't get compatible blood back to them within minutes of the receipt of the sample!

:angered:

[Dee]

We perform a TS on the day Pre-Admit testing is performed - up to 14 days before surgery. A form is completed inwhich the nurse asks if the patient has been transfused in the past 3 months. If yes - TX must be performed the day the patient arrives for surgery.

The Pre-Op form is faxed to Holding by Blood Bank on the day of surgery so the nurse can again ask the 3 month transfusion question. The Pre Op specimen is placed in "Todays Specimen Rack" on the day of surgery to ensure availability if tr rxn is reported and an electronic xm is performed with a 3 day expiration.

Patients with antibodies have antibody id performed on Pre-Admit specimen and antigen neg units are saved. The day of surgery a TX is performed and units are crossmatched. This process has really saved time on having units available for surgery and meeting regulatory requirements.

[monnie48]

At our facility we will do Type and Screens up to 3 weeks prior to surgery, if they have not been pregnant or transfused within 3 months. We perform the testing the day the sample is obtained. We then freeze the plasma. This way the plasma is available if the need should arise for a crossmatch the day of surgery. We do not use a separate Blood Bank armband so we do not have to deal with that aspect anymore.

[Kathyang]

We collect the specimen up to 10 days before surgery, if no transfusion or pregnancy history. We test the specimen the day it is collected. We put a blue dot on the tube so it is easy to find in that day's rack if needed. We set the blood up the day before surgery.

[Vic]

Here is my question...

CAP standard TRM.40500 states....."This may not exceed 3 days in patients who have been transfused or pregnant within the past 3 months, or if relevant medical/transfusion history is unknown or uncertain."

AABB standard 5.13.3.2 also has similar wording.

So...how can you be certain of a patients history? Is having them sign a form really adequate? Some patients would not be able to confirm or deny a transfusion as they do not rightfully know. Some would even sign the form saying they had not been transfused when in fact they have. The same could be said for pregnancies.

I ask this because I was asked this. I recently took the role as supervisor of our blood bank and for many years...the lab has collected a pre-admit specimen after asking -have you been transfused/pregnant in last 3 months. The type and screen is done the day of collection but (as long as there are no antibodies or history of) the crossmatch is done the day prior to surgery which could be 3 or 4 days later (but no sample is used past 7 days here). It was suggested to me that we keep preforming the pre-op type and screen as we do but then recollect the day of surgery to perform the crossmatch. Would you have to repeat screening test? What about arm-bands, do you re-band the patient? Does anyone else do this? Any input is appreciated.

[Malcolm Needs ☆]

I don't know, because I am English and, therefore, covered by English Law, but, if you ask this question of the patient and get them to sign the answer, are you not covered, if they are giving a false answer?

:confuse::confuse:

[KKidd]

Here is my question...

CAP standard TRM.40500 states....."This may not exceed 3 days in patients who have been transfused or pregnant within the past 3 months, or if relevant medical/transfusion history is unknown or uncertain."

AABB standard 5.13.3.2 also has similar wording.

So...how can you be certain of a patients history? Is having them sign a form really adequate? Some patients would not be able to confirm or deny a transfusion as they do not rightfully know. Some would even sign the form saying they had not been transfused when in fact they have. The same could be said for pregnancies.

:wave:

I ask this because I was asked this. I recently took the role as supervisor of our blood bank and for many years...the lab has collected a pre-admit specimen after asking -have you been transfused/pregnant in last 3 months. The type and screen is done the day of collection but (as long as there are no antibodies or history of) the crossmatch is done the day prior to surgery which could be 3 or 4 days later (but no sample is used past 7 days here). It was suggested to me that we keep preforming the pre-op type and screen as we do but then recollect the day of surgery to perform the crossmatch. Would you have to repeat screening test? What about arm-bands, do you re-band the patient? Does anyone else do this? Any input is appreciated.

Our procedure is very similar with no recollect. If a patient shows up too early, we collect the BB sample closer to the surgery date. TJC and AABB folks have had no problem with this. Any time we have a new specimen we must retest. If a person semms unsure or not able to clearly answer the question, we go with 3 days (when in doubt.....)

[Brenda K Hutson]

It is true that a patient may not know their transfusion history, and/or, may just sign the form erroneously (I have seen that). So I guess it is just another one of those things in Blood Banking where things are done from a statistical standpoint and are Policies that vary from Institution to Institution. So you are choosing to rely on your results for that "early" antibody screen. I don't know that I would see the point of obtaining another specimen on the day of surgery to re-test. If you are that concerned, I would just keep the 3 day limit. If you are willing to trust the documentation (and can at least look at the history at your own facility), then trust it; otherwise, it will keep you awake at night.

By the way; one large renowned Medical Center I worked at (which was following what another one is doing; both Hospitals you would know in a second if I told you), extend specimens for up to 30 days.

And I will tell you statistically from my own experience of 27 years and 6 Institutions, I have never experienced a problem with a missed antibody due to specimen extension.

Brenda Hutson, CLS(ASCP)SBB

Here is my question...

CAP standard TRM.40500 states....."This may not exceed 3 days in patients who have been transfused or pregnant within the past 3 months, or if relevant medical/transfusion history is unknown or uncertain."

AABB standard 5.13.3.2 also has similar wording.

So...how can you be certain of a patients history? Is having them sign a form really adequate? Some patients would not be able to confirm or deny a transfusion as they do not rightfully know. Some would even sign the form saying they had not been transfused when in fact they have. The same could be said for pregnancies.

I ask this because I was asked this. I recently took the role as supervisor of our blood bank and for many years...the lab has collected a pre-admit specimen after asking -have you been transfused/pregnant in last 3 months. The type and screen is done the day of collection but (as long as there are no antibodies or history of) the crossmatch is done the day prior to surgery which could be 3 or 4 days later (but no sample is used past 7 days here). It was suggested to me that we keep preforming the pre-op type and screen as we do but then recollect the day of surgery to perform the crossmatch. Would you have to repeat screening test? What about arm-bands, do you re-band the patient? Does anyone else do this? Any input is appreciated.

[adiescast]

I don't know if this documentation has ever been challenged in court. There are sufficient numbers of institutions who use this practice that it can probably be admissable as a standard of care in many places. Plus the Standards support it.

We don't do it because I am not comfortable that patients always remember whether they have been transfused and I wasn't comfortable with the manipulations we would have to do to retain the positive ID connection between the patient who goes home for 7 - 30 days and the sample (and therefore the blood).

[EDibble]

:D:D:DWe use a 14 day sample if the patient states they have not been transfused or pregnant within three months. Type and Screen are done that day or the next. Crossmatches are done the day before surgery. From reading this thread, this seems to be the prevailing practice.

[Stoogiesfreak]

We are being asked by our physician's to "extend" samples for possible transfusion during surgery. These are scheduled surgeries, mostly total hips and total knees.

The issue is we want to do all pre-op testing at one patient visit. We can do the Type and Screen on that day, but how long can a sample be held for future possible crossmatching. This is all pending that there is a negative transfusion history, etc.

Also, does anyone know of any documentation on this.

Thanks, I appreciate all responses in advance!

John

[Deny Morlino]

Our reference lab has indicated that as long as an antibody screen is negative and a patient has not been transfused the antibody screen can be honored for an extended period of time (like more than a month).

We perform the antibody screen for the same sort of presurgical patients you are referring to up to 14 days prior to the date of surgery, set up units, and still hold them for up to 3 additional days for a total time of 17 days. By what the reference lab indicates, as long as the patient is not transfused, the antibody screen should be valid for the duration of the patient's stay. Once the patient is transfused, the "three day clock" starts. Just our practice and an opinion for what it is worth.

[Stoogiesfreak]

Thanks Deny, I appreciate the information.

John

[SMW]

......

We perform the antibody screen for the same sort of presurgical patients you are referring to up to 14 days prior to the date of surgery, set up units, and still hold them for up to 3 additional days for a total time of 17 days.....

It seems like inventory control, storage and product outdating would be significant challenges when sequestering units from available inventory for as long as 17 days? I must admit, this is the first time I've heard of anyone actually crossmatching and physically holding units that far in advance of anticipated need.

[Deny Morlino]

I think I must not have been very clear in my previous post. Let me try again. The antibody screen is the testing that is honored for up to 17 days. We do not actually crossmatch the units until day of surgery for the Orthopedic patients with a normal release of 3 days. Hope that clears up my previous post.

[Stoogiesfreak]

Thanks Deny that helps! I have been in this business so long that I have old age attacks sometimes. Thanks for clearing that up for me.

Regards,

John