Retypes for adding on units

[speedwalker2k]

Hi Everyone,

When adding on units to patients who already have a type & screen done, we currently do a front type on the patient's original blood bank tube for confirmation before transfusing. This has been done for many years & we are now wondering whether a retype is necessary in this case. I'm wondering if anyone else out there does this & if so, what is the reasoning behind it? We always perform an immediate spin cross-match, so a mistype would be picked up at that point. We always retype new patients that have never been in our blood bank system. I am looking forward to any input others may have out there!

Thanks,

Judy

[Bill]

We currently do Back Type and IS crossmatch--Back Type because we seperate plasma from cells. This way we have 2 checks from same tube; reasoning of management, not my opinion.

[vilma_mt]

I can't see why you can't apply 'electronic crossmatch' rules.....2 blood types on record. It's a waste of reagent to perform typing for every add-ons. Performing IS xm do not catch mistypes....if a patient was mistyped as "O" you will not catch the error on IS xm no harm done (for red cell transfusion) but still an error.

[AMcCord]

We repeat the type with add on crossmatches. Just a little insurance policy that may cover some basic screwups, like grabbing the wrong tube, for example.

[adiescast]

When a sample has been put away after the work is completed and someone is taking it out again to do more work on it, the retype is intended to provide safety for the patient that you have the right sample to do the new work on. If you are performing electronic crossmatch, you do not need to pull out the sample for anything and so you do not need to retype it.

[Deny Morlino]

Same as AMcCord here. It is a safety check to be sure you have the correct patient's sample.

[clmergen]

And here I thought we were the only ones doing that.

[Eagle Eye]

we do not separate plasma. we do immediate spin crossmatch. We never retyped specimen for add on crossmatches. when we had old timers they used to do that even though it was not in our policy. Right now when we receive specimen who does not have prior history in our system we have blood type done by two techs from same sample and then that specimen can be used for additonal crossmatches.

[vilma_mt]

Separating red cells and plasma is a practice that's been discouraged because of the possibility of mislabeling. I referred to the Electronc crossmatch Guidance on my earlier post because it's something a policy can be built on.....minimun 2 ABO Types. There is nothing wrong with testing a specimen gazillion times but it's a waste of resources and increases turn around time.

"We believe that the published literature and observations of safe use over the past 13 years support the safety of properly implemented computer crossmatch (Refs. 3, 4, 5, 6, 7, 8, 9, and 10), and we regard computer crossmatch to be an acceptable method of compatibility testing when it is properly designed, validated, implemented, and monitored. However, there are many issues that could affect the safety and effectiveness of blood products when you use computer crossmatch in your blood establishment. The quality of the process depends on careful user validation and proper quality management."

This is so true in any process!

Edited April 17, 2010 by vilma_mt

[speedwalker2k]

Thank you everyone for your input. I am going to talk to my supervisor about this & we may stop this practice!

[tbostock]

We do a recheck the same as adiescast does.

[LisaM]

Hi Everyone,

When adding on units to patients who already have a type & screen done, we currently do a front type on the patient's original blood bank tube for confirmation before transfusing. This has been done for many years & we are now wondering whether a retype is necessary in this case. I'm wondering if anyone else out there does this & if so, what is the reasoning behind it? We always perform an immediate spin cross-match, so a mistype would be picked up at that point. We always retype new patients that have never been in our blood bank system. I am looking forward to any input others may have out there!

Thanks,

Judy

Hey! We do the exact same thing where I work, too! Oh yeah--we work at the same place! (Hi Judy!) LOL!

Seriously, I think we should check the CAP regulations to see what they say--I think it's a waste of time and reagent and maybe a better practice would be for us to put a separate rack in our refrigerator with the "current crossmatch" samples in it for the week. I'll print out the BB section of CAP tonight and do a little reading. . . .

--Lisa

[Malcolm Needs ☆]

Now, now Lisa and Judy; we can't have you two from the same establishment ganging up on poor little shy and innocent people like me who have to fend for ourselves as the only member from our establishment.

I shall get a complex and be all paranoid!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D:D

[PURVIS1031]

Electronc crossmatch is the way to go!

[Mabel Adams]

My workplace has a long-standing policy to retype the tube, which we still do on those patients requiring serologic xm. Interesting thing is, we don't record the results anywhere. Do the rest of you?

Our current BBIS requires that we scan the tube's original barcode every time we do a sero xm or any other testing on it so that seems like a pretty tight specimen ID step. Maybe modern processes like that can replace old habits.

[LisaM]

Now, now Lisa and Judy; we can't have you two from the same establishment ganging up on poor little shy and innocent people like me who have to fend for ourselves as the only member from our establishment.

I shall get a complex and be all paranoid!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D:D

You know you love us, Malcolm--and I'm sure you're no shrinking violet--lol! You can come work with us anytime---we'll have no problem picking your brain in person as well as online--hahahahaha!

[LisaM]

My workplace has a long-standing policy to retype the tube, which we still do on those patients requiring serologic xm. Interesting thing is, we don't record the results anywhere. Do the rest of you?

Our current BBIS requires that we scan the tube's original barcode every time we do a sero xm or any other testing on it so that seems like a pretty tight specimen ID step. Maybe modern processes like that can replace old habits.

We record ours on a manual logsheet, but I like the idea of scanning in the tube barcode! I'm not sure if our system would support that process, but it would be worth looking into.

[Malcolm Needs ☆]

You know you love us, Malcolm--and I'm sure you're no shrinking violet--lol! You can come work with us anytime---we'll have no problem picking your brain in person as well as online--hahahahaha!

Oh for the chance! Anything is better than working in Tooting (as a place - not as a Blood Centre - which is great) and living in Croydon (which is horrible)!!!!!!!!!!!!

:D:D

[Deny Morlino]

My workplace has a long-standing policy to retype the tube, which we still do on those patients requiring serologic xm. Interesting thing is, we don't record the results anywhere. Do the rest of you?

Our current BBIS requires that we scan the tube's original barcode every time we do a sero xm or any other testing on it so that seems like a pretty tight specimen ID step. Maybe modern processes like that can replace old habits.

We record in the workbook with the new units cross matched. We also refer to the date and indicate the tech who originally performed the Ab screen. Both are long standing practices here. When we used tube as our primary, we would perform IS cross matches; with the install of gel we transitioned to full cross matches for everything (conservative pathologist).

[L106]

When we accept a patient specimen into our Blood Bank, our computer system (Mediware HCLL), prints a specimen label (which we immediate attach to the sample.)

When we do any testing, we pull up a patient worksheet on the computer monitor and the first thing we have to do is scan the barcoded HCLL specimen label on the patient's tube. The computer recognizes if the scanned label does not match the patient's worksheet (and, of course, will not allow you to proceed.) It also will not allow a specimen to be crossmatched if the ABO/Rh and Antibody Screen has not been completed on that specimen. So if we later pick up a patient specimen to do "add-on" crossmatches, the computer checks the specimen ID and the ABO/Rh and Antibody Screen. Therefore, we do NOT retest the patient's ABO/Rh when we crossmatch additional donor units.

[tbostock]

My workplace has a long-standing policy to retype the tube, which we still do on those patients requiring serologic xm. Interesting thing is, we don't record the results anywhere. Do the rest of you?

Our current BBIS requires that we scan the tube's original barcode every time we do a sero xm or any other testing on it so that seems like a pretty tight specimen ID step. Maybe modern processes like that can replace old habits.

Yes, we add an "ABO Recheck" test in the computer and result it.

[GilTphoto]

We also recheck type on add ons and record the results in computer.

Edited April 21, 2010 by GilTphoto

[rravkin@aol.com]

Hi Everyone,

When adding on units to patients who already have a type & screen done, we currently do a front type on the patient's original blood bank tube for confirmation before transfusing. This has been done for many years & we are now wondering whether a retype is necessary in this case. I'm wondering if anyone else out there does this & if so, what is the reasoning behind it? We always perform an immediate spin cross-match, so a mistype would be picked up at that point. We always retype new patients that have never been in our blood bank system. I am looking forward to any input others may have out there!

Thanks,

Judy

Hey Judy,

The practice you describe here is what I have practiced in every BB I've worked at. The reason for this practice in current times probably relates to a level of comfort amongst technical staff, nursing staff, and physician staff including the lab pathologist(s). As you know an ABO incompatablity is of the most severe type that can occur between recipient and donor. We are not just talking about a reduced circulating red cell life, we are talking about a complete and immediate demise of ABO incompatible red cells that can, and does, lead to patient demise, as seen in current literature and historic literature relating to the initial discovery of the ABO system.

We also practice immediate spin crossmatch but the reactants here are not color coded and therefore one may perceive a reduction in reliability of such testing to confirm the ABO type of the patient. Considering the simplicity and second nature of this practice I think that many techs do question it but it's ability to confirm the type is sound. The impact of an ABO incompatibility is very far reaching; remember the ABO incompatible organ transplant at Duke University Hospital; that was all over the national news. Blood ABO incompatibilities doen't get as much exposure but the governing agencies that set policy for practicing blood banks keep a very close eye on this situation. So, in conclusion, we have a very sound and effective practice that avoids catastrophy. IF IT ISN"T BROKE THEN DOEN"T FIX IT! Hope this helps. :)

[bbbirder]

If you are computerized (or have some other, manual method to check the patient's blood type of record) I see no reason for repeating the type when you add on units. If you trusted the system you have in place and the type you got at that time so that you issued units based on that type, why would you retype the specimen? If you don't trust that type, why did you issue any units? (I am not talking about confirming the patients type by a second specimen or repeat type initially, just retyping when you add on more units.)

If you are not computerized or don't have a manual system to verify the type on record (before computerization we used a patient card system that allowed for a good review), then I would say you probably should perform another type.

[jhaig]

we do not separate plasma. we do immediate spin crossmatch. We never retyped specimen for add on crossmatches. when we had old timers they used to do that even though it was not in our policy. Right now when we receive specimen who does not have prior history in our system we have blood type done by two techs from same sample and then that specimen can be used for additonal crossmatches.

My question is .... what if the specimen was incorrectly drawn in the first place? It won't matter how many techs type it if it's the wrong patient. If you are a CAP blood bank, they may be moving towards two separate specimens at two separate draws not only being a recommendation, but a requirement. We have amended our retyping policy to include two draws at two separate times before transfusing any red cell products. If a redraw cannot be obtained, we give group O cells.