Help- Electronic cross-matching

[NAN47]

Hi I am a specialist Biomedical Scientist who is currently based at a hospital in Scotland UK, At the moment i am currently undertaking a higher specialist diploma in transfusion science, and i am currently preparing a presentation on electronic crossmatching/issue. As the hospital where i work doesnt use electronic issue, i was hoping that others may like to share there views on it with me, such as how it has affected their blood banks workload, blood usage etc and also if there has been adverse incidents resulting from its use?

many thanks, grateful for any help!

Patricia

[Malcolm Needs ☆]

Hi I am a specialist Biomedical Scientist who is currently based at a hospital in Scotland UK, At the moment i am currently undertaking a higher specialist diploma in transfusion science, and i am currently preparing a presentation on electronic crossmatching/issue. As the hospital where i work doesnt use electronic issue, i was hoping that others may like to share there views on it with me, such as how it has affected their blood banks workload, blood usage etc and also if there has been adverse incidents resulting from its use?

many thanks, grateful for any help!

Patricia

Hi Patricia,

Try getting in touch with Tim Maggs, the Lead BMS in Blood Transfusion at St. Thomas's Hospital in London and/or Matt Free, the Lead BMS in BT at King's College Hospital in London. Also Chris Elliott at Middlesborough Hospital. They have all switched to electronic issue.

I would also advise you to look on the MHRA website. If it is not on there already, their guideance on electronic issue is just about to be published on there.

:):)

Edited May 3, 2010 by Malcolm Needs

[NAN47]

thank you for your help, will try to contact those people. yes i have already obtained the MHRA guidance, and have included all the specifications of the process in my presentation - was just hoping to add a little something extra to it by including how it works for those who use it.

very grateful for your help

Patricia

[Malcolm Needs ☆]

yes i have already obtained the MHRA guidance

Patricia

Make sure that it is the one they are actually going to publish; it is quite different to the one they put out for consultation.

:):)

[NAN47]

ok thanks will check that out!

[sjb]

Hi Patricia,

We've been issuing electronically for 5 years (around 16K red cells pa, 80 something % issued electronically) - during that time we've had 2 reactions, which were weakly positive by manual gel (DiaMed). 1 in 2006, 1 last year - neither of which RCI could give a specificity for (which is a shame, as you could do some clever maths to work out the risk).

The MHRA still haven't posted their guidance, but I have attached a copy of it (assuming my low tech skills can manage that)

hth

Stephen

MHRA Guidance on Electronic Issue.pdf

[Steven Jeff]

Hi Patricia,

We've been issuing electronically for 5 years (around 16K red cells pa, 80 something % issued electronically) - during that time we've had 2 reactions, which were weakly positive by manual gel (DiaMed). 1 in 2006, 1 last year - neither of which RCI could give a specificity for (which is a shame, as you could do some clever maths to work out the risk).

The MHRA still haven't posted their guidance, but I have attached a copy of it (assuming my low tech skills can manage that)

hth

Stephen

Any chance of Cliff posting these guidelines to the reference section please. I haven't mastered that skill yet

Regards

Steve

[Malcolm Needs ☆]

Any chance of Cliff posting these guidelines to the reference section please. I haven't mastered that skill yet

Regards

Steve

I would strongly advise that we wait until the final version is published.

:redface::redface:

[sjb]

I would strongly advise that we wait until the final version is published.

:redface::redface:

Yup, that's the version, direct from one of the inspectorates finest...

Stephen

[dcubed]

We have been doing electronic xm for a couple of years now and it is wonderful. If we have a current type and screen on a patient and they do not have any clinically significant antibodies, we can allocate units of PRBC's in about 2 minutes. When we were using the immediate spin crossmatch, turn around time was sometimes adversely affected when upon doing the immediate spin crossmatch a patient was found to have a cold agglutinin or rouleaux. Blood usage has not been affected, if a transfusion is required, the type of crossmatch employed is irrelevant.

[NAN47]

Would just like to say thankyou to everyone who posted a reply for my request for information on electronic issue. It has been very helpful and gratefully received.

Would also like to add, that I have found this website to be very helpful towards my preparation for the higher specialist diploma in Transfusion Science ( wish i had discovered the forum earlier!!) Have found reading the posts very helpful and also all the topics in the Educational Materials section.

So thanks again everyone!

tricia:)

[Brenda K Hutson]

Hi I am a specialist Biomedical Scientist who is currently based at a hospital in Scotland UK, At the moment i am currently undertaking a higher specialist diploma in transfusion science, and i am currently preparing a presentation on electronic crossmatching/issue. As the hospital where i work doesnt use electronic issue, i was hoping that others may like to share there views on it with me, such as how it has affected their blood banks workload, blood usage etc and also if there has been adverse incidents resulting from its use?

many thanks, grateful for any help!

Patricia

I have used it for many years, at 2 different large Institutions (and hope to implement it at my current Hospital by the end of this year). IT IS WONDERFUL!! It absolutely saves time. As far as blood usage, I don't think it affects "usage," but it can affect your C:T (Crossmatch:Transfusion) Ratio depending on how you utilize it. Since it takes only moments to perform, a Hospital may opt to perform the Electronic Crossmatch at the time the blood is actually requested by the floor (rather than automatically performing the electronic crossmatch everytime RBCs are ordered). But if a patient needs to be transfused, they will be, regardless of the method utilized (that is why I say it shouldn't/wouldn't affect usage).

I have never seen any adverse affects from utilizing this. The computer must be equipped to match patient requirements with blood product attributes and either prevent errors (and there are things you do not want the Tech. to have the option to override) or to warn them.

Hope that helps....

Brenda Hutson, CLS(ASCP)SBB

[NAN47]

Thanks Brenda, that was really helpful.

I was also wondering how you went about assessing the feasibility of introducing the electronic issue process into a blood bank. ie how many of the requests for blood would actually be suitable for electronic issue , and trying to work out whether there would be a high enough percentage to warrant its introduction?. I have some thoughts on how I would go about this ( such as a retrospective study over say a 3 month period of crossmatch requests and ascertaining how many of these met the eligibility criteria) .

any guidance or advice on this would be gratefully received.

thanks tricia:)

[Brenda K Hutson]

Thanks Brenda, that was really helpful.

I was also wondering how you went about assessing the feasibility of introducing the electronic issue process into a blood bank. ie how many of the requests for blood would actually be suitable for electronic issue , and trying to work out whether there would be a high enough percentage to warrant its introduction?. I have some thoughts on how I would go about this ( such as a retrospective study over say a 3 month period of crossmatch requests and ascertaining how many of these met the eligibility criteria) .

any guidance or advice on this would be gratefully received.

thanks tricia:)

The patients that would not qualify for Electronic Crossmatch would be those with a history of clinically significant antibodies. But that is where there can be some gray areas; define "clinically significant." Different Institutions treat M,N,P1,Lea,Leb,A1 differently. I would say that within this group, the ones that any given Institution would normally perform a AHG Crossmatch on, would still be the ones to perform the AHG Crossmatch on.

Brenda

[jcdayaz]

Here is a scary situation for you all....A Tech I work with had a case last week where the Antibody Screen on a patient was perfectly negative. We do electronic crossmatching (although that wouldn't have mattered in this case). He then set up the 2 requested units for the patient and called the nursing unit to let them know the blood was ready. The nurse he spoke to replied "she has this antibody card, do you need to know about it?". She then faxed a copy of the card to the BB and it turns out the patient had an identified anti-E,c from years ago from an out-of-state hospital. Both units that had been set up were, of course, c positive. The units were not transfused...thank goodness. The Tech fixed everything and got appropriate units ready.

How scary is that??? That patient was very proactive in her own care and I applaud her for that! We need much more of that!

I was, however, a bit surprised to see 2 Rh antibodies just disappear. Even without stimulation I have always thought the Rh's stay around. Am I wrong?

[Malcolm Needs ☆]

Here is a scary situation for you all....A Tech I work with had a case last week where the Antibody Screen on a patient was perfectly negative. We do electronic crossmatching (although that wouldn't have mattered in this case). He then set up the 2 requested units for the patient and called the nursing unit to let them know the blood was ready. The nurse he spoke to replied "she has this antibody card, do you need to know about it?". She then faxed a copy of the card to the BB and it turns out the patient had an identified anti-E,c from years ago from an out-of-state hospital. Both units that had been set up were, of course, c positive. The units were not transfused...thank goodness. The Tech fixed everything and got appropriate units ready.

How scary is that??? That patient was very proactive in her own care and I applaud her for that! We need much more of that!

I was, however, a bit surprised to see 2 Rh antibodies just disappear. Even without stimulation I have always thought the Rh's stay around. Am I wrong?

I have seen plenty of Rh antibodies that have not totally disappeared, but have weakened to such an extent that they are only detectable by the use of either direct agglutination at 37oC with papain-treated red cells or, indeed, only detectable by the use of papain-treated red cells used in the IAT. This is one of the reasons why I think that antibody cards are vitally important, but I am not so sure that this vital importance is always explained to the patient.

Were either of these techniques used?

I agree though; it is a scary situation.

Obviously, I have also seen plenty of cases of just the opposite, where Rh antibodies have been easily detectable for many years after the initial identification.

:)

[jcdayaz]

I have seen plenty of Rh antibodies that have not totally disappeared, but have weakened to such an extent that they are only detectable by the use of either direct agglutination at 37oC with papain-treated red cells or, indeed, only detectable by the use of papain-treated red cells used in the IAT. This is one of the reasons why I think that antibody cards are vitally important, but I am not so sure that this vital importance is always explained to the patient.

Were either of these techniques used?

I agree though; it is a scary situation.

Obviously, I have also seen plenty of cases of just the opposite, where Rh antibodies have been easily detectable for many years after the initial identification.

:)

We use the Gel method on the Provue routinely. We resort to other methods when/if necessary--if we know there is a problem. The Tech had no clue based on his routine testing results! SCARY!

Yes, I agree with you on your antibody card statement with proper education of the patient.

[NAN47]

Hi there, thanks for that information - that is quite a scary situation,

can i just ask where the original units issued via electronic issue or were they cross-matched and found to be negative? If electronic issue wasnt used was there another reason why the patient wasnt eligible for EI.

many thanks

tricia

[NAN47]

ps jcdayaz, could you tell me where your hospital is based - its just that would be a interesting situation to include in my presentation on electronic issue.

thanks

[Brenda K Hutson]

Here is a scary situation for you all....A Tech I work with had a case last week where the Antibody Screen on a patient was perfectly negative. We do electronic crossmatching (although that wouldn't have mattered in this case). He then set up the 2 requested units for the patient and called the nursing unit to let them know the blood was ready. The nurse he spoke to replied "she has this antibody card, do you need to know about it?". She then faxed a copy of the card to the BB and it turns out the patient had an identified anti-E,c from years ago from an out-of-state hospital. Both units that had been set up were, of course, c positive. The units were not transfused...thank goodness. The Tech fixed everything and got appropriate units ready.

How scary is that??? That patient was very proactive in her own care and I applaud her for that! We need much more of that!

I was, however, a bit surprised to see 2 Rh antibodies just disappear. Even without stimulation I have always thought the Rh's stay around. Am I wrong?

Two things:

1. First, without that history of clinically significant antibodies in your Blood Bank, if you didn't perform Electronic XM,

you would most likely only be performing an Immediate Spin XM. So, the "scary" scenario is always a possibility;

whether performing an electronic XM, or an I.S. XM; either way, you probably would not pick up the antibodies

(unless IgM).

2. And I agree with Malcolm; I too have seen plenty of Rh Antibodies disappear.

You are lucky that this patient spoke up. One night while working the MN shift at a large Medical Center with a Trauma Center, the ER requested 2 units of uncrossmatched blood. I threw the Antibody Screen in just as quickly as we got the specimen. When the screen was positive, I called the ER and told them to stop transfusing; that the patient had antibodies. The MD said it was too late; they were already on the 2nd unit and the patient needed the blood. I then asked the MD to ask the patient (she was coherent; but that is another thing that could trip you up) her transfusion history. Just as I finished the work-up (anti-E and anti-c), the MD called back and said "the patient said something about having an antibody card; would that be helpful?! Yes, like about an hour ago!! Since the units were O NEG, they were (as is most likely) E-c+. Had we known about the card from the start, we actually kept 2 shelves of historically antigen negative RBCs and could have at least given E-c- units (though still uncrossmatched). That particular Medical Center had it's own Donor Center. When the Reference Lab in the Blood Bank performed Antigen Typing on units, they would send a copy of the results to the Donor Center. The Donor Center then plugged the results into the computer under that donor. So, when the donor came back, a white tag on the top of the unit would give all historical typing results (if there were any).

I think that the letters that usually accompany those cards, need to be written in terms that the public can understand; as well as emphasizing the importantce of telling Hospital staff immediately! What I have seen happen frequently is that all of the patient has to do is see the word "antibodies" on a letter and card and they immediately panic; thinking of things like HIV.......but at least then they call for clarification; providing an opportunity to explain it better. But the reality is, not all places send out antibody cards; in fact, my guess would be that most Transfusion Services do not send out cards.

Brenda

[jcdayaz]

Hi there, thanks for that information - that is quite a scary situation,

can i just ask where the original units issued via electronic issue or were they cross-matched and found to be negative? If electronic issue wasnt used was there another reason why the patient wasnt eligible for EI.

many thanks

tricia

The original units were electronically x-matched. Even if they were manually crossmatched the units would have been compatible. The antibodies weren't reacting. We routinely electronically x-match patients that have no antibodies.

The units never left the Blood Bank. When the Tech called the nurse to tell her blood was ready she told him about the antibody card. Thank goodness!!!!

[jcdayaz]

ps jcdayaz, could you tell me where your hospital is based - its just that would be a interesting situation to include in my presentation on electronic issue.

thanks

Tucson, AZ. (USA)

I hope you are not going to use this situation to present electronic crossmatching in a negative way. It works! A "real" (manual) crossmatch wouldn't have detected antibody and/or incompatibility in this instance anyway.

[L106]

jcdayaz - I've seen plenty of antibodies "disappear", including Anti-c and Anti-E. The situation you described is scary, but (for the most part) unavoidable and an inherent risk (especially in our very "mobile" society.)

[NAN47]

Hi thanks for that information,

jcdayaz - no I wont use that incident as a negative - have had a very positive response from those who are currently using electronic issue, i would just use it to highlight that as with so many things in life - you have to expect the unexpected!

thanks!

[jcdayaz]

jcdayaz - I've seen plenty of antibodies "disappear", including Anti-c and Anti-E. The situation you described is scary, but (for the most part) unavoidable and an inherent risk (especially in our very "mobile" society.)

Yes, let's talk about our "mobile society". How are we, as Blood Bankers, to know of previous history from another hospital? Many times patients don't even tell anyone they have been transfused at "X" hospital. It is worrisome, to say the least.

There are always inherent risks with transfusion. That goes without saying.