Testing Question

[Gkloc]

First I want to say hey to everyone I recently was just promoted to lead tech until I get my specialty in BB, hopefully after next year, and right now work in a small community hospital in PA and I'm trying to clean up the mess left behind by our last supervisor. And I found this site and been following it for any insight more experienced BB's have and every time I log on looking for help to a problem I've run into since getting promoted, and never having been in this position before, and everyone here seems really nice and knowledgeable.

So introduction done now this week we ran into a problem with one of the tests from before I even started working at this hospital (which is only 3 years), and as of right now we have a front type(ABO/Rh) test which is only ordered for patients needing FFP or Platelets. The problem I ran into this week is sometimes our ER just orders a Front Type for FFP but later wants blood and as of right now the procedure manual (which I'm in the process of reviewing and changing) is we can't give products off a specimen just ordered as a Front Type. Does anyone have any info for me that says that's right and set in stone as a regulation, or should I just get rid of that test? Or is there a way to use a tube drawn for a Front Type and then be able to convert it into a type and screen/crossmatch test? This question may seem like a bad one, but I started in this hospital right out of MT school and the supervisor at the time made sure that everything was done this way and everything went so smoothly and no problems happened (that I knew of), then she moved on and her replaced....there is no words to explain the mess I'm trying to clean up now. So any help with this would be much appreciated . And I look forward to posting more and helping with what I can here.

[lalamb]

We band patients for FFP. The lab orders an ABORh. (If it's a STAT we give AB FFP untill a banded specimen is collected, then type the pt and give type compatible). If the FFP order turns in to a crossmatch, we add the orders for antibody screen and crossmatch to that originally banded tube. The patient still has that armband on, so we don't need to redraw the patient.

It's cumbersome- we have to be really vigilent to make sure a xm isn't done on a FFP patient w/out an antibody screen

I would prefer to just do an aborh and absc and have it done, but then we're doing tests the Dr didn't order...

[Gkloc]

Thanks that's were my mindset was going about the aborh and then adding a screen later to the already collected tube so that the patient doesn't need to be stuck again. But thats another problem I am dealing with is the old supervisor moved us to banding all type and screen and crossmatch specimens but not aborh ones so.....

[ANORRIS]

5.11.1 AABB Standards for Blood Banks and Transfusion Services

Transfusion Requests

Requests for blood, components, tissue, and derivatives and records accompanying blood samples from the patient shall contain sufficient information to uniquely identify the patient, including two independent identifiers. The transfusion service shall accept only complete, accurate, and legible requests.

Based on this standard, the sample is sent with an accompanying order.

This makes me think that if the order for blood was not sent with the tube drawn for the Type for the FFP, then a new tube must be drawn and sent with the order for a T/S or XM.

[John C. Staley]

I'm having a little trouble with your term "front type". In my world that is an ABO cells only typing. You included the Rh so can I assume that what you are referring to is an ABO "forward and reverse" as well as an Rh type?

That being the case, we would initially perform a full type and screen for any transfusion of products. This testing was good for the entire hospital stay for FFP and Platelets. Obviously if RBCs were transfused then the 3 day rule came into play.

[David Saikin]

Good John . . . If you only do a front type (type the pt cells, not using pt plasma and reagent A and B cells0, you would be in violation of a CAP standard (I don't recall the number) which states that you must do a forward and reverse type.

[Malcolm Needs ☆]

I'm having a little trouble with your term "front type". In my world that is an ABO cells only typing. You included the Rh so can I assume that what you are referring to is an ABO "forward and reverse" as well as an Rh type?

That being the case, we would initially perform a full type and screen for any transfusion of products. This testing was good for the entire hospital stay for FFP and Platelets. Obviously if RBCs were transfused then the 3 day rule came into play.

I cannot add to John's (as ever) excellent post, but I would just like to welcome you, as a fellow member, to BloodBankTalk community where, I am sure, you, like I have, and contiinue so to do, have learned so much from the generous posters.

:D:D:D:D

[tbostock]

I would never just do a front type for any reason. Front and reverse go together kind of like peas and carrots.

As far as ordering tests that the physician didn't order, we have a list of reflex tests (things that our Medical Director has agreed are necessary). The Medical Staff (Med Executive Committee) agree on the list, and then we are covered. For example anyone getting blood products gets a type and screen because we've been caught too many times with just doing the ABO/Rh and getting in trouble when the screaming starts when blood isn't ready.

[Gkloc]

By front type I did mean forward and reverse typing and Rh typing. I would never just do a forward type without performing a reverse one and none of the BB techs here would do that either, so I apologize for my poor choice of terminology there. And thanks for the replies it has helped a lot.

[lalamb]

I would never just do a front type for any reason. Front and reverse go together kind of like peas and carrots.

As far as ordering tests that the physician didn't order, we have a list of reflex tests (things that our Medical Director has agreed are necessary). The Medical Staff (Med Executive Committee) agree on the list, and then we are covered. For example anyone getting blood products gets a type and screen because we've been caught too many times with just doing the ABO/Rh and getting in trouble when the screaming starts when blood isn't ready.

Thanks , that's a good idea - I'll ask my pathologist and medical staff to OK doing a type and hold on all patients getting blood and FFP. We use to stock only AB FFP so banding the pt wasn't an issue. Now we stock A,B O, and AB. so we had to come up w/a new plan.

[tbostock]

Thanks , that's a good idea - I'll ask my pathologist and medical staff to OK doing a type and hold on all patients getting blood and FFP. We use to stock only AB FFP so banding the pt wasn't an issue. Now we stock A,B O, and AB. so we had to come up w/a new plan.

Yes, it's really a matter of getting it approved as the standard of care. Have your Transfusion Committee approve it, then pass it on to Med Exec for approval.