Calling all Gel users

[velliott]

Can someone tell me what the Ortho package insert states about the age of a sample in order to perform an ABO / RH on a gel card? My manufacture, we are doing tube testing, states the sample should be less than 10 days olds. My concern is in pre-admission testing where you allow a type and screen or crossmatch to be drawn several weeks before the surgery if the patient has not been pregnant or transfused. Most of the time the tech crossmatching additional units will repeat an ABO / RH.

[David Saikin]

You have to perform the ab scr within 3 days of collection (regulatory requirement). . . how long you maintain the specimen for future testing is, basically, up to you. I have seen places that freeze the plasma and will save it for up to a month after collection.

[JOANBALONE]

Hi velliot,

My Ortho IFU for A/B/D Monoclonal and reverse card and A/B/D card says that EDTA samples should be tested within 14 days (key word 'should').

[Brenda K Hutson]

You have to perform the ab scr within 3 days of collection (regulatory requirement). . . how long you maintain the specimen for future testing is, basically, up to you. I have seen places that freeze the plasma and will save it for up to a month after collection.

Hi David,

That is a true statement for patients who have been pregnant and/or transfused in the past 3 months, but can you reference the regulation that states this applies to all specimens from any patient? While I agree it is optimal to perform the testing as soon as possible for a number of reasons (just one being that it is possible for antibodies such as the Kidds to disappear upon storage), I am not aware of a regulation stating one cannot test a specimen > 3 days for patients not pregnant and/or transfused in 3 months.

Thanks in advance,

Brenda Hutson, CLS(ASCP)SBB

[JOANBALONE]

Hi again velliot,

We stopped requiring patient retypes in gel when units were added on to an order. It just took too long.

JB

[daviem]

hi velliot

we used to freeze them prior to op, but an episode of someone receiving blood at another hospital and the patient "forgetting" to mention it till after procedure, meant that we tightened it up. So now they have one sample in assessment and then one day before or morning of op (if previous one clear) so far this is working well.

dm

[Malcolm Needs ☆]

PLEASE, PLEASE tell me that I read the original post of this thread incorrectly.

How could your techs re-group the red cells for ABO/Rh from a sample taken several weeks earlier, unless the red cells were cryopreserved or they are in to forensic medicine???!!!!!!

[LaraT23]

The antibody screen requirement for us is 24 hours from collection, we don't want any sneaky antibodies to decrease in titer while it sits in storage. I do keep specimens for 10 days for add on crossmatches, and no Malcolm, we do not re-test old red cells. As far as what the manufacturer says, I read that word "should" as well, they are just CYA, and you have to make your own determination based on other factors.

[Brenda K Hutson]

Having worked at numerous Institutions in my career, I have seen many different scenarios on this. Most places had a Policy on extending specimens for longer than the 3 days in which we normally require a new specimen (provided the patient has not been pregnant and/or transfused in last 3 months of course). I have seen specimens extended anywhere from 7 days to 30 days! All but one of those Institutions performed the Type and Screen on the day it came. The difference had to do with crossmatching. A couple used electronic crossmatch so it was not an issue. For those that used Immediate Spin, yes, they would pull the specimen out of the refrigerator "closer to the date of surgery" and perform the crossmatches. And it has always been my experience that when one pulls a specimen out of the refrigerator, they perform a confirmation type (forward only). I just kind of see this as a "quick and dirty" confirmation that the type is correct and that hopefully you have the correct specimen (though of course, given that there are limited blood types, this is not a huge safety net unless the patient is one of the low incidence ABO/Rh types. One large Institution where I worked was changing it from 14 days to 30 days. I questioned performing crossmatches at the latter end. They were changing to 30 based on another well known Medical Center that used 30. I called that Medical Center and they said they had never encountered any issues with this.

Still, for myself, I prefer to use a fresh specimen for my testing. But if you are an Institution that extends specimens, even if you perform the ordered crossmatches in the first few days, any additional blood requests during surgery would still be using an older specimen (unless you request a new one for additional crossmatches needed during the surgery).

Brenda Hutson, CLS(ASCP)SBB

The antibody screen requirement for us is 24 hours from collection, we don't want any sneaky antibodies to decrease in titer while it sits in storage. I do keep specimens for 10 days for add on crossmatches, and no Malcolm, we do not re-test old red cells. As far as what the manufacturer says, I read that word "should" as well, they are just CYA, and you have to make your own determination based on other factors.

[David Saikin]

Brenda

I, apparently, have been laboring under a delusion regarding this time frame. Thanks for setting me straignt.

Hi David,

That is a true statement for patients who have been pregnant and/or transfused in the past 3 months, but can you reference the regulation that states this applies to all specimens from any patient? While I agree it is optimal to perform the testing as soon as possible for a number of reasons (just one being that it is possible for antibodies such as the Kidds to disappear upon storage), I am not aware of a regulation stating one cannot test a specimen > 3 days for patients not pregnant and/or transfused in 3 months.

Thanks in advance,

Brenda Hutson, CLS(ASCP)SBB

[LisaM]

Where I work, we perform the type and screen on the day the sample arrives, then if the patient hasn't been transfused or pregnant within the last 3 months, we consider the preop sample "good" for 14 days from the time of draw. Otherwise, our policy states that 72 hours is the limit.

As far as saving samples, we keep about a month's worth, refrigerated, although that seems kind of gross to me. . . .

For samples from pregnant women who have antibodies, we freeze the plasma to use as a titer comparison for the next time they get drawn for an antibody screen during their pregnancy.

Also as an aside to this topic, regarding storage of reagent red cells and not patient red cells, we also store and use outdated antibody panel reagent cells. Just recently, we've gotten a new supervisor and she has instituted antigen typing as QC on the outdated cells whenever we have to use them for rule-outs, to be sure whatever we're ruling out with them, is still reacting.

[Malcolm Needs ☆]

Also as an aside to this topic, regarding storage of reagent red cells and not patient red cells, we also store and use outdated antibody panel reagent cells. Just recently, we've gotten a new supervisor and she has instituted antigen typing as QC on the outdated cells whenever we have to use them for rule-outs, to be sure whatever we're ruling out with them, is still reacting.

Good for her, and good to see you back amongst us LisaM!

Love the new photograph.

:blowkiss::blowkiss:

[LisaM]

^^LOL Thanks, Malcolm! I got a little sidetracked with repainting my laundry room, fall yard clean up, and I've been scarce lately. I'm in the process of repainting my dining room now and hope to get it done before Thanksgiving next week! Never a dull moment. . .

[Malcolm Needs ☆]

^^LOL Thanks, Malcolm! I got a little sidetracked with repainting my laundry room, fall yard clean up, and I've been scarce lately. I'm in the process of repainting my dining room now and hope to get it done before Thanksgiving next week! Never a dull moment. . .

Good Lord Madam, have you not thought about doing a little work around the house instead of constantly enjoying yourself!!!!!!!!!!!!!!!!!!!!!!!

:peaceman::peaceman:

[LisaM]

Yes, I'm glutton for punishment, but the room came out great--see: LOL

(and now that I've completely derailed this thread--back to the gel!)

Oh yes, and I forgot to mention--I also went to see Roger Waters' "The Wall" tour, at the end of September--awesome show!

Here's a link to some videos I took at the concert if anyone wants to have a look:

http://s425.photobucket.com/albums/pp333/LisaM0214/Guest%20Album/

You'll need a password to log in to see them: lisa0214 (<---all in lowercase)

Also, here's a link to some photos from the show (click then scroll down until you see my post at NIN):

http://forum.nin.com/bb/read.php?30,1053089,page=5

Edited November 16, 2010 by LisaM

[bbbirder]

I am sure that the FDA regulations say the antibody screening must be completed within 72hours of collection (or it used to... I often live in the past). I am not at work now, but will check tomorrow.

[AMcCord]

I am sure that the FDA regulations say the antibody screening must be completed within 72hours of collection (or it used to... I often live in the past). I am not at work now, but will check tomorrow.

I believe you are correct about the 72 hours and the FDA. Joint Commission also says 72 hours.