historical and present blood groups don't match

[janet]

A woman was seen at a hospital a few hours away from our hospital and grouped as O Rh:positive - we have a historical grouping of A Rh:positive (done in 2002 and 2004). They had the patient return, confirmed identification/transplant history(none), and retested (O Rh: positive again). Because we are linked through Meditech they are unable to file this result due to the historical discrepancy.

Any thoughts of what is best to do? We could both change our blood groups to UNKNOWN since we don't match (but that's not really correct, we both know what group we got!!).

Any thoughts or experiences would be appreciated!

[John Eggington]

Assuming it is the same patient; doe she have any condition that could be associated with 'loss' of ABO antigens? Do you use different technologies? Could you get a sample and retest yourself? An explanation for the difference may help you decide what to do.

[adiescast]

I would have to wonder whether this is the same patient. Does she report having been at your hospital in 2002 and 2004?

What was the strength of your A typing? Any possibility she was a subgroup? Did she get transfused recently (possibly with type O blood)?

[SMW]

I would focus the investigation on the identity of the individual(s) since my primary thought is that they are different people.

[Bill]

I would change Meditech to unknown and follow SMW's advice.

[janet]

So .... medical records thinks there was a registration error, the original patients demographics were replaced with this new patient's when she was first seen a year ago!!!!!!!! A likely explanation - but SCARY!!!

Thanks for the help!

[Bill]

The IS dept or Meditech should be able to trace the registrations, from what I was told from Meditech--every keystroke is tracked, but for how long that info is kept I am not sure.

[David Saikin]

Where I used to work, family members would "share" Medicare/Medicaid cards. We had multiple prenatals on the "same" patiient with different blood types.

[Malcolm Needs ☆]

Yes, we get that too with NHS Numbers.

[Eagle Eye]

we get same thing....patient blood changes from A to O to A

[KKidd]

Meditech has a temporary blood type. Could you enter one of the blood type there and put an explanation in the history comments. I have not had an ABO discrepancy, but we no longer perform Weak D testing on Adults. Sometimes we move the previous Rh pos reulst to temporary and the current Rh neg to the Blood type. As with anything make sure that it is carefully documented.

:pcproblem:pcproblem:pcproblem:pcproblem

[pbaker]

We just had this happen over the weekend. A patient came to our ER in January and was O+. When she returned for her pre-surgical testing in February she was A+. We went back to the signatures of the two registrations and they were markedly different. The true patient was A+ and someone else had used her identity to come to the ER (not sure with or without her permission). We changed the 2 blood types to unknown until the discrepancy was resolved.

[PammyDQ]

So .... medical records thinks there was a registration error, the original patients demographics were replaced with this new patient's when she was first seen a year ago!!!!!!!! A likely explanation - but SCARY!!!

Thanks for the help!

I saw a nightmare like this when patients with the same name and similar DOB were merged into one record and one person's demographics was replaced with the other's! Fortunately they had different blood types and this is how it was discovered. Medical records and IS had to go through all the data and separate it back to 2 different patients.

I have also heard of a case where someone loaned their insurance card to an uninsured friend that went to another facility to obtain covered health care...they didn't know it could be traced because the facilities were linked and their blood types differed!

Patient identity can sometimes be deceiving...almost...and I learned never to assume. I once worked on 2 specimens days apart from an OB clinic. It seemed like a duplicate order because one was named Janice "Doe" and one was named Janet "Doe". Both had the same doctor, home address and DOB. When I called to inquire at the clinic as to whether it was a duplicate order, they said no, they're TWINS!!! (did their parents not think in the future there could be identity problems???!!!)

[bldbnkr]

I worked for a lab that did prenatal work for a low-income prenatal clinic. No males could be treated there, of course. A nurse practitioner, or midwife, I'm not sure which, wanted to find out the Rh type of an Rh negative patient's spouse/partner/significant other. She drew his blood and sent it in with the patient's demographic information. I was then finding an A neg on a previously O neg patient. When I called the midwife to discuss my findings, she said "oh good...it isn't her blood, it is her husband's and now she won't need RhoGam".

After the steam finished coming out of my head I contacted corporate compliace to investigate the possible Medicaid fraud that had just been committed.

[Barbarakym]

Where I used to work, family members would "share" Medicare/Medicaid cards. We had multiple prenatals on the "same" patiient with different blood types.

This happens to this day in many urban areas with large amounts of un-insured people. They just don't understand the importance of a medical record history.

RE: Other possible reasons mentioned. Faulty admitting (to a wrong file) does happen. Not infrequently I am afraid.

I think safest bet is to always think identity first. Redraw and confirm and question the patient.

Kym

[Kathyang]

When I worked in a city hospital, we had this happen especilly in the Labor and Delivery. Patient's would share thier insurance card with a friend or relative. We would always redraw the specimen of the patient that was in-house to make sure that we had the correct patient at that time.

[Mabel Adams]

You would never want to leave a type in your computer that could cause harm if someone got the hare-brained idea to issue type-specific blood from a historical type (I saw it happen once to an inexperience tech that actually knew better but in the crisis forgot that detail of typing a current specimen).

I had a baby sitter 25 years ago that had named her twins Joline and Jolyn and got mad when the local college confused their records. I was glad one of them got married that year and changed her last name before their medical records could get entwined.