antibody patient and crossmatch question

[ChrisH]

Hi eveyone,

Hope you had a great weekend.

What is your standing practice in reguards to inpatients with known antibody (ies) and only type and screen ordered.

Do you crossmatch 2 units even though the doctor has not requested anything,

do you find antigen negative units to have on hand only but leave the crossmatch for when the doctor orders it.

or do nothing extra.

Thank you Chris

[Gkloc]

Here when we have any patient with a history of antibody(ies) or new patients with no hstories and the screen is positive we antigen type units and crossmatch 2 to have on hand in case the patient needs them so that there is no delay in patient care.

[Deny Morlino]

A screen indicates we have potentially compatible blood on hand in case a cross match is ordered. As a result, we request antigen negative units from our suppliers.

[David Saikin]

We screen and xm 2 units for these patients. The expectation with a preop T&S is that blood will be quickly and readily available.

[tbostock]

We antigen type so that we have two units, we put them on hold for that patient, but wait for the crossmatch until the physician orders the blood, unless OR patient, then we crossmatch them on OR day.

[John C. Staley]

We antigen type so that we have two units, we put them on hold for that patient, but wait for the crossmatch until the physician orders the blood, unless OR patient, then we crossmatch them on OR day.

In my previous life we did the same except for the OR patient. We didn't crossmatch the OR patient until they ordered the blood but we made sure we had at least 2 units on the shelf that were antigen negative and ready for crossmatching.

[L106]

Guess I'm the "odd-man-out" here. We report out the Type and Screen results as "Blood is not available on a Type & Screen Basis. Crossmatches should be ordered if transfusion is anticipated" and we notify the physician about the patient's antibody. Typically, we do not go about finding donor units for the patient unless the doc orders crossmatches.

However, I usually peek at the patient's hemoglobin and what surgery procedure they are having (if any.) If it looks likely that transfusions might be necessary, we usually go ahead and do the antigen typings and crossmatching to find 2 units for the patient to have on our shelf.

Donna

[AMcCord]

We do what David does.

[Liz]

Good for you Donna! I agree, the Blood Bank staff has so much more experience than the ordering physician. So yes it depends on the case. One can always ask the BB supervisor or director so as not to be blamed for making a smart decision.

If there are antibodies we would inform the doctor of the extra time needed. Keep him/her in the picture. Most often you will be asked to prepare (wash, filter irradiate and do a rain-dance). Seriously though, we would keep the ag negative units stand-by and crossmatch when (if) requested.

[KKidd]

We only obtain 2 antigen negative units if the patient is pre-op. THen the physician is contacted to see if they want the blood crossmatched. We also tell them how long it will take to have blood available. For an in-house patient, we do not routinely cell type for the antigen. Each case is evaluated and the physician contacted as needed.

:bye:

[jbrun]

At our facility, we are similiar to Donna. It depends on the patient and is thus a case by case basis. We make certain that the physician is aware of the antibody status and try to ascertain their wants but also anticipate patient needs. Sometimes we antigen type and sometimes we wait.

[Dr. Pepper]

We do as David does as well. The thought behind the type and screen is that you probably won't need the blood, but if you do, you'll need it in a hurry. An electronic or immediate spin crossmatch takes just a few seconds. Not so for a full crossmatch and screening donor units, etc.

[ElinF]

We would screen and cross 2 units of blood to be ready for the patient if the antibody screen is positive.

[adiescast]

We do two units for ER and OR patients.

[Malcolm Needs ☆]

Having had experience of a circumcision case that required 28 units, and a case of epistaxis that required 10, I would strongly advise that the doctor is always contacted and told of potential delays (and by that, I mean potentially fatal delays) and suggest that a minimum of two units be cross-matched.

At the old Westminster Teaching Hospital (now, alas, defunct) there was a liver in the museum with a huge split down it. The sign underneath simply said "Patient coughed during liver biopsy!. It is as well to remember that even the simplest operation can go wrong.

I would also suggest even more strongly that the antibody specificity be identified before the operation takes place, backed-up, if necessary, by your own Doctor-in-Charge of the Blood Transfusion Laboratory. I have, within the last four years, been faced with identifying one case of anti-K+Era, and one Oh (Bombay, if you must) with stong anti-H, both whilst the patient was on the table having a "cold" (routine, rather than urgent) operation.

Putting such pressure on a Reference Laboratory, let alone a Hospital Blood Bank is totally unacceptable.

:ohmygod::ohmygod:

[Deny Morlino]

Putting such pressure on a Reference Laboratory, let alone a Hospital Blood Bank is totally unacceptable.

:ohmygod::ohmygod:

As unacceptable as it may seem, the physicians refuse to listen to the recommendations of blood bankers more often than not resulting in pressure additions for themselves as well as the blood bank departments.

[Malcolm Needs ☆]

I agree Deny, but this is why I say that your Doctor-in-Charge of Blood Transfusion should really be involved as early as possible in such a situation, so that Clinician speaks to Clinician on equal terms, because, sadly, as I know only too well from experience, some Clinicians (not all, by any means) see the Technician as having little, if any, knowledge.

[Mabel Adams]

We used to go ahead and crossmatch 2 units but we had a nurse interpret the crossmatch order that fed back to her computer from ours as a transfuse order and she gave blood to someone with no orders. The MD couldn't figure out where the crossmatched blood came from. Now we call the MD to ask if they want us to set up units. If we can't get an answer the default would be to do the xm as before but most of the time we can get the needed information. Many of them do not want the blood set up. We have had no emergent needs where blood wasn't ready. Obviously if we are talking about an anti-k we would have a longer conversation with the MD and probably order in antigen negative units.

[Eagle Eye]

We find two antigen negative units and crossmatch them.

Except patient with anti-e , we talk to physician and make sure they know the turn around time for blood.

[lateonenite]

We have an automatic test added to anyone with a positive antibody screen or history of a positive antibody screen that comes up on their side as "Crossmatch delay" and we answer it with a comment. We also notify the treating clinician if the patient has an antibody.

If the phenotype is difficult, or there are multiple antibodies, we will order two units at least from Red Cross (but we also look at the Hb incase we need more). We have high enough stocks most of the time for straightforward things like Rh or Kell we can find units in our own fridge.

The only time we will crossmatch without an order (which we soon rectify by either explaining to the doctor, or getting our hematologist involved to speak to said doctor) is if the patient has an auto and compatibility is impossible; then we get our hematologist to liaise with the clinical team - all incompatible units must be approved by our docs first.

[lateonenite]

some Clinicians (not all, by any means) see the Technician as having little, if any, knowledge.

Except, lol, when they want reassurance that the transfusion will be or has been "safe" and don't necessarily want to be the only responsible party. Admittedly that's usually toddler doctors (as opposed to baby-doctor-interns). It's equal parts amusing and frustrating in the middle of the night, because they don't want to wake up either the hematologist or haem reg.

[Brenda K Hutson]

I am in the process of changing our SOP to address this exact issue. What it "will" say is that anytime a positive antibody screen is obtained, the Physician should be notified ASAP. If it is a pre-op for the following day, staff must contact the Physician (can call answering service in evening) both to notify them, and to inquire as to whether they would now like to change the order from a Type and Screen to a Type and Screen and Crossmatch. Even if they do not, depending on what the antibody(ies) is and/or the nature of the surgery (thus the chance of them using blood), we may elect to at least have antigen screened units avaialable.

Obviously I have not yet thought out all of the scenarios; nor all of the specifics, but it is "coming soon to an SOP near you!"

While you may very well have some Physicians get upset with you for calling to notify them, I promise you that the ones who get upset the next day when their patient is on the table needing to be transfused and it is at this point you choose to "spring it on them," will make you realize that not only is it safer for the patient, but it is the lesser of 2 evils with the Physicians as well. You can't please everyone! Just make patient safety your highest priority and let that guide your decisions (as well as any regulatory considerations).

Brenda Hutson

Hi eveyone,

Hope you had a great weekend.

What is your standing practice in reguards to inpatients with known antibody (ies) and only type and screen ordered.

Do you crossmatch 2 units even though the doctor has not requested anything,

do you find antigen negative units to have on hand only but leave the crossmatch for when the doctor orders it.

or do nothing extra.

Thank you Chris

[parnj]

We crossmatch 2 antigen neg units.

[jeanne.wall]

It has been some years since I was in a transfusion service but a positive antibody screen, or even a history of an antibody in a patient with a negative antibody screen was a “call value”. We’d call the physician and have a discussion about blood need and availability. It really helped getting everyone on the same page. Sometime was did the compatibility test, other times we just found antigen negative units, and, on rare occasions, we did nothing because the physician had determined that the patient wouldn’t be requiring transfusion.

Jeanne

[DPruden]

We used to automatically setup 2 units, but we do not routinely do this anymore. We always call the MD and let them know their patient has an antibody. If the patient is going to surgery, we consult with our Medical Director and depending on the patient's diagnosis and the antibody, he will instruct us to crossmatch antigen negative units.