Unit Re-typings and labeling tubes

[KBBB]

Has anyone had to deal with a Tech who doesn't label tubes for unit re-typing? ...or does anyone not require it because it's "only unit re-typing?" I am an indoctrinated Blood Banker and label everything.

[tgambill]

Everyday place I have worked required ALL tubes to be labeled. I hae the unit re-types set up so that when the units are entered, the re-type is ordered and a label prints automatically. Our labels consist of one bar coded label and 2 smaller labels with the information but no barcode. I have instructed the techs to use these labels, and write A, B, and D on the labels to make it easier for them. So far, everyone likes this idea.

[David Saikin]

label all tubes for everything

[Malcolm Needs ☆]

I agree with David, but, in this case, especially.

What, after all, are the most important blood group antigens? ABO and D.

Anti-A and anti-B mis-matches can be fatal, but, in most cases, cause major morbidity.

Anti-D can cause death in utero.

Not to label the tubes, and to cause a transfusion reaction or HDFN, is not only unprofessional, it could be construed as involuntary manslaughter (and I'm not certain the word "involuntary" is justified in this case).

:angered::angered:

[jayinsat]

Scenario: You received 20 O pos PRBC's from your supplier. You enter them into inventory and pull a segment to retype (key word is retype because the donor center has already verified the blood type with at least two independent tests). Your procedure for retyping O POS prbc's is run anti-A,B only. You line up 20 test tubes with Anti-A,B added and then drop one drop of cells, directly from the segment into the tube. You do this in a prenumbered rack and line up the segments in order with the rack (1-12 first row, 2-24 second row, etc). You then spin all 20 tubes (12 at a time as your serofuge only has 12 slots), read and record your reactions on a pre-printed worklist. If all 20 tubes show no agglutination, you have confirmed that all are indeed type O. So basically, you are only checking for the lack of agglutination with anti-A,B.

If any segment shows agglutination, you go to the original unit, using the number printed on the segment, and retest. If it is indeed mislabeled, you return it to the supplier.

Why does that process require labelling each tube individually? Automated instruments don't label each gel card/plate individually. They simply maintain an orderly process.

Ok....launch your stones! :fingerscr

[JOANBALONE]

I agree with jayinsat. I haven't labeled a retype tube in 20 years. I retype only the same blood type at one time.

JB

[Auntie-D]

I label everything - it's at very least good practice... And agree with what Malcolm says about manslaughter.

In England units are guaranteed, in Scotland not. But I don't know of any labs in Scotland that check the groups of they bags unless the EI - your immediate spin should guarantee ABO incompatibility.

As for tube groups - I only actually label with the details of the patient not the reagent as - blue = A, yellow = B and no colour = D. The controls all get labelled with a C to distinguish them.

[mollyredone]

I agree with James. I keep the tubes and segments in order until the whole batch is done. Haven't had a mismatch yet!

[jayinsat]

I label everything - it's at very least good practice... And agree with what Malcolm says about manslaughter.

In England units are guaranteed, in Scotland not. But I don't know of any labs in Scotland that check the groups of they bags unless the EI - your immediate spin should guarantee ABO incompatibility.

As for tube groups - I only actually label with the details of the patient not the reagent as - blue = A, yellow = B and no colour = D. The controls all get labelled with a C to distinguish them.

The key here is we are discussing unit retypes, not determinging ABORH Group/type on the unit or patient. We are only talking about verifying the blood group of a unit received from a donor center. Most labs that receive large quantity shipments of blood daily simplify this process because the risk is so minimal, especially since the test itself is only an abbreviated test.

Edited November 11, 2011 by jayinsat
spelling problems. :(

[Mabel Adams]

And to play devil's advocate: writing symbols on the tube to tell you what is in them works we know. Could you use color coding to tell you what is in them? Hmm, all the tubes marked with blue contain anti-A and all those marked with yellow contain anti-B. Hmm. The reagents are colored blue and yellow. Hmm, isn't that the same as a symbol? I know it makes blood bankers shudder, but what really does it matter what the symbol is so long as the person reading them can detect it reliably?

And yes, I spent many a year typing patients with a very rigid process and not labeling the tubes except for D and D control. I later started labeling because I was training new people and not all could be trusted to have a rigid, precise system. I do at this point advocate labeling patient testing. Here's a thought: how many techs label the tubes but don't look at the labels as they read the results? If a tree falls in the forest and no one is there to hear it, does it make a noise? If you require labeling but no one reads them does it provide safety or just make us feel better?

[SMILLER]

I kinda go along with what Jay and others have said about marking unit IDs on tubes for unit typing verification. (I admit I only do it when there is an inspector around).

The only problem would be that if one tube out of a batch turns out with an unexpected reaction, you would have to redo the whole batch. But if you are careful with keeping everything in order, this would not happen very often.

We do encourage students to label everything.