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Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?


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If by "pretransfusion" you mean the pre-admission testing done before a patients surgery admit date to ensure safe blood is available on the date of their procedure, then yes, we will need a 2nd sample drawn. It can be drawn by a second phlebotomist in that outpatient draw location the same day as the first sample (rare, phlebotomists dont have access to our blood bank system to check), or collected on the date of their admission - either is acceptable as long as samples are properly labeled for blood bank.

But if you mean samples drawn in the doctors office just as an fyi with no hospital admission/transfusion anticipated, then no.

We do electronic crossmatch and I believe 2 samples are a requirement to do so. Its a great practice in general anyway imho - you dont have to work in blood bank long before you see all manner of swapped labeling, misdraws and general wierdness. You just pray it doesnt involve your name :P

Robert Wood Johnson New Brunswick NJ

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Currently our facility and our sister hospital (TriHealth in Cincinnati, Oh) does not but we are currently discussing this matter. If you perform electronic crossmatches, it IS a CAP standard to perform testing on a second phelebotomy (we still do tube crossmatches). It is only a matter of time before the standard is required for all samples that have the potential to be used for transfusion (pretransfusion testing) no matter what method is used to do crossmatches, so you might want to jump on the band wagon soon. It is the safest practice - and from what I heard, not too terribly difficult to implement in a hospital setting - when you explain to nursing the risks vs benefits of a redraw (which everyone hates). It is also possible to use EDTA samples from hematology from a seperate encounter (on same day as type and screen) which will reduce the amount of redraws needed. And most people needing blood have a CBC drawn around the same time ... so you just have to be able to prove it was from a different time of draw.

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Yes, we require a 2nd spec at a separate draw from all 'new' patients. Instiuted July 2010. We have a special tube not available on the floors that the BB controls. We order the ABO confirmatory test and send the tube with label to be drawn. We give group O's if necessary befroe the 2nd spec, but we make the ordering doc sign for them, like an emergency release. We have seen our rate of 'wrong blood in tube' (WBIT in the terminology of Sunny Dzik) drop gratifyingly. We instituted electronic XM Sept 2011. Boston Medical Center, Boston, MA

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"If you perform electronic crossmatches, it IS a CAP standard to perform testing on a second phelebotomy (we still do tube crossmatches)."

Can you tell me which CAP standard you are referring to? I cant find it. Thanks

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We only draw a second specimen in cases where the Blood Bank armband has been removed or when the specimen outdates.

Once upon a time, when pre-admit testing was not done almost always the morning of the procedure, we used to armband patients and have them wear it for a few days until they came in for the surgery. If they lost the armband, we would redraw them.

Scott St.Marys-Saginaw, MI

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CAPTransfusion Medicine Checklist 07.11.2011

TRM.40300 Historical Record Check Phase II

ABO, Rh, and antibody screen test results are compared against results of the same tests

recorded previously to detect discrepancies and identify patients requiring specially selected

units.

NOTE: Comparison of records of previous ABO and Rh typing are an essential step in compatibility

testing. Available laboratory records for each patient must be routinely searched whenever

compatibility testing is performed. If no record of the patient's blood type is available from previous

determination(s), the transfusion service should be aware that there is an increased probability of

an incorrect blood type assignment and, consequently, of a hemolytic transfusion reaction. If a

laboratory collects an additional sample for the purpose of verification of patient identity, a repeat

antibody screen need not be performed on this specimen.

TRM.40670 ABO Verification Phase II

The recipient's ABO blood group has been verified by repeat testing of the same sample, a

different sample, or by performing a historical search of laboratory records.

NOTE: Verification of the patient's ABO blood group must be performed by repeat testing of the

same sample, a different sample, or a historical search of laboratory records for that patient. Repeat

testing of the same sample may be inadequate unless the sample has been drawn using a

mechanical barrier system or digital bedside patient identification system.

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We require a 2nd specimen prior to transfusion or surgery if we have no history. For patients that have preadmission testing we send a hot pink form to OR notifying them that we will need a 2nd specimen. The nurses draw it when they start the IV. Karen

Lawrence Memorial Hospital, Lawrence Kansas

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Mabel-

We require this extra draw to confirm ABO (and by extrapolation, patient identity) only once on their first ever visit with us - people who have no history on file. Any time in the future we deal with them again, either current stay or future admits, we dont require any additional tubes be drawn (besides whatever T&S is required due to specimen outdating I mean). So I think you can argue its a self-limiting blood loss and the return in patient safety far outweighs the cost. We perform the front and back type in tube. Since nearly all of our initial T&S samples are run in gel its also a crosscheck for type discrepancies due to quirks of methodology.

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We require a second specimen only on non-O patients with no BBK history. It can be a microtainer sample. Since all of our neonates get group O blood, they are excluded. For group O patients and neonates, we simply repeat the ABO/Rh on the same specimen.

Children's Hospital Central California

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Mabel-

We require this extra draw to confirm ABO (and by extrapolation, patient identity) only once on their first ever visit with us - people who have no history on file. Any time in the future we deal with them again, either current stay or future admits, we dont require any additional tubes be drawn (besides whatever T&S is required due to specimen outdating I mean). So I think you can argue its a self-limiting blood loss and the return in patient safety far outweighs the cost. We perform the front and back type in tube. Since nearly all of our initial T&S samples are run in gel its also a crosscheck for type discrepancies due to quirks of methodology.

What is the time delay you insist on between samples and how do you deal with Trauma or major haemorrhage in a new admitted 1st time patient.

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We do require a second specimen from a different draw to perform a second ABO/Rh when no type is on record. We will first try to use a specimen from Hematology, if available, to do the retype testing instead of having the patient drawn again. Facility is Missouri Baptist Medical Center.

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We do require a second specimen from a different draw to perform a second ABO/Rh when no type is on record. We will first try to use a specimen from Hematology, if available, to do the retype testing instead of having the patient drawn again. Facility is Missouri Baptist Medical Center.

Do you have the same sample labelling requirements for your FBC samples as your Blood Transfusion samples.

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I'm sorry, but what is an "FBC sample"?

Sorry as Malcolm Needs is often pointing out although we think we have a common language there are differences between US and UK english. FBC is full blood count, I think you may call it a CBC. We could not use our Haematology samples in transfusion as they almost all have printed labels on them from ward or GP ordering systems.

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Thanks for the explaination of FBC! Our hematology samples aren't necessarily labeled the same as our blood bank specimens either, but we are only performing the ABO/Rh confirmation testing so it's ok with us. With this specimen, we are at least sure it is from a different patient identification and specimen collection time. We do not use that sample for compatibility testing, only the second ABO/Rh.

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We also use CBC samples that are drawn at a separate time as our recheck. They are usually drawn by our phlebotomists using a barcode-scanning handheld, so it has the same info on it that our Blood Bank samples have. Anyone that we do not get a chance to do a CBC and they need an urgent transfusion, they get type O blood until a specimen can be obtained.

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My interpretation of the CAP requirement is that two ABORh types must be performed in order to issue an electronically crossmatched unit but those don't necessary need to be performed on two separately drawn samples.

The laboratory I work in does not require an additional sample in order to issue electronically crossmatched units. A second ABORh type is performed using the same sample used for the initial ABORh type by a second tech by tube or by a second tech on another automated instrument.

They also do not require a confirmatory ABORh type on a sample from a current encounter before issuing components to a patient who has been seen previously in our hospital. They are issued based on historical type.

Annadele

How has anyone that has instituted patient blood management principles (including limiting phlebotomy losses) made it work with the drawing of 2 samples for blood type checking? Do you draw really small repeat samples? Just do a forward type or...?
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Our hematology samples aren't necessarily labeled the same as our blood bank specimens either, but we are only performing the ABO/Rh confirmation testing so it's ok with us.

I'm sorry to be a miserable old grouch, but what is the single most important test that is carried out by a Blood BanK? The ABO, I would say, because, if you get this wrong, it doesn't matter how good you are with all your other tests, you could end up with a very dead patient. Therefore, I don't think that you should compromise on labelling, even if it is only a confirmatory test. Just my opinion.

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I agree with you Malcolm (does that make me a grouch too :P)! And typing the same specimen twice (which has been done in other places I have worked; some requiring a 2nd Tech., and some, allowing the same Tech.) only catches (maybe; you have to allow for biased Testing) a mistype; not a misdraw. Having worked in 5 Hospitals (this being my 6th), I have seem a LOT of misdrawn/mislabeled specimens in my day. I think the 2nd blood draw (at a different time; by a different phlebotomist) is a great idea; regardless of the method of crossmatch.

Brenda Hutson, MT(ASCP)SBB

I'm sorry to be a miserable old grouch, but what is the single most important test that is carried out by a Blood BanK? The ABO, I would say, because, if you get this wrong, it doesn't matter how good you are with all your other tests, you could end up with a very dead patient. Therefore, I don't think that you should compromise on labelling, even if it is only a confirmatory test. Just my opinion.
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What is the time delay you insist on between samples and how do you deal with Trauma or major haemorrhage in a new admitted 1st time patient.

Its not a set length of time, its a separate stick signed by a different phlebotomist who ideally has repeated the same identity checks and agrees armband vs label etc is correct. If for any reason someone needs blood and the second specimen has not come in yet, they are issued blood under the standard emergency release policy - O Pos uncrossmatched (unless woman of childbearing age) with ordering doctor accepting responsibility and stating life threatening need. Having to order under a special pathway and explicitly stating they are putting patient life at unknown risk issuing blood without full compatibility testing generally squashes circumventing the system.

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