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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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We are currently doing the ABO retype on all non O's with no current history. However, I have had a lot of trouble trying to get our LIS to allow us to perform only the forward ABO and not the back type nor the RH. We are using a log book currently. It seems everyone else is doing a full type. Are any facilities only doing the forward ABO using Meditech? Pathologists' Regional Laboratory Lewiston, Idaho

Thanks

Teresa

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We require a second specimen from a different draw time if we have no previous history for RBC transfusions, using a computer crossmatch/dispense process. We have 2 exceptions; when there is an autologous donation available, and when the patient is type O. Otherwise, we immed spin crossmatch the autologous unit(s) or type O RBC.

Our LIS is set to generate a message to the patients' EMR when we do not have a historical ABO/Rh in our system, which initiates a new blood bank specimen collection by our pre-surgical team. For other transfusion patients we order a non-billed Patient Retype and use a hematology specimen collected at a different time, or send a phlebotomist to collect.

Kent Hospital, a Care New England facility, Rhode Island

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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

This is very similar to our system which we instituted in September of this year, although we have been doing electronic crossmatches since January of 2010. There was a great deal of pushback from certain areas at first, but things have settled down lately. Two separate ABO types are required for the computer xmatch, so we have been able to use this practice much more frequently since September. I use this as a carrot for the grumblers who think that type verification was invented just to annoy them. Until the type is verified we will issue only type O cells and type AB FFP. A properly labeled CBC specimen is acceptable for use if it was drawn at a separate time and preferably by a different phlebotomist. We are also using this as an opportunity to crack down on tube labeling issues in general, since we had been much too lenient in the past regarding non-blood bank specimens.

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We are currently doing the ABO retype on all non O's with no current history. However, I have had a lot of trouble trying to get our LIS to allow us to perform only the forward ABO and not the back type nor the RH. We are using a log book currently. It seems everyone else is doing a full type. Are any facilities only doing the forward ABO using Meditech? Pathologists' Regional Laboratory Lewiston, Idaho

Thanks

Teresa

We created a test in our LIS called ABOCONFIRM which is a forward type and Rh only. We can order and run it on a hematology sample from a different draw time or if we answer YES to NEEDCONF? the system will order it and a label will print on the nursing unit. We are using Meditech so I don't know if that is an option for you. We use Cerner Classic.

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We created a test in our LIS called ABOCONFIRM which is a forward type and Rh only. We can order and run it on a hematology sample from a different draw time or if we answer YES to NEEDCONF? the system will order it and a label will print on the nursing unit. We are using Meditech so I don't know if that is an option for you. We use Cerner Classic.

Is your ABOCONFIRM test completely separate from you original type? We created a forward type test, but it is having conflict with the original type. I don't know how to explain this very well I am not computer savey.

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Yes, it is a completely separate test. We built the Confirmneed question as a detail into the crossmatches so that anytime we answer a crossmatch it asks if we need the confirmation. If we answer yes it automatically orders it. Also the pre-op nurses order it if they are seeing the patient more than 3 days out from surgery. Than at least that is already done when we get the type and crossmatch the morning of surgery. You may need to have your LIS person consult with Meditech as to how to do this so there is no conflict. As our chemnistry PHD person says" if we can imagine it, the computer can be made to do it". Good luck.

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We are currently doing the ABO retype on all non O's with no current history. However, I have had a lot of trouble trying to get our LIS to allow us to perform only the forward ABO and not the back type nor the RH. We are using a log book currently. It seems everyone else is doing a full type. Are any facilities only doing the forward ABO using Meditech? Pathologists' Regional Laboratory Lewiston, Idaho

Thanks

Teresa

We are using Meditech C/S version 5.64. Currently, we test the uncentrifuged blood sample with anti-A,B on receipt for patients with no ABO/Rh on file. Our Type and Screen (a G-type test) includes a T-type test for entering the result of the anti-A,B serological tube test and BT (a B type test) for ABO/Rh interpretion. A test CONFIRM is configured in Meditech to include results entry for anti-A, anti-B, anti-D and BTU (a B-type test) for the ABO/Rh interpretation. Based on the result entered for the anti-A,B test, either the test CONFIRMO or the test CONFIRM is automatically reflexed when the result is saved and filed. The test CONFIRM is ordered on a new specimen (second venipuncture) to be collected from the patient. That second blood sample is tested with an A/B/D gel card (anti-A, anti-B and anti-D). The results are entered in Meditech and serve as the second ABO/Rh blood type on the patient, satisfying the Meditech requirements for the computer crossmatch. So we have two B-Type tests in our Meditech system, BT and BTU. BTU is also used for donor unit ABO/Rh confirmation tests.

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We are using Meditech C/S version 5.64. Currently, we test the uncentrifuged blood sample with anti-A,B on receipt for patients with no ABO/Rh on file. Our Type and Screen (a G-type test) includes a T-type test for entering the result of the anti-A,B serological tube test and BT (a B type test) for ABO/Rh interpretion. A test CONFIRM is configured in Meditech to include results entry for anti-A, anti-B, anti-D and BTU (a B-type test) for the ABO/Rh interpretation. Based on the result entered for the anti-A,B test, either the test CONFIRMO or the test CONFIRM is automatically reflexed when the result is saved and filed. The test CONFIRM is ordered on a new specimen (second venipuncture) to be collected from the patient. That second blood sample is tested with an A/B/D gel card (anti-A, anti-B and anti-D). The results are entered in Meditech and serve as the second ABO/Rh blood type on the patient, satisfying the Meditech requirements for the computer crossmatch. So we have two B-Type tests in our Meditech system, BT and BTU. BTU is also used for donor unit ABO/Rh confirmation tests.

Are you charging for this confirmation front type?

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....... That second blood sample is tested with an A/B/D gel card (anti-A, anti-B and anti-D). The results are entered in Meditech and serve as the second ABO/Rh blood type on the patient, satisfying the Meditech requirements for the computer crossmatch. So we have two B-Type tests in our Meditech system, BT and BTU. BTU is also used for donor unit ABO/Rh confirmation tests.

According to AABB Standards for the Computer Crossmatch (5.15.2) the two determinations of the recipient's ABO group (5.15.2.2) require both a forward and reverse type be performed (as specified in 5.13.1) if the computer system is used to detect ABO incompatibility.

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According to AABB Standards for the Computer Crossmatch (5.15.2) the two determinations of the recipient's ABO group (5.15.2.2) require both a forward and reverse type be performed (as specified in 5.13.1) if the computer system is used to detect ABO incompatibility.

Not a problem, we are not AABB accredited

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Dansket, Thank you so much your email, helped my IT work through the LIS. Can you please tell me how you are able to reflex the CONFIRM order? Is it attached to the B-type test or the anti-A,B test?

Thank your

Teresa

You are very welcome.

CONFIRM is our name for an LIS Order Group configured as an Order Type of ADD and a Spec Type of NEW. On page 2 of the LIS Order Group dictionary the BBK test entered is also named CONFIRM.

The Anti-A,B test in the BBK Test dictionary is configured for test results of 1+, 2+, 3+ and 4+ defined as positive test results and 0 (zero) is defined as a negative test result. On page 5 of the BBK Test dictionary for the test CONFIRM, the Reflex Order Group CONFIRM is entered for test results 1+, 2+, 3+ and 4+. The test CONFIRMO is entered for a test result of 0(zero). CONFIRM or CONFIRMO is reflexed by Medtech after the user files and saves the test results of the anti-A,B test.

Hope this helps.

Dan

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We require a second sample in a tube that is not available on the floor, that the BB controls. We also do electronic XM.

Barnes-Jewish Hospital, St. Louis MO

We also have a separate tube that we control. We go a step futher and put a strip of parafilm around the cap so they can't pull it off and pour over a previously drawn tube (yes, they were collecting extra and saving it for the confirm). Nursing draws all lab work at our facility.....

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We also have a separate tube that we control. We go a step futher and put a strip of parafilm around the cap so they can't pull it off and pour over a previously drawn tube (yes, they were collecting extra and saving it for the confirm). Nursing draws all lab work at our facility.....

Incredible.

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We also require a second specimen from a second venipuncture if there is no history. If unable to obtain a 2nd specimen, we give type O red cells and AB plasma. We usually can find an EDTA from Hematology to use and rarely have to actually draw a 2nd specimen or give O blood. We have been doing this for 3 years and have had excellent results. Parrish Medical Center in Titusville, FL 210-bed hospital.

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