Using shared samples for Blood Bank testing

[brobinson]

I have worked in the blood banking field for some time now. I recently started as manager at a different health care system and the practice of doing "add-ons" for transfusion service samples is common. I have worked in multiple hospitals over the years and have never encountered this practice before. On a rare occasion (pediatric or extremely difficult draw patient) some places pemitted this, but it never was common practice. I perform inspections/assessments for CAP and AABB and have never seen this being routinely done but can not find any standard, etc. that says it can not be done. We have a collection manager system so we do know the identity of the collection personnel so other sections of the lab do not understand why this should not be done. Our medical director, technical specialists and I want to discontinue this practice, but we honestly do not know what valid objections would be other than it makes us uneasy. Any thoughts on how to persuade the rest of our managers and laboratory director that we should not do this?

[Bill]

There are many hospital laboratories that use the add on practice--in 4 of 5 where I have worked, the add on practice has been used quite successfully. As a patient, I would object to a redraw just because the technical specialist is "uneasy."

[MAGNUM]

We had this same "problem" when I took over the blood bank. Sometimes the phlebs get lazy or dont want to hear the patient complaints about another stick, but they have been shown the error of their ways. The main reason is "because I say so!"

[John C. Staley]

I'm afraid that I agree with Bill. I'm not sure why you are uncomfortable with the practice other than "That's not the way we did it where I came from." In the labs where I supervised the blood banks the process and requirements for patient identification and blood collection was exactly the same for all area of the laboratory, to include the blood bank. When ever possible we would share the samples.

:abduction

[Eagle Eye]

If you have same specimen collection requirement for the lab and blood bank.....We do not require signature for non blood bank specimen. On rare occassion we would share our specimen with other department but do not use other lab specimen for blood bank tests. Sometime we would use hematology specimen for (particularly red cells) for additional workup after confirming the reactivity with their specimen. (in other words if we were to use CBC specimen to run additional panel, we will run antibody screen on the CBC specimen before using CBC specimen).

[brobinson]

I really appreciate your comments. This process causes a lot of extra work for the BB techs because all the calls come into our department, then the techs need to leave the department to go track down the tube. This is a real problem on evening and second shift when we have only 2 or 1 tech on the shifts. We realize that as far as customer service it is a good practice and we do want to do what is best for the patient, it is just that at one of our facilities they are constantly having to go track down the tubes and they spend a lot of time doing so. That is time away from performing testing and being there to issue blood when needed in some instances. Since our specimens are labeled the same way regardless of where the testing is being done, it does fit into an acceptable sample. I just really wanted to get some other perspective into this practice. I guess we will need to work on a better way to get the tubes to our BB. Again, thank you.

[tbostock]

Beverly, I agree. You do have to balance customer service with safety. And as long as your labeling requirements are the same, I would probably accept them. We do two blood types here, so we are always tracking down CBC specimens to use for the confirmation type, so I feel your pain.

Maybe you can work with your Hematology dept to have them store tubes so that they are easier to find.

[webersl]

The only supporting argument I can give you is specimen volume. You can say that you need to be assured that you will have enough volume to perform the type and screen, antibody ID, crossmatches, and enough left over should there be a transfusion reaction and you need to repeat above testing to confirm there was not a BB error. Present that even a sample that is just a "type and screen" can often convert to a crossmatch depending on the patient's need - so there is no way to know which samples you may need large volumes on and which you don't. My hospital had always drawn a separate sample for blood bank, so I have never had to defend the continuation of that practice - so far.

[Barbarakym]

Any thoughts on how to persuade the rest of our managers and laboratory director that we should not do this?

I agree with you. Wrong blood in tube is a much more common experience in the regular laboratory. Phlebotomists et al, tend to be much more careful with identification when they know they are drawing blood bank specimens. For us it is easy as we use Blood Bank Bands. BB Band number must be written while at the patient's side and thus can not be added later. No BB band number, no Blood Bank testing.

Kym

[Generic]

At our hospital we rarely use samples from other parts of the lab (really, we will only take them from hematology). The rest of the lab used to not be as stringent on correct labeling as we in the blood bank are, although that has changed recently. I think that our lab has a form the nurse has to fill out with the reason the sample needs to be transferred from hematology to blood bank, but I've never seen it. We don't allow other parts of the lab to use our samples, the reasoning behind this as it was told to me is that if something happened and we were taken to court, we could run into legal issues if the sample was taken out of the blood bank. My main gripe about accepting samples from hematology is that the barcode labels they use in the main lab are huge and cover up the entire patient label. I prefer to be able to see that it is correctly labeled myself, and it is nearly impossible to peel the barcode label off and not destroy the underlying patient label. The processing area is always really busy, and there have been instances where the wrong barcode label has been put on a sample...

[Malcolm Needs ☆]

Agreed Generic. I think that the medico-legal overtones are hugely important.

[Dr. Pepper]

Maybe you can work with your Hematology dept to have them store tubes so that they are easier to find.

Some time ago we hit upon a system that makes the hunting much easier. We have a different color set of racks for each day. The hem specs are sorted by the last 2 digits of the specimen # as they are resulted. The 5 storage racks (standard epoxy-coated 108 hole) are divided into 2 sections, rack #1 having #s ....01 through ....09 in front, ....10 through ....19 in back, etc. Works great, you have at worst 1/10 the number of specs to look through. We have a similar system for chemistry specs.

I would like to think with all my heart that people pay more attention to proper labeling of blood bank tubes, but I doubt that really happens. Still, we will use any tube for a second confirmatory typing, and will use other dept tubes for cells for DATs or eluates or more serum/plasma to do antibody IDs, but only use tubes specifically drawn for BB for the actual type, screen and crossmatches.

[Mabel Adams]

I'll throw out one idea I have heard in the past. I don't think anyone did any testing on this; it was purely speculation. The idea was that when the Hematology analyzer pierced the EDTA tube it could carry a small amount of cells from the previous specimen into the current specimen. It wouldn't be enough to interfere with the hem testing but if the patient had, say, a barely detectable anti-c and the specimen ahead of it was c positive, the contaminating RBCs could absorb out enough of the anti-c to make it undetectable when tested later in Blood Bank. I would actually like to see some SBB student do this as a project with known antibodies and antigen positive specimens so I can lay it to rest as a source of interference. Any takers?

[Malcolm Needs ☆]

I'll throw out one idea I have heard in the past. I don't think anyone did any testing on this; it was purely speculation. The idea was that when the Hematology analyzer pierced the EDTA tube it could carry a small amount of cells from the previous specimen into the current specimen. It wouldn't be enough to interfere with the hem testing but if the patient had, say, a barely detectable anti-c and the specimen ahead of it was c positive, the contaminating RBCs could absorb out enough of the anti-c to make it undetectable when tested later in Blood Bank. I would actually like to see some SBB student do this as a project with known antibodies and antigen positive specimens so I can lay it to rest as a source of interference. Any takers?

That would involve an awful lot of elutions!!!!!!!

:surrender:surrender:surrender:surrender:surrender

[Mabel Adams]

I think since we are looking into a disappearing antibody, the study could be done to prove that weak antibodies are still detectable even after "chasing" an antigen positive sample through the Hem analyzer. One could look for a decrease in titer before and after but I don't think elutions would be necessary.