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Computer crossmatch and missing specimen


kirkaw

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Hi All,

We had a situation yesterday where we could not locate a specimen when the OR called wanting 2 more units of red cells for a heart surgery in progress. We had 2 independent determinations of the patient's blood group and type on the current specimen and our computer system has the logic to alert the user of discrepancies between donor and recipient ABO/Rh..

The question is, could I have issued those 2 units with only the computer crossmatch?

Thanks,

Amelia

PS. We found the specimen in a rack from a different date, but I was wondering if I would have been in violation of standards if I had not been able to put my hands on that specimen.

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There are no standards that I'm aware of that would address your issue. Your decision is driven by your internal policies and procedures. In our case, if a patient is known to qualifiy for electronic crossmatch we don't need or physically handle the specimen, just add the order to the existing current Type and Screen in the computer and crossmatch away!

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If your system is validated to perform an electronic crossmatch and all the required elements are met, why do you physically have to have specimen at hand at time of crossmatch? Do you recheck the blood type before electronically crossmatching the unit? The problem is: if your SOP requires you to do something with the specimen and you don't do that part you are in violation of your SOP. It would require medical director approval as a deviation from SOP.

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We do handle the specimen each time. We want people to verify on every order that they have the right patient and there is nothing that has been overlooked. I don't feel everyone must do this but it is what we do. We had some sort of problem that would have been prevented by this--maybe the band number being entered in the computer wrong--can't quite remember.

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We would do a Computer Crossmatch without retrieving the specimen. We do use a separte blood bank armband and the BB band number must be scanned initially from the specimen bar code. Once entered the specimen is not required for additional Computer Crossmatches

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We don't physically have the specimen in hand with our electronic crossmatch. But we do make sure the specimen is available. It must be available for 7 days past the transfusion in case of reaction. If we couldn't find the specimen, we would have the patient redrawn.

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Our policy requires us to retrieve the sample. This for us serves as a second check if a new tech is crossmatching units, to verify that there isn't a name/MRN discrepancy (proper labeling was done) that might have been missed by testing tech.

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There are no standards that I'm aware of that would address your issue. Your decision is driven by your internal policies and procedures. In our case, if a patient is known to qualifiy for electronic crossmatch we don't need or physically handle the specimen, just add the order to the existing current Type and Screen in the computer and crossmatch away!

I agree.

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  • 4 months later...

Hi Everyone, I am so glad I found this thread. I am looking for guidance. We are debating what our policy should be regarding handling the tube again for an electronic crossmatch. We would like to NOT handle the tube again but cannot decide how we would type in the bb id, or where would we take it from, if not pulling the original sample. We result the bb id when resulting the type and screen, is this where you would get the id from? Thanks!

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