Specimens sent to reference Labs

[Carol F]

I am curious, when you send a specimen out to your reference lab for workup and crossmatch how do you handle the units when you receive them back? Do you 1) retype the unit? 2)confirm the crossmatch? 3) confirm antigen typing on the units? Thanks in advance for the input

[Malcolm Needs ☆]

I am curious, when you send a specimen out to your reference lab for workup and crossmatch how do you handle the units when you receive them back? Do you 1) retype the unit? 2)confirm the crossmatch? 3) confirm antigen typing on the units? Thanks in advance for the input

Why on Earth would you do any of these? If the Reference Laboratory has performed the cross-match, then they take responsibility, and if there are any clinical sequalae, they, surely, take the wrap. If you do any of the above, you take the responsibility, and you take the wrap.

[Marilyn Plett]

In the US, the extent of reference lab services and liability may depend on the contract.

[BANKTECH]

We will retype the units as we do with all red cells brought into inventory. We do not confirm the crossmatch (as the reference facility generally has done absorptions or a technique we are not able to repeat....so if we did a crossmatch, we would likely call incompatible). Antigen testing is not repeated if the reference facility confirms the antigens. However, if the antigen testing is historic, we will perform at our facility. When the unit has been crossmatched and/or confirmed antigen testing performed by the reference facility, we will make a note of this on the unit.....so if we have to look at it with an inspector for any reason, we know and can dig out the paperwork.

[LCoronado]

We will retype the units as we do with all red cells brought into inventory. We do not confirm the crossmatch (as the reference facility generally has done absorptions or a technique we are not able to repeat....so if we did a crossmatch, we would likely call incompatible). Antigen testing is not repeated if the reference facility confirms the antigens. However, if the antigen testing is historic, we will perform at our facility. When the unit has been crossmatched and/or confirmed antigen testing performed by the reference facility, we will make a note of this on the unit.....so if we have to look at it with an inspector for any reason, we know and can dig out the paperwork.

We repeat everything - unit types must be confirmed and we extend that to mean antigen typing as well. We have to enter crossmatch results in the computer system in order to dispense the unit without getting an exception message stating that we are dispensing uncrossmatched blood, and we don't want to enter reactions/results we haven't actually performed.

[Eoin]

I'm with Malcolm. Seems we do things differently here on this side of the water. Units come with Compatibility and Traceability Tags and a Compatibility Report for the patient. If it hits the fan, they are responsible. Mind you, we do have an SLA. Also as part of ISO15189, the reference lab must be accredited (we get proof of their compliance(EQA etc and their registration)>

Cheers,

Eoin:cries:

[Malcolm Needs ☆]

I'm with Malcolm. Seems we do things differently here on this side of the water. Units come with Compatibility and Traceability Tags and a Compatibility Report for the patient. If it hits the fan, they are responsible. Mind you, we do have an SLA. Also as part of ISO15189, the reference lab must be accredited (we get proof of their compliance(EQA etc and their registration)>

Cheers,

Eoin:cries:

Thanks Eoin.

In addition, with a lot of the units we cross-match (mostly, but not always for cases of DAT), many of the hospitals wouldn't have CE-marked grouping reagents available to re-group the units (for example, anti-k, anti-Kpb, anti-U).

[LCoronado]

Thanks Eoin.

In addition, with a lot of the units we cross-match (mostly, but not always for cases of DAT), many of the hospitals wouldn't have CE-marked grouping reagents available to re-group the units (for example, anti-k, anti-Kpb, anti-U).

Malcolm - that's true. I should have qualified my statement to say that we repeat everything to the extent possible, given our limitations as a smaller transfusion service. :imslow:

[Eagle Eye]

we need to re type, re crossmatch, re test antigen typing. We can not use the crossmatch reuslt from our blood center as they are not authorized to do do.

I guess US standard is diffrent than EU standard!

[jerriemc]

We retype the units and perform the cross match. Our reference lab does not perform cross matches they just screen units for the antigen. We had a real problem with this once. They sent us units on a patient negative for the antigens they had found antibodies too. All 4 units were strongly incompatible. I called them and they sent 2 more units that were also incompatible. I finally spoke with the reference lab supervisor and she agreed to cross match units before sending them. About an hour later she called me back asking for more specimen on the patient they were going to have to send her off to another reference lab.

[Sandy L]

We would never use a reference lab’s crossmatch. Our reference lab would perform antibody identification and antigen typing and may in some instances also pre-screen units for compatibility using the patient’s plasma. The units would come to us labeled with antigen typing results. If compatibility “screening” was done they would have a label saying that the unit must be crossmatched. We would enter the units into our inventory, perform unit ABO/Rh confirmation testing and would crossmatch the unit. The crossmatch may be incompatible in our hands (e.g. patient has warm autoantibody) and would be signed out as such. We would add a statement to the tag to state testing done by reference lab indicating for example “Warm autoantibodies present. Units are incompatible with neat plasma. No underlying alloantibodies were detected in adsorbed plasma at [name of reference lab]. MD notification complete to: __” or a similar type of statement when alloantibodies are present and units are antigen negative.

[Malcolm Needs ☆]

I am simply amazed at the number of members whoare saying that their Reference Laboratory will not cross-match for them. Whilst it is something that we do not jump at the chance of doing, and will NOT do, if we have identified all the antibodies and can provide antigen negative blood, in the case of an auto-antibody we will do it, and in particular, if there are underlying alloantibodies, we would expect to do it.

This may change when the new BCSH Guidelines come out, when, if we detect no atypical alloantibodies masked by an auto-antibody, immediate spin cross-match at the hospital will be mandated, but we would still cross-match for those patients with alloantibodies masked by auto-antibodies.

The mind boggles.

[AMcCord]

It's all about liability - don't forget that the US is 'sue happy'. It didn't used to be like this. Several years ago a change was made in that our reference lab would crossmatch units, but they would be referred to as 'prescreened with patient plasma' and reported as compatible or incompatible. The crossmatch of record was still our project. We recently received notification of another change. They will now perform the crossmatch of record, if requested, or will perform compatibility screening - the choice is ours. We would probably only request the crossmatch of record for warm auto patients.

Edited August 29, 2012 by AMcCord