We are getting ready to change our crossmatching procedure to only Immediate Spin crossmatches if the antibody screen is negative and the patient does not have history of antibody formation in the past.

I need some good articles to prove to my staff that this is safe. (It is a standard in AABB I know, but they are still leery)

Anyone know any good literature to back this up? Or has anyone seen any good blogs about that on this site. Tried searching and I didn't really see any.

Thanks

Evrybody that goes that route experiences the same angst. If it is OK with the FDA and the other regulatory agencies (AABB,CAP) there should be no qualms about it. This has been an acceptable practice for over 20 yrs. but I can't tell you where to find literature to make your staff feel any better. I'm hoping to go with the e-xm and get a BB vending machine for the pt care areas - that is making my staff nervous.

Evrybody that goes that route experiences the same angst. If it is OK with the FDA and the other regulatory agencies (AABB,CAP) there should be no qualms about it. This has been an acceptable practice for over 20 yrs. but I can't tell you where to find literature to make your staff feel any better. I'm hoping to go with the e-xm and get a BB vending machine for the pt care areas - that is making my staff nervous.

That is what I tell them, but they don't want to take my word for it. I have people who are still washing cord cells (for manual gel), even though the provue has no washing step. they don't care, they still want to wash. They don't believe me I guess! : )

If they are not following your procedures - - - that could be a problem during an inspection. Some changes (esp to entrenched Blood Bankers) are difficult to introduce.

The Technical Manual may have some references. Have the doubting staff members review the literature. BTW, if I told my staff that they didn't have to do something like that anymore, they would be doing cartwheels!

R1R2

We did immediate spin for years then switched to electronic in 1995. It was hard for the techs back then to switch. If we told the current techs they had to start doing AHG XMs on everyone they would mutiny!! They complain about doing immediate spin during computer downs! GOOGLE immediate spin crossmatch. I found a lot of references.

We are getting ready to change our crossmatching procedure to only Immediate Spin crossmatches if the antibody screen is negative and the patient does not have history of antibody formation in the past.

I need some good articles to prove to my staff that this is safe. (It is a standard in AABB I know, but they are still leery)

Anyone know any good literature to back this up? Or has anyone seen any good blogs about that on this site. Tried searching and I didn't really see any.

Thanks

Use your crossmatch data for past 12-48 months to make your case. How many patients with a negative antibody screen had incompatible crossmatches? Due to unexpected antibody? Due to ABO incompatibility?

Change is hard but you might mention that this has been standard BB practice across the industry for in the neighborhood of 20 years in hospitals both large and small. How about some buy in from your Medical Director?

Going to ISXM is going to decrease the amount of time it takes you to get an ABO compatible unit of blood ready for transfusion which your ED will love I'm sure. Maybe give them a chance to "parallel test" for a couple of days, just to help them make the transition from the "old AHG" method to the "new, streamlined IS method". Once they do it a couple of times I bet they will be hooked.

I believe the original reseach was published by Boral and Henry in Transfusion around 1980. They were concerned about the standard 2 unit crossmatch (AHG of course) for every piddling surgery (think gall bladders, hysts, D&C etc). Besides the time and expense of testing, you tied up a lot of blood inventory for OR cases that never took the blood. They wondered if you just did an antibody screen, and in the off chance that the patient did indeed need the blood, could you do an IS crossmatch to ensure ABO compatibility, issue the unit and finish the XM at your leisure? So they looked at how many antibodies would be "missed" by the screen (relatively insensitive, 2 donors pooled in those days) but picked up by the XM, and if so, how common was that antigen, and came up with the figure that a negative screen alone was 99.99% effective in preventing the transfusion of imcompatible blood. BBers soon adopted the "type and screen" approach to those OR cases. After several years of success, someone said, how about applying this to all transfusions? So that 1 in 10:000 chance of bumping into an unexpected, say, anti-Wra became an acceptable risk of transfusion.

Malcolm, do you have the Boral and Henry article composting on your desk somewhere?

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Many a true word is spoken in jest Phil. We have just had a fire at home (care of a very kind neighbour and a deep fat fryer) that has made (hopefully, temporarily) 20 families homeless, including my own (hence I haven't been on here much for the last week or so), and I fear that most of my old papers may well have suffered from water damage, amongst them the one by Boral and Henry.

On the other hand, I attach an article I put together about 12 years ago now (it's also in the library section) that cites a lot of these papaers and may help ElinF to pursuade her staff that it is not dangerous to perform the immediate spin X-M under the circumstances described.

I hope a) I can attach it and that it is of some help.

Best wishes,

Malcolm[ATTACH]644[/ATTACH]

Goodness Malcolm!! Hope all are OK! Sorry to hear of the damage. Prayers for your family and neighbors.

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Many a true word is spoken in jest Phil. We have just had a fire at home (care of a very kind neighbour and a deep fat fryer) that has made (hopefully, temporarily) 20 families homeless, including my own (hence I haven't been on here much for the last week or so), and I fear that most of my old papers may well have suffered from water damage, amongst them the one by Boral and Henry.

On the other hand, I attach an article I put together about 12 years ago now (it's also in the library section) that cites a lot of these papaers and may help ElinF to pursuade her staff that it is not dangerous to perform the immediate spin X-M under the circumstances described.

I hope a) I can attach it and that it is of some help.

Best wishes,

Malcolm[ATTACH]644[/ATTACH]

Malcolm, I'm so sorry! I hope the damage turns out to be minimal. I'll be gone for a few weeks, you're welcome to stay at my place as long as you feed the cat. It might add a bit to your commute, though.

Thanks for sharing the article. I misremembered about the unpooled screening cells (I do seem to be overdrawn at the memory bank from time to time these days).

Thank you.

Yes, we are all okay and safe, although my son, Harry, did have to jump out of the first floor window, but he's fine.

Malcolm, that must be devastating! Here's hoping that you are all okay and that you can find a place to live soon!

Mari

Malcolm I am so sorry to hear about fire... Good to hear that your family is safe...

I see Malcolm has posted a very helpful article. I agree, most have been doing this for 20 years at least. I think in addition to giving your techs the article to read, you really need to take the proverbial bull by the horns and with your medical director say that "this is the way we are doing it from now on." You are the leader and as such, you make the decisions and as was pointed out above, everyone needs to be following the procedure and not doing their own thing. That will get you on an inspection.

Malcolm, I am very happy to hear that your family is safe.

I am having to use my wife's iPad, and I can't seem to get the "Thanks post" icon to work, but, believe me, I do thank you all for your kind best wishes.

.

Many a true word is spoken in jest Phil. We have just had a fire at home (care of a very kind neighbour and a deep fat fryer) that has made (hopefully, temporarily) 20 families homeless, including my own (hence I haven't been on here much for the last week or so), and I fear that most of my old papers may well have suffered from water damage, amongst them the one by Boral and Henry.

On the other hand, I attach an article I put together about 12 years ago now (it's also in the library section) that cites a lot of these papaers and may help ElinF to pursuade her staff that it is not dangerous to perform the immediate spin X-M under the circumstances described.

I hope a) I can attach it and that it is of some help.

Best wishes,

Malcolm[ATTACH]644[/ATTACH]

I am so sorry about your house fire. That is awful and devistating. Especially if you lost valuables. So glad you are safe though and I pray that things return to normal for you soon.

With the extinuating circumstances I am even more so grateful you posted this for me. I have already started reading it and am excited to pass it on. You have a mind of great knowledge and love reading all of your answers to eveyone's questions. Thanks Malcom!

Thank you Elin. we are all safe and the insurance is now kicking in, so we are better off than an awful lot of people.

Malcolm,that was a very useful artichle,I completely agree.But I have to add one neglected point:

1. Immediate Spin Crossmatch
   The Immediate Spin (IS) crossmatch is performed only after an antibody screen is done and found to be negative on a current specimen. The patient should have no history of clinically significant antibodies.
   The immediate spin crossmatch is meant to detect ABO incompatibility. It can also detect cold reactive (clinically insignificant) antibodies that react at room temperature (RT).
   If the patient's expected ABO antibodies are not reactive or weak at immediate spin,donor units should be ABO confirmed prior to testing with this method.
   

Malcolm,that was a very useful artichle,I completely agree.But I have to add one neglected point:

1. Immediate Spin Crossmatch
   The Immediate Spin (IS) crossmatch is performed only after an antibody screen is done and found to be negative on a current specimen. The patient should have no history of clinically significant antibodies.
   The immediate spin crossmatch is meant to detect ABO incompatibility. It can also detect cold reactive (clinically insignificant) antibodies that react at room temperature (RT).
   If the patient's expected ABO antibodies are not reactive or weak at immediate spin,donor units should be ABO confirmed prior to testing with this method.
   

I entirely agree with you.

I would suggest that you write a very precise protocol for crossmatching. It should spell out - exactly - under what circumstances an IS Xm is to be used and under what circumstances it is not, what antibodies are considered clinically significant and require antigen negative units with AHG and IS Xm, what antibodies are clinically insignificant and require a compatible AHG crossmatch along with the IS but not antigen screened units, etc. This seemed to give my techs, especially the rotators, the security blanket they needed in order to feel like they were doing the right thing for their patients.

I don't have exact references off the top of my head, but there are 2 excellent articles out there in cyberspace on this topic that were done by folks at MD Anderson in Houston and at University Hosp. Ann Arbor, Michigan. I found them by googling IS crossmatch and my medical director found them very informative when we were making the decision to make the switch. Both of these places did an extensive case review for stats, thousands of cases.

Malcolm... sorry to hear about the fire. Glad to hear that you and your family are safe.

The Technical Manual may have some references. Have the doubting staff members review the literature. BTW, if I told my staff that they didn't have to do something like that anymore, they would be doing cartwheels!

R1R2

AMEN to that, there would be dancing in the streets, and general partying because less work to do.