josie Posted December 21, 2012 Share Posted December 21, 2012 I would like to ask for your opinion and supporting document regarding this subject. The patient has a current record of blood type and antibody screen done within 72 hours by another technologist. The Operating Room called and need emergency release of blood. Our current policy is to give O neg to child bearing age and O pos for male and above 50yrs old for female. Recently, we had a discussion about giving type specific blood blood during emergency release. My question is can you look at the current record of blood type and antibody screen in the book which is done within 72 hours by another tech and issue a type specific blood basing from that? If your answer is no, can you please let me know the supporting document that I could print.Personally, my answer is no and I would really appreciate for a document that support this. If your answer is yes, I would like to hear from you also. I appreciate all your answer.Thanks so much.Josie Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 21, 2012 Share Posted December 21, 2012 In the UK, the BCSH Guidelines allow you to do this, PROVIDED that there have been two samples grouped from the patient, taken at different times, even if they are taken on the same day. Link to comment Share on other sites More sharing options...
R1R2 Posted December 21, 2012 Share Posted December 21, 2012 We use the same reasoning as Malcolm. Link to comment Share on other sites More sharing options...
Joanne P. Scannell Posted December 21, 2012 Share Posted December 21, 2012 Ditto ... i.e use the same protocol as you would for a 'routine' transfusion ... whatever that is for your facility. Here, we require 2 techs/2 blood types on only BB Banded specimens. Link to comment Share on other sites More sharing options...
SMILLER Posted December 21, 2012 Share Posted December 21, 2012 If the T&S is done within 3 days AND the patient still has the same armband on used for BB ID, then I do not see the problem. I would think that it would be up to the director of your institution to decide when to use type specific in other situations, such as when an armband has been removed or the screen results are unavailable for some reason.In emergency situations, it only takes a minute to do a ABO Rh and IS XM anyway; and for institutions that do electronic crossmathes, as mentioned above, it seems like the question is moot.But I, too, would be interested on seeing any regs on this from AABB, CAP, JCAHO etc.Thanks, Scott Link to comment Share on other sites More sharing options...
cthherbal ☆ Posted December 21, 2012 Share Posted December 21, 2012 We require 2 separate blood draws on any new patient prior to issuing type specific. We use Blood Bank arm bands. The original type and screen (large tube) has the band # label on it. The 2nd sample is a small tube and the phlebotomist writes the original band # from the patint's wrist on the tube. If emergency blood is needed prior to us testing 2nd confirmation sample, we would issue Group O RBCs. Link to comment Share on other sites More sharing options...
DOGLOVER Posted December 21, 2012 Share Posted December 21, 2012 If the patient had 2 blood types from different samples on record, the other type could be from a past admission, we would do an immediate spin xm on type specific blood and issue it. Forget the emergency issue, the paperwork would be more trouble than the immediate spin. If we did not have a 2nd type we would simply do the immediate spin on groupO blood. We do not require a 2nd type when the patient types as group O. j Of course, for the above to work, the patinet must still have their BloodBank armband in place.Merry Christmas everyone. Link to comment Share on other sites More sharing options...
josie Posted December 21, 2012 Author Share Posted December 21, 2012 Thank you very much for all your reply. Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 21, 2012 Share Posted December 21, 2012 I may be missing something here but if you have a specimen tested within 72 hours assuming this is the same admission and armband (if aplicable) why are you doing emergency release? And if you have "proven" the blood type on this admission why not give type specific even if it has to be emergency release. Link to comment Share on other sites More sharing options...
David Saikin Posted December 21, 2012 Share Posted December 21, 2012 If we have a current type and screen on the patient we will issue type specific rbcs/plasma. That is one of the reasons we do preop T&S. Unfortunately, the Medical/Surgical textbooks teach that if you (the MD) want uncrossmatched blood it needs to be O Negative. Our policy on emergency release is: No pt information: Group O - Positives to all but females of childbearing age. (there is plenty of documentation in the literature about sensitization rates that support this policy). I just had an FDA inspection. They looked at our emergency release policy and then at our emergency releases - which were all O Negs. Guess what - they said to follow our policy, so we have "reminded" the Medical staff of the unanaimous approval of our emergency release policy and "stressed" to our technical staff (all generalists) that they need to enforce it. If we have a valid/current T&S we give type specific - I have had type specific sent back because "they" wanted O Negs and could not/would not understand why the pt's own type would be better. Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 21, 2012 Share Posted December 21, 2012 True David. Then you have the doctors that don't want to sign the emergency release so they wait for crossmatched blood...I had one doctor sent back a spiked unit of emergency release O Neg. Spiked but not started because the A Pos crossmatched blood was ready. I called and explaind that the O Neg had been crossmatched as well and was compatible but he refused to give it...go figure. Link to comment Share on other sites More sharing options...
David Saikin Posted December 21, 2012 Share Posted December 21, 2012 I gave up trying to figure . . . now I just say how it is. I tell them they call call the pathologist if they want to argue while their pt is bleeding (I refuse to call) or they can take what I'm giving . . . (The pathologist is here 2 half days a week (if we're lucky). . . they threaten and bluster, but I am still employed . . . Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 21, 2012 Share Posted December 21, 2012 My new position here our pathologist wonders through for 5-10 minutes about once a week. If I say no that is the end of it. Everyone above me just refers them back to me.... I'm kind of nervous not having the pathology back up but when they do call him he just refers them back to me too... Link to comment Share on other sites More sharing options...
Dansket Posted December 22, 2012 Share Posted December 22, 2012 All,With the sudden onset of apparent life-threatening hemorrhage, patient care systems are stressed to the limit and it becomes a potentially dangerous situation that can become a sentinel event. I really don't understand blood bankers who boast how rapidly they can produce an ABO typing on an individual so that they can issue "Type-Specific" uncrossmatched blood. You cannot harm a patient issuing group O Red Blood Cells, it is virtually impossible. You can harm a patient by issuing non-group O Red Blood Cells for a variety of reasons! Why is it thought that a patient is better served by transfusion of "Type-Specific" Red Blood Cells as opposed to group O Red Blood Cells as a life-saving treatment? I'm very interested in hearing the argument from those who practice issue of "Type-Specific" Red Blood Cells during resuscitation.Thanks,Dan Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 23, 2012 Share Posted December 23, 2012 Dan, my current position is at a rural facility. Its not at all about getting type apecific because it is "better" but because of inventory. On a perfect day i have at most 8 units of O neg and a stat order from my supplier will take minimun an hour. I can give quite a few units in an hour even just to stabalize and ship the patient. If i can determine that my 23 yo female trauma is actually A pos and give type spwcific I have a lot more inventory to work with. Link to comment Share on other sites More sharing options...
Mabel Adams Posted December 23, 2012 Share Posted December 23, 2012 I agree with giving type-specific in this scenario but with the caveat that patient ID is critical once you go to type-specific. Do nurses ever think that they don't have to do the ID checks because the blood is uncrossmatched and they think that always means group O? Link to comment Share on other sites More sharing options...
Dansket Posted December 23, 2012 Share Posted December 23, 2012 Dan, my current position is at a rural facility. Its not at all about getting type apecific because it is "better" but because of inventory. On a perfect day i have at most 8 units of O neg and a stat order from my supplier will take minimun an hour. I can give quite a few units in an hour even just to stabalize and ship the patient. If i can determine that my 23 yo female trauma is actually A pos and give type spwcific I have a lot more inventory to work with.My situation is very similar, we are not a trauma center and 35 miles from the donor center (typically 1+ hours for a delivery). Our minimum inventory level for ONEG is also 8 units. If we exhausted the ONEG rbcs, I would switch to OPOS (minimum inventory level of 18 units) before I would issue uncrossmatched non-group O rbcs. Who knows what Nursing will do, particuarly if there is more than one patient needing uncrossmatched blood at the same time? Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 23, 2012 Share Posted December 23, 2012 Dan. I totally inderstand where you are coming from. I just think that if i have history on a patient and a current type it is better inventiry management to give type specific Link to comment Share on other sites More sharing options...
John C. Staley Posted December 27, 2012 Share Posted December 27, 2012 The only reason I would NOT release type specific blood to this patient would be if the patient had been released from the facility and then re-admitted. My concern here would be for proper patient identification. :blahblah: Link to comment Share on other sites More sharing options...
EMB4879 Posted December 27, 2012 Share Posted December 27, 2012 I may be missing something here but if you have a specimen tested within 72 hours assuming this is the same admission and armband (if aplicable) why are you doing emergency release? And if you have "proven" the blood type on this admission why not give type specific even if it has to be emergency release.I was wondering the same thing?? Ideally the specimen is good (if no recent history transfusion/pregnancy) indefinitely or at least until 72 hours post transfusion. We are a level I trauma center and switch to type specific ASAP! Even if only 1 tech types the specimen (some times twice or once manually and once on the ProVue). We save our O neg and O pos as much as we can. Emergency release is for those patients you dont know anything about! You could have a patient with no specimen, or specimen with testing incomplete.This I would have imput from your medical director (who hopefully has a blood bank backgound?) Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 28, 2012 Share Posted December 28, 2012 ;( I miss having a medical director with a blood bank background...... Link to comment Share on other sites More sharing options...
vilma_mt Posted December 30, 2012 Share Posted December 30, 2012 I would like to ask for your opinion and supporting document regarding this subject. The patient has a current record of blood type and antibody screen done within 72 hours by another technologist. The Operating Room called and need emergency release of blood. Our current policy is to give O neg to child bearing age and O pos for male and above 50yrs old for female. Recently, we had a discussion about giving type specific blood blood during emergency release. My question is can you look at the current record of blood type and antibody screen in the book which is done within 72 hours by another tech and issue a type specific blood basing from that? If your answer is no, can you please let me know the supporting document that I could print.Personally, my answer is no and I would really appreciate for a document that support this. If your answer is yes, I would like to hear from you also. I appreciate all your answer.Thanks so much.JosieFor a patient with current ABO and Negative Ab Screen (current/previous), it seems cumbersome to issue blood by emergency release than waiting few mins to perform IS XM. That said, if it can't be helped, I would be cautious giving Type Specific blood if there's only 1 ABO type on record either current or historical. Never assume the previous tech performed ABO type correctly!Emergency released blood does not necessarily mean it has to be "O" PRBC. It's compatibilty testing is incomplete. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 30, 2012 Share Posted December 30, 2012 Never assume the previous tech performed ABO type correctly!Or, indeed, that the sample was taken from the correct patient. Link to comment Share on other sites More sharing options...
PAWHITTECAR Posted December 30, 2012 Share Posted December 30, 2012 I constantly say that blood bankers should trust no one. Sometimes not even yourself. Double check everything Link to comment Share on other sites More sharing options...
rmblack Posted December 31, 2012 Share Posted December 31, 2012 I agree with giving type-specific in this scenario but with the caveat that patient ID is critical once you go to type-specific. Do nurses ever think that they don't have to do the ID checks because the blood is uncrossmatched and they think that always means group O?My biggest fear is that the staff at bedside may give you the incorrect name or DOB or whatever then a tech looks into the computer system and hopefully finds the right patient. Too many chances for error. I have told my techs that if we do not have a current type (within 72) to give type O in these situations. I think the potential is too great that either nursing could give us incorrect information or the tech looks up the wrong patient. I see way to many patient ID errors to trust that they are giving me the right patient name. Most of the time it is a room number and they don't remember the name. They actually think that's acceptable.I will often follow the units up to the areas to obtain the physician signature and the nurses are not performing patient ID checks. I had a patient yesterday that has a history of anti-Fya and Kell and came in as a trauma. The surgeon wanted two units uncrossed after I told him the odds and chances. Luckily I already had 4 units typed negative for Fya and Kell. The patient has a history of A pos. But I still performed a quick tube type just to make sure they ID'd the patient correctly in the ER. When I took the units up the nurses grabbed them and ran them in without any checks at all.Something to think about.Happy New Year Everyone!! Link to comment Share on other sites More sharing options...
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