Type specific vs O red cells for unconfirmed patients

[Lbiggs]

So again a topic I brought to my lab manager's attention was the current protocol of issuing type specific red cells to non-emergent patients without history without the confirmation of patient blood type via retype from previously drawn or 2nd phlebotomy. Every other place I have worked at that a patient had no history required a retype or only O units were issued until retype could be used to confirm patient's ABO. The lab manager here wants to see the science behind the safety measure. Does anyone know of any AABB study or article or any others that address this?

[Malcolm Needs ☆]

It is a requirement in the 2012 BCSH Guidelines in the UK that two samples be tested on different occasions before anything other than group O blood be given.  I know this is the UK, rather than the USA, but it may help you.

 

If you put "BCSH Guidelines" into your search engine, you should be able to find it.  It is the one concerning pre-treansfusion compatibility procedures in blood transfusion laboratories.

[David Saikin]

The USA regulations state that you must have a process that verifies that transfusions must be verified as being given to the correct pt.  Whether you do this by multiple blood types or barrier protection/identification is incumbent upon each faciltiy to determine. 

[JoyG]

There is a 2009 WBIT Blood Bank Safety Practices report from CAP.  I have attached it here.  Hope this helps.

2009-WBIT-CP.pdf

[Dansket]

The science is very basic!  When you issue non-group O red blood cells in an non-emergent situation, there is a real possibility of transfusing ABO incompatible red blood cells to a patient, i.e., there is risk associated with this practice. What is the Lab Managers compelling reason to do this?

 

When you issue group O red blood cells in an non-emergent situation, there is no possiblity of an transfusing ABO incompatible red blood cells to a patient.  There is no risk here!

 

Our policy requires that group O red blood cells be issued uncrossmatched unless all tests required by routine pretransfusion compatibility testing have been completed.  There is no ambiguity for staff to address with this approach.

[DPruden]

When you issue non-group O red blood cells in an non-emergent situation, there is a real possibility of transfusing ABO incompatible red blood cells to a patient, i.e., there is risk associated with this practice. 

 

Our policy requires that group O red blood cells be issued uncrossmatched unless all tests required by routine pretransfusion compatibility testing have been completed.  There is no ambiguity for staff to address with this approach.

I am trying to find an AABB standard/FDA regulation to quote on this very subject and I can't find it.  I know there used to be a prohibition against issuing non-group O RBCs using a historical ABO type, but I can't find it!