Per surgical patient crossmatch orders

[Lbiggs]

I have recently ran into an issue that I would love to change in our facility but need documented information that I can reference for our pathologist to agree. Other facilities that I have worked at have extended their T&S and XMs for 10 days when the pre surgical patient has confirmed they have neither been transfused or pregnant within the prior 3 months. I have been trying to find the text in the AABB technical manual, but must be missing it somehow. Anyone know where I might be able to find documented reference material to provide for our pathologist, I would really appreciate it.

[David Saikin]

You probably will not find the documentation you are seeking.  The only caveats are for those who have been transfused/pregnant within the past 3 months.  I have seen places which freeze the preop specimens and save for up to one month.  There is no regulated "specimen outdate" for pts who do not meet the 3 day criteria.

[SMILLER]

AABB does not seem to have anything specific to say (for patients not tx'd or pregnant in the last 3 mos)other than: "the length of time that a pretransfusion specimen is valid for testing should be determined based on the manufacturer's package insert recommendations..." (17th ed).  Also, there is a bit refering to "changes with storage" under "Factors Affecting Ab ID" that suggests that EDTA samples up to 14 days old are suitable for antigen typing.  In the same section the fact that Abs deteriorate with time is pointed out.

 

This seems to give a lot of leeway, as manufacturer's tend to refer the user to regulatory agencies regarding age of specimen!

 

Scott

[Lbiggs]

Thank you David and Scott. May not be able to win over my pathologist.

[Liz0316]

try phrasing it as a "standard of care." We keep PAT specimens for 21 days provided we have documentation that the patient has not been pregnant or transfused in the last 3 months.

Liz

[Deny Morlino]

Lbiggs,

You do not mention your reference lab for blood bank. The reference lab is often a good resource for best practice references as they have contact with many other labs, and are normally the "experts" we refer to.  Ours is ARC, and I will call on their pathologist to clarify or discuss with my own pathologist as ARC's pathologist is focused on blood and transfusion whereas my pathologist must be more of a "generalist".  The two have a very good working relationship.  Something to consider.

[AMcCord]

The last time I saw Joint Commission standards they seemed to require that crossmatches be performed with a specimen less than 72 hours old. Our lab is not TJC inspected and I haven't seen that particular element for awhile so............anyone out there who is THC inspected, can you clarify that point?

 

That said, we allow a specimen outdate of 7 days for pre-admission testing on the basis of all the things discussed above.

[ADawson]

Try Chapter 15 of the AABB manual 17th ed, particularly Sample Age. We too allow 10 days for pre-surg samples with no transfusion or pregnancy in last 3 months. Hope this helps.

[pbaker]

AABB Std 5.13.3.2 talks about needing a specimen within 3 days of transfusion IF pregnant or transfused within the previous 3 months, or if history is unclear or unobtainable. 

 

We use the results from the pretesting up to 30 days out and collect a new specimen for ABO/Rh day of surgery.  If blood is needed, we crossmatch using the new specimen and the old antibody screen results.  Again, we only do so if no transfusions or pregnancies in 3 months.