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Does anyone know of any standards that require repeat of special antigen typing that was performed by a reference lab.  At this time, the facility I work at will repeat any special antigen typing that was performed by the ARC and then documents this information in the computer system (and on paper) and places their own special antigen stickers on the units in addition to the tag attached by the ARC.  Any info would be greatly appreciated!  Thanks!

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We do not repeat antigen typing that is performed by our reference lab (ARC). We enter the antigen typing results performed by ARC into our LIS with a notation that the testing was performed by them. Being a smallish community hospital sometimes we do not even have the antisera that would enable us to repeat the testing. 

 

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Years ago we always repeated the antigen typings performed by our blood supplier reference lab.  After years of doing that and no discrepancies we decided not to repeat the typings and that was probably 10 years ago.  In this day and age of billing compliance, I'm not sure if it would be correct to bill for repeat testing.

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I was told by a CAP inspector that if we didn't confirm all the antigen testing we sent to a reference lab, we shouldn't be repeating/confirming any antigen testingperformed at the reference lab. In other words, we were confirming the antigen testing that we had anti-sera for, but not the ones we do not have the anti-sera for.

Since we stopped retesting, we have had 3 inspections and have never been questioned about this.

jl

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So you have to pay for the antigen testing from the ARC and then use up your own reagents also? How are these being charged?

At this time, the patient is being double-billed (for the reference lab testing and the inhouse testing.)  Whether the patient pays the bill or not, I do not know.   This practice has been questioned by many, but so far, the policy is still in effect.    

Thank you everyone for the responses!  You guys are so helpful!

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This question was addressed specifically at the 2013 'Ask the Standards Committee' session at the AABB annual conference. The word was that it is NOT necessary to reconfirm antigen typings performed by an IRL.

They did not mention a CAP standard, only that this is unnecessary for AABB purposes.

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Years ago we always repeated the antigen typings performed by our blood supplier reference lab.  After years of doing that and no discrepancies we decided not to repeat the typings and that was probably 10 years ago.  In this day and age of billing compliance, I'm not sure if it would be correct to bill for repeat testing.

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The reference lab at our local blood supplier had always wanted us to repeat the typings. They thought there was a bit more room for error using historical records on previous donations by that donor rather than actually performing the typings. But we have never seen a discrepancy, either. Thanks for the question and the responses, as it got me to thinking that perhaps their philosophy might have changed. So I just called the reference lab, who said they have no recommendations either way. Up to you. Some of their hospitals they supply repeat the typings, some don't. I shall take this up with our medical director, particularly when some vials of antisera approach the price of a used car.

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Our Blood Bank discontinued this practice approximately 10 years ago.  We were also advised by our billing team that if we retested in house it was "double billing" and the charges may drop on a bill but we would never be reimbursed for the testing.

 

kirkaw has outlined the AABB guidelines and I bet if you did a cost analysis on this, include the tech time, reagents etc, you would see a huge savings to your BB with no compromise to the quality of pt care.

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There was a bad transfusion reaction that made the news a few years back.  Of course this was in the lay press so the details may be in question, but it centered on the receiving hospital not rechecking something on the unit.  I can't remember the details but I concluded at the time that the only thing that would fit the bits of information reported would be if the patient had an antibody and the hospital did not recheck the special antigen typing.  How is that for vague?  Does anyone know more about the case?

 

We don't retype special antigens on units at this time but just today I had a new wrinkle arrive. Our supplier has just converted to ISBT and has decided to use the option to print the antigen type on the lower right quadrant.  This weekend we got in our first units that were antigen typed (for S, Fya, E & c) since the switch to ISBT and none of them had all of the antigen types on the label; they also were not on a tie-tag on the unit.  The only place all of the antigen typing results were listed for the units was on the packing slip.  As I understand it, this happened because to reprint the ISBT label, the on-call tech would have had to come in.  This would surely cause us to be charged a call-in fee. She promised that the donor had been typed twice.  I heard recently of a new rule allowing blood centers to label as antigen negative any unit whose donor has been antigen-typed for that antigen 2 times in the past. I don't know if this is the rule being invoked but it seems likely because otherwise the unit would have been labeled whenever it was tested. For now, I had the tech retype them all so we can label them with our sticker. Then I guess I need to consider a procedure change that includes accurately transferring the correct antigen results to the correct unit (at least on the after-hours occasions that they come this way), probably in a way that looks different than how we tag the unit when we type it ourselves. After attending a session at the AABB meeting on non-ABO transfusion reactions I might be a little more anxious about this.  Does anyone have a supplier that does not attach special antigen typing results to the physical unit?  If so, do you have a process for making sure that you transfer the right results to the right unit besides "be careful"?

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I found out that the ARC computer requires two techs to log in to be able to reprint the label with the antigen typing results on it so after hours we will just get a paper listing the unit numbers and the antigens. I thought other places that are thinking of using the Ag type on the ISBT label or other ARC sites might want to know this in advance.

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Why bother sending the sample away if you are just going to repeat it in house anyway - seems silly.

 

We are lucky in the UK that our BTS guarantees the blood groups - l can't imagine the work involved in reconfirming all of these! Doesn't give me any faith in the reference centres in the US...

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We do not repeat special antigen typings. We only have a choice of currently serologically tested units or units that have been historically neg for an antigen. However, these historically neg units are not labeled as antigen neg so we not accept them. The only exception is when there is no typing sera available for a particular antigen but there are historically neg units available.

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Yes, ARC is changing the ISBT paradigm and putting antigen typing results on the bag label (except after hours apparently when it will be on an accompanying paper only).

 

Rumor has it that Puget Sound Blood Center in Seattle is now molecular typing their donors and making the historic database available to their customers.  That means you can check the supplier's data base, choose two historically c neg units out of your own inventory to type and not have to screen 20 to find two nor order them from the supplier.  How sweet is that?!

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Yes, ARC is changing the ISBT paradigm and putting antigen typing results on the bag label (except after hours apparently when it will be on an accompanying paper only).

 

Rumor has it that Puget Sound Blood Center in Seattle is now molecular typing their donors and making the historic database available to their customers.  That means you can check the supplier's data base, choose two historically c neg units out of your own inventory to type and not have to screen 20 to find two nor order them from the supplier.  How sweet is that?!

 

I think my mind just exploded with how great of a system that is.

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Yes, ARC is changing the ISBT paradigm and putting antigen typing results on the bag label (except after hours apparently when it will be on an accompanying paper only).

 

Rumor has it that Puget Sound Blood Center in Seattle is now molecular typing their donors and making the historic database available to their customers.  That means you can check the supplier's data base, choose two historically c neg units out of your own inventory to type and not have to screen 20 to find two nor order them from the supplier.  How sweet is that?!

 

When is the next flight to Seattle...I'm moving there. :)

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I'm loving the antigens on the ARC labels. It's going to save us huge time (and $$$) - cherry pick for the Ag neg units you need, verify the types and crossmatch. We've already done that several times for patients and we just got switched to ISBT labeled units within the last 6 weeks.

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Some region of ARC is providing you historically or molecular labeled antigen negative units?  Which region?  Ours is putting confirmed types on the labels but that is all we can get.  Occasionally we get it on a unit that we didn't order that way, but mostly we only get antigen negative if we ask for (and pay for) it.  I'd like to know more of how your ARC is doing it.

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We will soon be mass genotyping donors in the UK as well, although it has not yet got off the ground. Be aware though, that the ABO group will still be performed serologically, as a) it is easy and cheap and B) there are huge variations in the ABO genes that do not always translate to what would be expected.

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This summer we did a trial supplier run with Lane Blood Center in Eugene Oregon.  They would email a historically negative database to us with each shipment-just the units that were sent to us.  It was heaven!  Saved us a lot of time and anti-sera.  I asked ARC if they could do that and they said no.

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