Posted October 10, 201410 yr comment_57800 I know we need to have two ABO/RH testings before giving the patient any blood.  The scenario is as follows...patient came in, doctor ordered a type and screen. no orders for any blood or any component. Do we need to do another ABO/RH??? i dont think so since no blood was given...right ? If this same patient needed blood in the future, we can do another ABO when that time comes...right? thank you..
October 10, 201410 yr comment_57815 Currently we are not doing computer crossmatches, and we are simply retesting the same specimen by the same tech for ABO/Rh. No inspecter has had a problem with this: but again, we are currently doing wet crossmatches for all of our patients. Scott
October 10, 201410 yr comment_57817 Currently we are not doing computer crossmatches, and we are simply retesting the same specimen by the same tech for ABO/Rh. No inspecter has had a problem with this: but again, we are currently doing wet crossmatches for all of our patients. Scott If you're in the UK, the new guidelines discourage this.
October 10, 201410 yr Author comment_57825 Apparently at this facility where i just started....they repeat the ABO on the patient EVERYTIME they crossmatch a unit on the same Type and screen tube..so basicly if i do a type and screen at 8am, then a blood order comes in that evening and another tech pulls the tube from the fridge to crossmatch a unit, that evening tech has to repeat the ABO!!! that seems like overkill, waste of time and reagents... i was always under the impression that as long as we have a history of an ABO on the patient in the system plus a valid (not more than 3 days old) type and screen done..we can go ahead and crossmatch units...RIGHT?
October 10, 201410 yr comment_57826 Correct. That is incredible overkill. Sounds like you had an adverse transfusion event once and the partial-knee-jerk reaction was to retype everyone constantly? Sooner or later you have to hold the people who draw the blood responsible for what they do. One retype per patient to verify type/Rh then T&S only after 3 days to recheck the screen. If you aren' t the Supervisor who can delete this requirement, I would sure as heck talk to your Supervisor and the Medical Director and ask for the rational. Certainly not a standard/requirement/recommendation or anything else so how would they rationalize this?
October 10, 201410 yr comment_57827 It sounds like that was set up to make sure that the tech selected the correct tube to crossmatch with. I don't see the value of repeating the ABO/Rh on the same tube multiple times, but there should be other safeguards in place to prevent mismatches like performing two separate ABO/Rh, performing electronic crossmatches, or having barcoded patient into on the patient sample. However, what they are having you do is not wrong. Each Blood Bank interprets the regs and sometimes put other checks and balances put in place due to limitations with computer systems, or sometimes in response to an adverse event in the past.
October 10, 201410 yr comment_57828 True Terri, but the MHRA in the UK has found that the more checks there are in a procedure, the more chance there is of something going wrong, because the next person checking thinks that the one before them would have found anything that is wrong, and the person before them doesn't check properly because they think that the person checking after them will find any mistakes. I sort of agree with Karrie61, when she says that phlebotomists must take responsibility, but the same applies to everyone in the line, from the person ordering the blood, right through to the person who takes down the transfused unit.
October 10, 201410 yr comment_57834 Apparently at this facility where i just started....they repeat the ABO on the patient EVERYTIME they crossmatch a unit on the same Type and screen tube..so basicly if i do a type and screen at 8am, then a blood order comes in that evening and another tech pulls the tube from the fridge to crossmatch a unit, that evening tech has to repeat the ABO!!! that seems like overkill, waste of time and reagents... i was always under the impression that as long as we have a history of an ABO on the patient in the system plus a valid (not more than 3 days old) type and screen done..we can go ahead and crossmatch units...RIGHT?sometime it is not in policy but techs from old time chose to do that way. when i was trained in blood bank 15years ago these techs who were there for .20-25 years were doing exactly same ---every time they were crossmatching from a tube which was worked on by different tech before, they would repeat just front type before doing crossmatch. one of the tech would just pipette plasma for crossmatch and then was using plasma in same tube with same pipette to make suspension for front typing....I always wondered why they were doing such a practice...they said,"just incase..."I can not even imagine any of my current techs doing same!!! Edited October 10, 201410 yr by Eagle Eye
October 11, 201410 yr comment_57836 I think it could be because the culture there has always been that the tech putting his/her name on the crossmatch doesn't want to trust anyone else's work. Â In the days of log books, before barcodes and required competency assessments, there may have been some basis to the concerns. Â Now, with computers and barcoded specimens, it is likely that a careful evaluation of the chance for error would suggest the policy is no longer necessary or justifiable.
October 13, 201410 yr Author comment_57847 Yes i was talking to one of the older techs at the hospital and it was put forth just in case kinda scenario. Â But im thinking its time to change that. Â There is no reason to do more work, waste tech time and also reagents. Â I just have to find a way to get everyone on the same page as far as checking for blood types and previous history before crossmatching and issuing units.Â
October 13, 201410 yr comment_57850 Wow! I guess I am getting too old in the business (25 years). In the old days we use to work exclusively in Blood Bank, however I know the culture has changed to cross-training in multiple areas of the labs. Still, this is a highly specialized area, and we must be seriously confident in our PPPs and techs. If performed correctly, an immediate spin Major crossmatch will capture ABO incompatibility. Further, it takes under a minute to perform a history check, and EVERY single time you crossmatch, add-on, or assign a blood product, you need to know your patient. Respectfully, Cottonball, MT(ASCP)SBB
October 13, 201410 yr comment_57852 Wow! I guess I am getting too old in the business (25 years). In the old days we use to work exclusively in Blood Bank, however I know the culture has changed to cross-training in multiple areas of the labs. Still, this is a highly specialized area, and we must be seriously confident in our PPPs and techs. If performed correctly, an immediate spin Major crossmatch will capture ABO incompatibility. Further, it takes under a minute to perform a history check, and EVERY single time you crossmatch, add-on, or assign a blood product, you need to know your patient. Respectfully, Cottonball, MT(ASCP)SBB The OP isn't talking about IS XM though, but regrouping every time. I still do IS crossmatch, even though it is no longer a requirement with electronic crossmatch. I just like to double check myself immediately, rather than waiting 40 minutes for the XM to finish before finding the wrong group has been selected.
October 13, 201410 yr comment_57871 Currently we are not doing computer crossmatches, and we are simply retesting the same specimen by the same tech for ABO/Rh. No inspecter has had a problem with this: but again, we are currently doing wet crossmatches for all of our patients.ScottRetesting the same specimen by the same tech may detect testing errors but it will not detect specimen collection errors. It you want to detect WBIT, collecting a second blood sample would be more effective.
October 14, 201410 yr comment_57907 "The OP isn't talking about IS XM though, but regrouping every time. I still do IS crossmatch, even though it is no longer a requirement with electronic crossmatch. I just like to double check myself immediately, rather than waiting 40 minutes for the XM to finish before finding the wrong group has been selected." I don't understand. If you are doing electronic crossmatches, why is it taking 40 minutes for the XM to finish? In the US, an electronic XM means no serological work is done. If you are talking about an IgG XM it might make sense to do an IS IM before setting up the IgG XM. In fact, an IS XM is required with an IgG XM if our computer system is down.Â
October 15, 201410 yr comment_57915 "The OP isn't talking about IS XM though, but regrouping every time. I still do IS crossmatch, even though it is no longer a requirement with electronic crossmatch. I just like to double check myself immediately, rather than waiting 40 minutes for the XM to finish before finding the wrong group has been selected." I don't understand. If you are doing electronic crossmatches, why is it taking 40 minutes for the XM to finish? In the US, an electronic XM means no serological work is done. If you are talking about an IgG XM it might make sense to do an IS IM before setting up the IgG XM. In fact, an IS XM is required with an IgG XM if our computer system is down.  Ah terminology difference! We call an electronic crossmatch one where the units have been corssmatched on the analyser, rather than the bench. What you call electronic crossmatch, we call electronic issue - as we are just issuing the blood, not crossmatching it.
October 15, 201410 yr comment_57941 Understood! Amazing how a "pond" can change the meaning of terms!
November 5, 201410 yr comment_58132 This practice was very big in the past (redoing ABO group when crossmatching).Isn't that why the old terminology was "Type and Cross"?
November 6, 201410 yr comment_58144 How many times have you heard "Type and cross for 2 units......" when a typing need not be performed? On a new sample, "Type and cross" also conveniently ignores the need for and importance of an antibody screen. How about the semi-oxymoronic "Type and screen for 2 units......."? I think that the vast majority of secretaries, nurses and doctors have absolutely no understanding of how and why we perform pretransfusion testing (aside, perhaps, from a very vague appreciation of ABO/Rh typing) and of our different testing algorithms. Repeat typings on the same specimen obviously proves nothing except the competence of different techs in performing a routing typing. Of interest, however, was a comment by a well-known US blood banker/quality guru at a lecture I attended recently. She was very opposed to the practice of getting a second typing from a different draw to verify ABO. Her rational was that critical decisions are made based on every other lab test performed, yet we don't redraw and retest every hemoglobin, potassium, etc to make sure the right guy got stuck. Philosophically, I had to agree with her point. Get it right the first time. But I have still slept better at night after we adopted the "two typings on different specs " rule years ago.
November 6, 201410 yr comment_58149 I must admit, I had never thought about it in those terms Dr Pepper - and she was quite correct.
November 7, 201410 yr comment_58151 I would be surprised if this guru is currently responsible for the activities of an active transfusion service. It is easy to state, "Get it right the first time". I think the guru's logic is flawed in that it compares apples to oranges! A lab test result can vary from minute to minute, ABO blood types do not. Physicians can challenge a lab test result if it doesn't fit with their clinical assessment and request repeat testing or repeat specimen collection.  Not so with a ABO blood type. How does this work when patients share identities and insurance cards? I would also challenge the guru's logic regarding the inability of donor centers in the United States to guarantee that the blood container ABO/Rh label is correct.. Why can't they "get it right the first time"? Transfusion Services are required to confirm the correctness of the ABO container label, because the donor center cannot guarantee it is correct.  The electronic crossmatch is based on the logic, Determine the ABO/Rh (donor center) and then verify it (transfusion service). This logic works for both donor units and for patients, "Trust but verify".
November 8, 201410 yr comment_58167 The purpose of a type and screen is for those patients where the probability of needing a blood transfusion is less than 50% so you don't want to tie up your inventory and you can crossmatch a unit and have it ready in 5 min. Now if your facility is requiring 2 blood types before you give out type specific blood rather than group O, then I recommend you collect a 2nd specimen [or get a CBC specimen collected at a different time] to verify the blood type. Then you won't be caught if the patient emergently needs blood. What does your policy say if you don't have 2 blood types on file? Give group O or O Negative?CAP recommends 2 blood types as a way to prevent hemolytic transfusion reactions, but as to how your implement that is up to your facility.
November 10, 201410 yr comment_58172 I have to agree with Dansket on this one. A physician isn't able to look at the patient and think a Type and Screen should be repeated because they look more like an O Pos instead of an A Pos.
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