ABO/RH

[aj2018]

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..

[Malcolm Needs ☆]

Yes.

[tbostock]

Correct

[Auntie-D]

^what the oracles above say!

[SMILLER]

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

[Auntie-D]

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.

[aj2018]

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?

[Karrieb61]

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?

[tbostock]

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.

[Malcolm Needs ☆]

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.

[Eagle Eye]

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, 2014 by Eagle Eye

[Mabel Adams]

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.  In the days of log books, before barcodes and required competency assessments, there may have been some basis to the concerns.  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.

[aj2018]

Yes i was talking to one of the older techs at the hospital and it was put forth just in case kinda scenario.  But im thinking its time to change that.  There is no reason to do more work, waste tech time and also reagents.  

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. 

[COTTONBALL]

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

[Auntie-D]

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.

[Dansket]

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

Retesting 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.

[mollyredone]

"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.

 

[Auntie-D]

"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.

[mollyredone]

Understood!  Amazing how a "pond" can change the meaning of terms!

[goodchild]

This practice was very big in the past (redoing ABO group when crossmatching).

Isn't that why the old terminology was "Type and Cross"?

[Dr. Pepper]

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.

[Malcolm Needs ☆]

I must admit, I had never thought about it in those terms Dr Pepper - and she was quite correct.

[Dansket]

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".

[profbaud]

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.

[goodchild]

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.