Second ABO/Rh sample

[cheru26]

My hospital is planning to implement a second sample for ABO/Rh for all patients that do not have historical on file.   The hospital I work is a women and children’.    We see from preemie to adult women and everything between. 

 

 

We are straggling (make physician happy) to come up with a cut of age to request second sample. 

 

My question is what is the cut off age to request for a second sample?

 

Do you collect second sample on neonatal patient?  We are thinking of forgoing requesting second sample for neonatal patient up to 4month old.

 

 

What about patient age 4month-1 year?

[Auntie-D]

I was under the impression that once a baby has been tested it doesn't need testing again until 4 months?

 

Malcolm?

[David Saikin]

On infants/newborns  that would have to NOT be a cord blood type.  then the type should be good for 4 months.  The hospital can set stricter requirements than the standards.  For older children (<5) I would think a finger stick could accomplish a second type with only one or 2 drops of blood - you'd only need a front type as a confirmatory type UNLESS your policy states you need two complete types . . .

[cheru26]

I agree, once their history is established there is no need to re-test up to 4 month old. The AABB standard is clear on that. My question is what is the cut off age to collect second sample and confirm ABO/Rh?

[Malcolm Needs ☆]

I would say that any person older than 4 months requires a second sample, because they will be producing their own ABO antibodies and will be transfused with their own ABO type, in most cases.

[MAGNUM]

Post 4 months of age, we require a confirmatory sample.

[lewisda]

Neonates should have 2nd sample to confirm ABO Rh, and cord can be used as 2nd sample

[Abdulhameed Al-Attas]

The ABO/Rh confirmatory policy has been developed to prevent transfusion from a misidentified sample.

Our guidelines states unless electronic patient identification systems are in place, a second sample should

be requested for confirmation of the ABO/Rh group of the first time patient prior to transfusion, where this

does NOT impede the delivery of urgent red cells or other components.

 

The ABO/Rh confirmatory is a STAT test and should be handeled accordingly, it must be from a seperate collection phlebotomy and collected at a different time from the initial one.

 

It should NOT be a retained sample from the initial collection and delivered as a second one after Bank Bank calls for a ABO/Rh confirmatory sample.

 

Yes,post 4 months of age, we require a confirmatory sample, as MAGNUM stated.

We must always remember that the most important test done in the Blood Bank is ABO grouping. 

Edited October 15, 2014 by Abdulhameed Al-Attas

[Kathy H]

Babies sick enough to require a blood transfusion will almost always have other lab samples drawn at a different time from the initial blood type.  They also typically have IV's or other venous access and a sample could be drawn from there just before starting the transfusion to avoid sticking the baby.  We have a policy to first look for another sample in the lab (usually Hematology) before requesting more blood from the child.  We also use cord bloods for the 2nd sample when available.

[ChrisH]

We also are going to start to use a second sample

 

Another question.  What do you do if someone goes to OR from the ER and no second sample?  Would this be emergency release?

[Malcolm Needs ☆]

Until you get a second sample, YES!

[cheru26]

Chris H,  I would think the scenario would not be considered emergency since you have one sample history. I would issue O Rh Specific until the second sample.  I am writing our SOP to state if there is no second sample issue O Rh Specific.

[Auntie-D]

Chris H,  I would think the scenario would not be considered emergency since you have one sample history. I would issue O Rh Specific until the second sample.  I am writing our SOP to state if there is no second sample issue O Rh Specific.

 

This is what we did in the last place I worked to save on ONeg. The worst that is going to happen if its WBIT is the patient develops an anti-D.

[Likewine99]

I agree with Cheru26

[Mabel Adams]

We give all of our neonates group O blood so I wouldn't worry about getting a second type on them since we can't give the wrong blood group if the first type was wrong.

[Malcolm Needs ☆]

 You can if they are O_h!!!!!!!!!!!!

[Auntie-D]

Oh no.....

[aafrin]

Malcolm, you are absolutely right. I recall that In the last year or so we have had one neonate who was of Bombay group. In the last week we also had one young adult OPD health check patient who was also Bombay Group. We have called him to check whether he can be suitable as a donor if required. Still awaiting him...

[Mabel Adams]

Well, Malcolm, we would get the same results on a 2nd type so it wouldn't help an O_h baby any having done it twice, would it?  If a neonate was Bombay (O_h) we couldn't tell the difference from an O, right? Since we do the antibody screen on the mom, we would assume the baby is group O and use O blood like usual.  Would they have much anti-H yet so their own antibody screen would be positive?  Will they have a transfusion reaction?  How might this play out over the course of their NICU stay?

 

The odds of this are really low here but I am curious.

[Malcolm Needs ☆]

You couldn't tell the difference Mabel - hence the devilish emoticon!

[Sandy L]

Our standard protocol for transfusing neonates under 4 months is to transfuse group O Red Cells and AB plasma products.  We do not require a 2nd sample to confirm ABO/Rh for this patient population.  On occassion we get a Directed Donation RBC unit for an infant that might be other then group O. In this infrequent instance we require a second sample to reconfirm the ABO/Rh and will also perform the antiglobulin test for passively aquired maternal ABO antibodies in the infant plasma.

[profbaud]

you could use a specimen from Hematology that is drawn at a different time for your retype.  The policy should be for all patients and not a certain age.  Most preemies and babies get O Neg so then your policy could address that they only need 1 blood type if they are receiving O neg or a quick heelstick if you are doing type compatible.

[jlmoses]

Generally we do not draw a second sample.

     Since the purpose is to be sure there was no error - WBIT, we have 2 phlebotomists (nurses or lab) identify the patient by AABB standards (pg 368, 18th ed. Technical Manual).     

     Unequivocal ID of the patient shall be made before drawing blood specimens. If any errors or discrepancies are found during this process of ID, blood specimens shall not be drawn until resolved.

     BLOOD SPECIMENS MUST BE LABELLED AND SIGNED IN THE PRESENCE OF THE PATIENT. Minimum requirement as stated by AABB: “2 independent patient identifiers and date collection”. Patient’s last and first names, unique ID number (visit ID, MR#, DOB, BB#), date and phlebotomist’s signature, as well as the signature of the 2nd verifying person. The 2nd person signing must be present in the room when blood is being drawn. If 2nd signer was not in the room when phlebotomist verified the patient’s information, (s)he must confirm the patient’s ID again. Patients may not be banded after blood has been taken out of patient’s presence. If the phlebotomist leaves the room prior to tube being signed, the specimen must be re-drawn. If two signatures and/or hospital IDs are not on the tube, a second specimen drawn at a different time (must be properly labeled).          

     All patients must be banded with either a hospital ID band or the Red Blood Bank band (drawing of an out-patient). This band must remain on the patient from the time of specimen collection until the transfusion episode is complete. 

     Since only Blood Bank tubes are signed this way, we would not use a hematology tube. The OB nurses identify,sign, and label the cord specimen  in this manner as well.

     FYI, the only floor we really have to reject specimens from now and then for not following the "RULES" - you guessed it- the ER.

[Auntie-D]

jlmoses - that assumes they are following your policy. Sadly some do not - especially in emergency situations when errors are most likely to happen. The only way to esure that there is no WBIT is with two independent draws.

[pbaker]

jlmoses - We just had to stick a patient for the third time because the nursing staff does not follow policy.  The first time they forgot to document the 2nd employee identifying the patient.  The second time both identifying employees failed to notice that the patient did not get armbanded.  Hopefully, the third time is a charm.  I would be very careful about relying strictly on following of policy for patient safety.