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Donor unit confirmation required in US but not in UK


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I posted this question in UK Guidelines forum and Malcolm responded that isn't a requirement in UK.  UK donor centers guarantee that what is in the bag matches the label.

 

It is not an FDA requirement for transfusion services to serologically confirm the ABO/Rh type of red cell components using rbcs from a donor tubing segment, it's the CAP, AABB, etc.  

 

I'm trying to drum-up interest in the transfusion services community to push their donor centers to implement the same practice in the US that UK donor centers do!

 

Please don't tell me they can't do it!  This is 2015, not 1980...

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It's been years since i've worked in a donor center so my knowledge of what goes on today is a bit out of date (1980's was the last time).  What is done differently in the UK that allows hospitals and transfusion centers to skip the confirmation of the donor blood type?  From my memory, each donor unit was typed by two separate technologists at two separate times before the unit was labeled with a blood type.  Those results were also compared to historical records for the donor (if they weren't new).  Is there something else that is done there?  I don't understand how the donor facilities could be able to affect a change in this policy as long as they are in compliance with FDA, CAP, AABB etc standards.  Wouldn't lobbying AABB and CAP be the way to go? 

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I would guess the AABB would say that since the product comes to your facility from another source, you are obligated to ensure that the typing is correct before using it in your facility.  Or that a total of 2 typings (donor center and transfusion facility) needs to be done on each unit? 

 

Doesn't exactly make you confident in donor facility testing though.

 

Scott

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I would guess the AABB would say that since the product comes to your facility from another source, you are obligated to ensure that the typing is correct before using it in your facility.  Or that a total of 2 typings (donor center and transfusion facility) needs to be done on each unit? 

 

Doesn't exactly make you confident in donor facility testing though.

 

Scott

http://www.pathlabtalk.com/forum/index.php?/topic/8062-final-labeling-segment-testing/#entry62472

 

Check last post from SMW. Is there a transcript of this available? It would be amazing if we didn't have to do unit confirmations. That would be such a favorable logistical improvement. No longer need isolated refrigerator space for unconfirmed units, ABO/Rh of Neg confirmed stickers, thousands of tests/year, principal use of anti-a,b, processing lag, etc.

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What is done differently in the UK that allows hospitals and transfusion centers to skip the confirmation of the donor blood type?

 

I believe I am correct in saying that this was only introduced after the testing was automated and the results sent to the computer with no human intervention, but the unit is still typed twice each time.  If there is human intervention, then the unit is discarded.  Is this correct John Eggington?

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Scott,

 

I think it is a risk management calculation.  Transfusing ABO incompatible red cells far outweighs the risk of transfusing ABO incompatible plasma. Trauma centers are now using group A plasma for untyped recipients.  It is acceptable to give group O platelet pheresis units to non-group O recipients.  We eliminated the minor crossmatch in US decades ago!

Edited by Dansket
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We used to have a blood supplier that was also a centralized transfusion service so they retyped all of the units from segments on the transfusion service side.  The units came to us labeled as retyped (little added sticker) so we didn't have to retype them.  It was lovely.  I left that lab about they time that they switched from CAP to JC accreditation and JC says that the 'transfusing facility' has to do the type confirmations.

 

New technology does add some wrinkles.  We are a multi-hospital system sharing a BBIS.  We at the big site retype all of the units on receipt and send them out to the others so they don't have to retype them.  If JC ever questions it, the retyping results are right there in the shared computer system, but technically they aren't retyped at the "transfusing facility".  Some of our small hospitals aren't JC accredited yet so it has not been a problem for us yet.

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I have not seen a mislabeled unit in 35 years, though the supervisor before me saw 1 or 2 in the 10 years she worked before I came to this facility (long before computers). It would seem that maybe this is something that is outdated/no value added and the practice should be re-evaluated by those who write the regs.

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I did have one unit from the blood supplier that was labeled B Pos and typed as O pos.  No weak reaction at all.  I crossmatched it to an O pos patient (just for kicks and giggles) as well as another B pos unit we had received at the same time and the first one was compatible while the second (which had retyped correctly) was not!  I sent that unit back.

 

What I remember Auntie-D saying on one discussion was that while they didn't retype units, that they did redo the antigen typing on antigen negative units, which is something we don't do here in the US, right?  If it comes with a hangtag stating that it is antigen negative, we retype the main type but not the antigen.  Certain blood suppliers state that two techs have to retype it before they can put a label on it.

Edited by donellda
Blood supplier name removed from post
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What I remember Auntie-D saying on one discussion was that while they didn't retype units, that they did redo the antigen typing on antigen negative units, which is something we don't do here in the US, right?

 

With all due respect, this may be true (Gawd knows why, but it may be true), but most hospitals don't carry the antisera to retest the antigens (or have the red cells available to use as positive and negative controls), and, certainly, when we are providing U-, Vel-, Lan-, etc blood, they couldn't anyway, not least because it is VERY difficult to tell the difference between a U variant and a true U negative, a Vel weak and a true Vel negative and a Lan weak and a true Lan negative, but, if hospitals would like to try, then good luck to them.

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In the early eighties we used to get a mislabled unit once every few years, but I've seen only one since the late eighties and that was a CPDA1 pedi unit int the late 90s that was labeled O neg but retyped as O pos.  Twas a great puzzle for the Red Cross.  They finally typed the contents of the unit and found it to be O neg, while the segments were O pos.  Turns out the person helping at the blood drive usually cut off the tubing to discard because the units would go for further processing as Adsol units.  They were supposed to remember the exception when they did CPDA1 units and not cut off the tubing.  Habit prevailed and the tubing was cut off into the discard bin.  They quickly realized their error and fished it back out of the bin and reattached it to the unit!!!  Of course, they mistakenly grabbed the wrong one.

 

One question: in the UK, do you all share a blood bank computer system so that unit data is transmitted to you electronically when you receive the units? We had a prior computer system that made it too easy to scan in parts of one unit for a different one.  I don't remember anyone ever doing it with blood type, mostly exp dates, but retyping would be one way to catch computer entry errors.  Not to say there aren't better ways to solve that computer system's weaknesses.  I'd favor not having to retype units, but we must think of the gaps and address them.

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One question: in the UK, do you all share a blood bank computer system so that unit data is transmitted to you electronically when you receive the units? We had a prior computer system that made it too easy to scan in parts of one unit for a different one.  I don't remember anyone ever doing it with blood type, mostly exp dates, but retyping would be one way to catch computer entry errors.  Not to say there aren't better ways to solve that computer system's weaknesses.  I'd favor not having to retype units, but we must think of the gaps and address them.

 

Quite recently this has been introduced (previously you had to scan the barcodes on the bag for the donor number, product, group and expiry). It is known as EDN - electronic distribution note. The box containing the blood has a tag with a barcode - you click a cog on the computer desktop and all units allocated your hospital download to an 'invisible' file. You then going into the hospital LIMS and barcode the tag in. This then imports all the units in the system. Some LIMS have it set up just to set the group but others to include the full Rh phenotype (genotype?), K type, any other antibodies that the units are antigen negative for, whether the unit is irradiated, methylene blue treated, and also CMV status.

 

It is a FAB system and virtually fool proof (I think)

 

ETA - hopefully I won't have offended Malcolm with my terminology this time. I'm hungry so not thinking on complete form...

Edited by Auntie-D
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