How to handle EDTA patient samples?

[knelson]

Hi, everyone!

It is way overdue, but we are finally preparing to switch from red top serum tubes to pink EDTA tubes for patient samples (for antibody screens, xmatches, etc.).  We currently separate the serum from the red cells and put the serum in another labeled tube, which is then rubberbanded to the mother tube.  I would like to get away from separating the specimen to eliminate labeling errors, if possible.  Labeling errors are not common and are usually  something like the tech omitted the time, phleb initials, or BB# on the separated serum tube.  However, they are still errors that I would like to not to have to deal with.   For those of you that use EDTA patient samples, what is your practice for handling the patient samples?  Do you separate the plasma from the red cells?  If not, do you respin the tube every time you add on additional testing, such as additional xmatches done two shifts later, etc.?  How long do you respin the tubes?   Your input is greatly appreciated.  Thank you!

[R1R2]

No to separating plasma from red cells because most of our testing is automated.   For manual testing - very little "jostling" of the red cell layer occurs during patient testing so specimen re-spinning is usually not required if the tech is careful.   We are electronic crossmatch so the majority of additional red cell requests do not require serological crossmatches.    Also, for additional requests for blood that requires serological crossmatch  we do not include a repeat  patient front type.     

[Laurie Underwood]

We do not separate the plasma from the red cells and we do not respin the tube for added testing.

[frenchie]

We do separate the plasma from the red cells, it has been a big learning curve for the techs, I had to monitor for several weeks and finally got 100% compliance for tech initials and date.

We do ISXM in gel buffered card, so it is easier for us to have a clean, red cell free plasma prior to testing.

 

[jalomahe]

We do not remove the plasma to a separate tube for the very reasons that you mentioned (labeling errors) and in worst case scenario if the plasma tube was mislabeled you could be using the wrong specimen for crossmatch. So by only keeping your original tube you are increasing patient safety by eliminating a step for an error to occur. Plus if your lab is into LEAN processes this is making your process LEAN.

The techs her are anal-retentive enough that if they are using a specimen for xm or any other test they want the original plasma in the original tube. We also use electronic crossmatch so we don't have to use the specimen after the initial testing too often.

If we do need to use the specimen for xm or additional testing and it has been refrigerated we will let it come to room temp and then respin just to get rid of any stuff that the cold might have generated. If it hasn't been refrigerated yet then as long as there is clear plasma there's no need to respin.

 

[AMcCord]

We do not separate plasma from the red cells. I think that just opens up another opportunity for error and adds a step to the workload. Once testing is complete we toss it into a plastic shoe box in the fridge.

Our testing is mostly done on the Echo - if we need to add an automated test, the specimen is brought to room temp and respun for 6 minutes at 3500 RPM. If the tube happens to land upright in the storage box and the plasma/cell separation is good, we would not respin for an immediate spin (tube) crossmatch.

Edited July 6, 2016 by AMcCord

[Mabel Adams]

We don't usually separate but do if the patient needs an antibody ID.  Then we are often going back into the cells to do auto control and antigen types and may have to use the plasma later for more serological crossmatches.  We don't want to put the MTS pipet all the way through the plasma to reach the cells because the tips aren't long enough and we would contaminate the pipet and overflow the specimen tube.  We tape the plasma tube to the primary tube at the time of separation.  We are currently doing tube blood types and gel screens using 6 ml pink tubes.  When we get automation and start doing gel blood types we will see if anything changes for us.

[mollyredone]

We do separate into another tube for antibody ID, for the same reasons as Mabel, but when it is done, we pour it back in the primary tube.  We use a 6 ml EDTA tube.