Second blood groups, computer crossmatch, and automation

[AuntiS]

Hello blood bank world!

 

Background – we are currently not automated (use manual gel), do not use Computer Crossmatch (please don’t yell at me, CSA standards call it Computer Crossmatch  ), but do have staff who collect blood using Positive Patient Identification.  We are looking automation (not yet at RFP).  We are planning ahead for Computer Crossmatch and Automation.  What we want to do is retest samples collected using PPI without having to removing them from the analyzer or relabel with a new specimen number.  We use Meditech (Magic).

 

If you have a moment, can you provide some feedback? 

 

1. What automation platform do you use?

2. What LIS?

3. Do you use middleware?

4. Do you use positive patient identification?

5. To get a second blood group, by retesting the sample (i.e. PPI) do you:

   • Generate a new specimen number and re-label or aliquot?

   • Generate new tests for the same specimen number. If so, will the analyzer retest that same sample with the new tests and generate a second ABO/Rh?

6. Do you use history from another site (like Clinical Connect here in Southern Ontario or other Electronic Health Record) as a historical result?

   • If so, have you created a new test that your LIS will use as a second group to use for Computer XM?

7. Do all your samples expire after 96 hours?  Or do you have a pre-op policy that allows for more time as long as the patient has not been transfused/pregnant.  We have a 28 day policy.

8. Any other brilliant ideas or thoughts?

 

Thanks in advance to ANY info you have!  We just want to do this right from the beginning  

sandra

[BankerGirl]

On 3/9/2017 at 2:59 PM, AuntiS said:

Hello blood bank world!

 

Background – we are currently not automated (use manual gel), do not use Computer Crossmatch (please don’t yell at me, CSA standards call it Computer Crossmatch  ), but do have staff who collect blood using Positive Patient Identification.  We are looking automation (not yet at RFP).  We are planning ahead for Computer Crossmatch and Automation.  What we want to do is retest samples collected using PPI without having to removing them from the analyzer or relabel with a new specimen number.  We use Meditech (Magic).

 

If you have a moment, can you provide some feedback? 

 

1. What automation platform do you use?  We use Immucor Echo

2. What LIS?  Meditech c/s

3. Do you use middleware?  No

4. Do you use positive patient identification?  Yes

5. To get a second blood group, by retesting the sample (i.e. PPI) do you:

   • Generate a new specimen number and re-label or aliquot?  No

   • Generate new tests for the same specimen number. If so, will the analyzer retest that same sample with the new tests and generate a second ABO/Rh?  Yes.  It could but you would have to either manually program the test or take the sample rack off and rescan it for the test to download.  I have chosen to continue to perform the second type by Tube. We had some discrepancies with ABO Types on the Echo.  We have occasional specimens where the back type fails to match and one cord blood sample that was weak enough the Echo called it O Pos when it was truly AB Pos.  We wouldn't have caught the cord blood error if we hadn't done it in tube.

6. Do you use history from another site (like Clinical Connect here in Southern Ontario or other Electronic Health Record) as a historical result?  We use historical types from our previous computer systems but not from anyone else's testing.

   • If so, have you created a new test that your LIS will use as a second group to use for Computer XM?  Yes, we call it Historical Blood Type.

7. Do all your samples expire after 96 hours?  Or do you have a pre-op policy that allows for more time as long as the patient has not been transfused/pregnant.  We have a 28 day policy.  Our samples all expire at midnight on the third calendar day.

8. Any other brilliant ideas or thoughts?  I love Electronic Crossmatch!  I also love the Echo on most days, although we sometimes go through days where it seems the Echo is more work than benefit.  There are just some times when I scratch my head on it's interpretation of some wells and all the "?" results.

 

Thanks in advance to ANY info you have!  We just want to do this right from the beginning  

sandra

 

[John C. Staley]

I'm curious.  What benefit do you see in retesting the same sample?  

[Dansket]

1. What automation platform do you use? ProVue

2. What LIS? Meditech C/S version 5.67

3. Do you use middleware? No, ProVue is not interfaced to Meditech

4. Do you use positive patient identification? Yes, Typenex Blood Recipient Identification System

5. To get a second blood group, by retesting the sample (i.e. PPI) do you:

• Generate a new specimen number and re-label or aliquot? No, a new specimen number is generated and a new blood sample is collected if original blood sample was agglutinated by anti-A,B (manual tube test).

• Generate new tests for the same specimen number. If so, will the analyzer retest that same sample with the new tests and generate a second ABO/Rh? No

1. Do you use history from another site (like Clinical Connect here in Southern Ontario or other Electronic Health Record) as a historical result? No

   • If so, have you created a new test that your LIS will use as a second group to use for Computer XM? Yes, depending on results of testing with anti-A,B, CONFIRM or CONFIRMO.

2. Do all your samples expire after 96 hours?  Or do you have a pre-op policy that allows for more time as long as the patient has not been transfused/pregnant.  We have a 28 day policy. All samples expire at 2359 on the third calendar day (day sample collected counted as day zero)

3. Any other brilliant ideas or thoughts? By retesting the same blood sample, you won't detect specimen collection errors.

 

[AuntiS]

On ‎3‎/‎11‎/‎2017 at 11:25 AM, John C. Staley said:

I'm curious.  What benefit do you see in retesting the same sample?  

Hi John,

This allows you to get the second blood group required for the computer crossmatch (EXM) without collecting a new sample IF PPI is used (our hospital uses Mobilab).

According to the CSA Standards:

10.6.3.2

If a computerized crossmatch system is used, two determinations of the recipient’s ABO group shall be made: the first shall be on a current sample and the second shall be by one of the following methods:

a) testing of a second current sample;

comparison with previous records; or

c) retesting of the same sample.

 

Note: Retesting of the same sample detects technical errors only. It will not detect sampling or identification errors. See Clause 10.6.3.3.

 

10.6.3.3

Retesting of the same sample shall only be done in situations where positive patient identification technology is used at the time of specimen collection.

sandra

 

 

[AuntiS]

Quote

To get a second blood group, by retesting the sample (i.e. PPI) do you:

• Generate a new specimen number and re-label or aliquot?  No

• Generate new tests for the same specimen number. If so, will the analyzer retest that same sample with the new tests and generate a second ABO/Rh?  Yes.  It could but you would have to either manually program the test or take the sample rack off and rescan it for the test to download.  I have chosen to continue to perform the second type by Tube. We had some discrepancies with ABO Types on the Echo.  We have occasional specimens where the back type fails to match and one cord blood sample that was weak enough the Echo called it O Pos when it was truly AB Pos.  We wouldn't have caught the cord blood error if we hadn't done it in tube

Very interesting!!!  Something that could be done easily using the Echo, but less convenient if using gel cards...

Quote

Do you use history from another site (like Clinical Connect here in Southern Ontario or other Electronic Health Record) as a historical result?  We use historical types from our previous computer systems but not from anyone else's testing.

• If so, have you created a new test that your LIS will use as a second group to use for Computer XM?  Yes, we call it Historical Blood Type.

So, you are able to enter a blood group from another computer system into Meditech and it allows you to use it as a second blood group eligible for EXM?  We are having some difficulties with that here...

sandra

[BankerGirl]

Sandra,

Our previous computer systems were all converted in one of two ways into Meditech.  Meditech won't utilize the type from these systems as a second type but they are viewable in the BBK History as either comments or as conversion types.  This is why we order the BTHX test.  It is just a blood type and must be resulted manually.