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2rd determination of recipient's ABO

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5.16.2.2    ~~~~~~~~Second  ABO by one of the following:

a) testing of a second current sample;

b. comparison with previous records; or

c) retesting of the same sample.

 

In the case that there is no other sample, there is no history and Retesting the same sample is not an option..  Where do you get your second sample?  

This happens to us daily in the ER and our Outpatient transfusion clinic.  Currently we carry the first blood product around and do a bedside finger stick and test the ABO.   We're being told that is going away.    

How does your hospital handle this situation ?  

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We give group O.  If it is a female of child bearing potential (horrible phrase), which, in the UK is 50 or younger, we give D Negative.  If it is a male or a female of 51 or older, we give D Positive.

This is enshrined in the British Society of Haematology (formally the British Committee for Standards in Haematology) Guidelines, so, if we go against these, we have to either have a very good reason for so doing, or we get our knuckles rapped in a big way (including, possibly, being taken to court).

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Retesting of the same sample will not catch a wrong-blood-in-tube.  If performing a computer crossmatch, CAP states that you can only use same specimen if specimen was drawn using a mechanical barrier system or digital bedside ID system.  I believe there was an other thread regarding Typenex/Hollister no longer meeting the requirements of a barrier system.

We will use a hematology specimen for our verification if it was drawn on a separate phlebotomy event.  The blood bank can order the verification per protocol if another specimen isn't available.  If blood is needed in the interim, we issue type O.  It's a hard stop in our BB system.

Edited by Carrie Easley

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1 hour ago, SMILLER said:

Why is retesting of the same sample not an option?

Scott

BSH Guidelines say that it has to be a sample taken at a different time and, ideally, taken by a different person.  I agree with this, because, firstly, if the sample was taken from the wrong person in the first place, testing two samples taken at the same time will not identify a problem, and, secondly, if the sample is taken by the same person, they may not be as "good" (or professional) at identifying the patient properly, as "they already know who is the patient".

There, you see, I do agree with some Quality!!!!!!!!!!!!!!!!!!!!!!

Sorry, didn't see Carrie Easley's post, which says virtually the same thing.

Edited by Malcolm Needs

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We never retest the same sample. If we don't have a second sample we crossmatch group O neg. We require a second type to switch blood groups and rh.

In an emergency, we'll switch to rh pos for adult males or women >55.

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This is obviously still a ticklish issue. Several good arguments are presented above, but a couple of things come to mind....

A mis-draw is always a possibility, but some of the algorithms above suggest that it happens on a regular basis. Does anyone here have statistics ? I'd love to see what the data says.

Even when drawing a second specimen, based on blood group frequencies, the odds are very favorable that you'll get a corroborative ABO/Rh typing, EVEN IF THE SAMPLE IS COLLECTED FROM A COMPLETELY RANDOM PERSON.

Just a couple of thoughts.....

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1 hour ago, exlimey said:

A mis-draw is always a possibility, but some of the algorithms above suggest that it happens on a regular basis. Does anyone here have statistics ? I'd love to see what the data says.

Even when drawing a second specimen, based on blood group frequencies, the odds are very favorable that you'll get a corroborative ABO/Rh typing, EVEN IF THE SAMPLE IS COLLECTED FROM A COMPLETELY RANDOM PERSON.

Just a couple of thoughts.....

The statistics collected by the SHOT organisation in the UK are as near "perfect" as one could ever expect (I accept that nothing is perfect), but their rules on copyright are severe.  May I suggest that you put "shot" into your search engine, have a look at the 2016 report, and concentrate on the pages in the middle to late teens?

I fully agree with your second point and, indeed, this is "taken into account" in the SHOT statistics.

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If the patient ID causing the wrong-blood-in-tube problem is happening at the bedside, there is no guarantee that any other sample drawn-- either at the same time as the BB specimen or later--is going to be OK. 

Scott

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14 minutes ago, SMILLER said:

If the patient ID causing the wrong-blood-in-tube problem is happening at the bedside, there is no guarantee that any other sample drawn-- either at the same time as the BB specimen or later--is going to be OK. 

Scott

A friend of mine, who used to work in one of the London teaching hospitals (I won't name which one) told me an alarming story once.

Apparently, a phlebotomist took blood from a lady in a bed.  The correct questions were asked, but asked incorrectly.  Instead of asking for the patient's name, the question was asked as, "Are you Joan Doe?", to which the patient readily replied in the affirmative.  The sample typed as A, D Positive.

For some reason (fate?) someone in the laboratory telephoned the Blood Bank at the hospital from which she had been transferred, and asked what blood group they had made the patient.  They had typed her as group O, D Positive.

A second sample was requested, and the same phlebotomist bled the same patient, but did not ask the appropriate questions the second time as "she knew the patient was Joan Doe".  Unsurprisingly, the second sample also typed as A, D Positive.  This was rejected by the laboratory, and my friend and the doctor went up to the ward and, this time, the doctor took the blood (and asked the correct questions correctly).  The patient said that she had not been bled before that particular day, and this sample typed as O, D Positive.

It turned out that the lady bled by the phlebotomist had advanced dementia, and would have answered "Yes" if she had been asked if her name was "Old King Cole", and so the phlebotomist had bled the wrong patient the first time and, because she now "KNEW" that the patient she had bled was Joan Doe, had bled her again without asking ANY questions.

Fortunately, an A into O mis-matched transfusion was avoided by pure chance, and the phlebotomist was thoroughly retrained.

One can try and rule out most problems with wrong blood in tube, but it is difficult to rule out stupid!

Scared the living daylights out of me!  :o:o:o:o:o

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Just now, BldBnker said:

Why is the bedside type "going away?"  We do that and have for years (decades), which has saved us on several occasions.  It's cheap, easy and quick.  Just curious.

It's probably all tangled-up in training, competency and proficiency. Maybe an administrative nightmare?

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On ‎10‎/‎13‎/‎2017 at 11:03 AM, BldBnker said:

Why is the bedside type "going away?"  We do that and have for years (decades), which has saved us on several occasions.  It's cheap, easy and quick.  Just curious.

I am curious...how are you doing the test, I am assuming slide, and how are you recording the results?  

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On ‎10‎/‎13‎/‎2017 at 11:03 AM, BldBnker said:

Why is the bedside type "going away?"  We do that and have for years (decades), which has saved us on several occasions.  It's cheap, easy and quick.  Just curious.

We're upgrading our computer system and they didn't build the ABO slide "bedside check"  so they are telling us we aren't doing them anymore. 

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On ‎10‎/‎13‎/‎2017 at 11:03 AM, BldBnker said:

Why is the bedside type "going away?"  We do that and have for years (decades), which has saved us on several occasions.  It's cheap, easy and quick.  Just curious.

One reason may be that a lot of labs can't afford a staff member to "disappear" for awhile.  

 

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