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ABO Retype


Ehowell66

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Hi folks, 

Currently when a patient does not have a prior blood type on file,  we will collect a second specimen (drawn at different time, different person).  The forward type is repeated and resulted as the second type.  This was set up before I became supervisor.   Recently a CAP inspector told me she thought all ABO/Rh typing's  needed a forward and reverse done.   How do you do your retypes?    Based on TRM 40550 it seems the retype would need a reverse typing as well,   thoughts?       

Thank you

 

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Were you cited with a deficiency?  If not, I would ignore inspector's musings.

I dislike the term "retype", it seems ambiguous to me.  The last time I looked at CAP standards they required that the patient's ABO be confirmed or verified, but did not prescribe a testing protocol/method.

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              At my previous job we only did the front type for our "retype" ABO and no inspector ever said anything. Basically when you do an immediate spin crossmatch, you are only checking the front type of a patient since you are using the patient's cells, not the plasma.

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18 minutes ago, ANORRIS said:

AABB ---BOTH

Agreed!  From the 31st Edition of the BBTS Standards:

Standard 5.14.5 Pretransfusion Testing requires two ABO group determinations and cites Standard 5.14.1 as the precursor.  5.14.1 states the ABO group shall be determined by testing the red cells with Anti-A and Anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent red cells....

TRM.40550 Forward/Reverse Typing Phase II

For each patient, red blood cells are tested with anti-A, anti-B, anti-D, and serum/plasma is tested using A1 and B reagent red cells.

NOTE: The ABO/Rh type of the patient's red blood cells must be determined by an appropriate test procedure. Tests on each sample must include forward and reverse grouping.

CAP and AABB are in agreement.

 

 

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14 hours ago, Ehowell66 said:

Hi folks, 

Currently when a patient does not have a prior blood type on file,  we will collect a second specimen (drawn at different time, different person).  The forward type is repeated and resulted as the second type.  This was set up before I became supervisor.   Recently a CAP inspector told me she thought all ABO/Rh typing's  needed a forward and reverse done.   How do you do your retypes?    Based on TRM 40550 it seems the retype would need a reverse typing as well,   thoughts?       

Thank you

 

This is what we have always done, but I am in the process of rebuilding the verify type to include a serum type for just this reason.

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2 hours ago, tcoyle said:

Agreed!  From the 31st Edition of the BBTS Standards:

Standard 5.14.5 Pretransfusion Testing requires two ABO group determinations and cites Standard 5.14.1 as the precursor.  5.14.1 states the ABO group shall be determined by testing the red cells with Anti-A and Anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent red cells....

TRM.40550 Forward/Reverse Typing Phase II

For each patient, red blood cells are tested with anti-A, anti-B, anti-D, and serum/plasma is tested using A1 and B reagent red cells.

NOTE: The ABO/Rh type of the patient's red blood cells must be determined by an appropriate test procedure. Tests on each sample must include forward and reverse grouping.

CAP and AABB are in agreement.

 

 

You are correct that both CAP and AABB agree as to how the initial ABO/Rh determination be done.

However they do not agree as to how the ABO/Rh verification testing is done!

TRM.40550 refers to the initial determination of a patient's ABO/Rh typing on a current blood sample. There is another CAP standard for "ABO Confirmation" as part of the "Computer Crossmatch" requirements.

See TRM.40670 ABO Group and Rh(D) Type Verification Phase II.  "The recipient's ABO group and Rh(D) type has been verified by repeat testing of the same sample, a different sample, or agreement with a historical type in the laboratory's records." This checklist requirement does not state the method of repeat testing nor does it refer to TRM.40550.

Edited by Dansket
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On Thursday, July 19, 2018 at 7:58 AM, tcoyle said:

Agreed!  From the 31st Edition of the BBTS Standards:

Standard 5.14.5 Pretransfusion Testing requires two ABO group determinations and cites Standard 5.14.1 as the precursor.  5.14.1 states the ABO group shall be determined by testing the red cells with Anti-A and Anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent red cells....

TRM.40550 Forward/Reverse Typing Phase II

For each patient, red blood cells are tested with anti-A, anti-B, anti-D, and serum/plasma is tested using A1 and B reagent red cells.

NOTE: The ABO/Rh type of the patient's red blood cells must be determined by an appropriate test procedure. Tests on each sample must include forward and reverse grouping.

CAP and AABB are in agreement.

 

 

I respectfully disagree. The CAP standard you cite is for the initial type. Any other time CAP mentions type confirmation (ie. TRM.30575, and TRM.4670) they state ABO only.

Jenny

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Hello,

The people have spoken and thanks for the comments!  I agree that the verification of a blood sample per CAP does not state how to do this.  However, AABB is quite clear that determinations of ABO group be performed with the Anti-A and Anti-B reagents and with A1 and B reagent red cells.  

A question to consider:  isn't it safer for the patient to do the full ABO group test when actual testing is required rather than performing only the front type?  With the front and back type of testing you have a built in monitor to help discover discrepancies. 

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 This is the Canadian Standard:

A little vague.......

 

10.6.1.3

To provide ABO- group-compatible red blood cells, there shall be at least two determinations of the recipient’s blood group on record: one from a current sample and the second from the

  1. recipient’s previous records;  
  2. testing of a separate sample collection; or
  3. retesting of the same sample where positive patient identification technology was used at the time of sample collection.

Note: Positive patient identification technology refers to a computerized system that uses a barcode, radio- frequency identification (RFID), or another electronically readable element on a patient’s identification band to confirm identity.

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8 minutes ago, tcoyle said:

A question to consider:  isn't it safer for the patient to do the full ABO group test when actual testing is required rather than performing only the front type?  With the front and back type of testing you have a built in monitor to help discover discrepancies. 

To address this question of safety, I would like to see hard data from the AABB community as to the frequency of events where an ABO discrepancy was detected in the second ABO determination that was not detected in the first ABO determination.  More importantly, did the detection of an ABO discrepancy (missed by the first ABO determination) prevent the transfusion of ABO incompatible red blood cells? 

My responses above assume that the ABO discrepancy was demonstrable by repeat testing of the first blood sample.

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  • 3 weeks later...
7 hours ago, AMcCord said:

One caveat I would add - if you are inspected by TJC, you are required to follow AABB standards.

I'm curious.  Do the TJC inspectors cite AABB standards when they see a deviation/variance or do they cite TJC standards? 

I ask this because when the State of California (also requires facilities to follow AABB Standards) inspects and finds deficiencies they cite CA regulations, not AABB Standards.  Also when HFAP inspects and finds deficiencies in a CA facility, they cite HFAP standards, but do not mention AABB Standards.

My point is that when non-AABB regulatory agencies require facilities to follow AABB Standards, it doesn't mean that they perform an "AABB" inspection nor do they follow the AABB Inspection Checklist form.

In other words, how does TJC determine, whether or not, if a facility is following AABB standards?

 

Edited by Dansket
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3 minutes ago, Dansket said:

I'm curious.  Do the TJC inspectors cite AABB standards when they see a deviation/variance or do they cite TJC standards? 

I ask this because when the State of California (also requires facilities to follow AABB Standards) inspects and finds deficiencies they cite CA regulations, not AABB Standards.  Also when HFAP inspects and finds deficiencies in a CA facility, they cite HFAP standards, but do not mention AABB Standards.

My point is that when non-AABB regulatory agencies require facilities to follow AABB Standards, it doesn't mean that they perform an "AABB" inspection nor do they follow the AABB Inspection Checklist form.

Right.  My sense is that the standards for a particular inspection agency, like JCAHO or CAP, are specific for that agency, and those are what your facility is inspected by.  Having said that, I believe that when a Blood Bank area is inspected (in the US at least), the particular agency's standards are based on AABB guidelines.   (Likewise ALL agencies must follow, at a minimum, CLIA legislative requirements for all areas of the clinical lab.)

Scott

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How on Earth can one body claim to "own" a procedure, if that procedure is 1) almost universal throughout the world, and 2) if the proper procedure is there to enhance patient safety?  It seems absolutely preposterous to me (if I were them, I would be very flattered that people wanted to follow my example/direction, UNLESS of course, they are unsure of what they have written vis-a-vis patient safety and are frightened of being sued if something goes wrong.

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1 hour ago, Malcolm Needs said:

How on Earth can one body claim to "own" a procedure, if that procedure is 1) almost universal throughout the world, and 2) if the proper procedure is there to enhance patient safety?  It seems absolutely preposterous to me (if I were them, I would be very flattered that people wanted to follow my example/direction, UNLESS of course, they are unsure of what they have written vis-a-vis patient safety and are frightened of being sued if something goes wrong.

Short (facetious) answer: $$$$$$$$$

Long answer - my opinion - Facilities required or choose to follow AABB Standards (and therefore get an inspection) are required to pay for/buy said standards. At the very least, they are "institutional members" that pay an annual membership fee. The AABB Standards are very different from the Technical Manual (in which the universal, public domain procedures reside). I may be wrong, but I think the standards get some kind of tacit approval by the FDA, whereas the TM gets peer-review. Of course, both documents/books are available to anyone for a fee......:unsure:

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I think that originally in the US, (before a senator's wife endured a tragedy after a false-positive pap smear was reported by a 50-paps-per-hour histology aide causing the birth of CLIA) labs were sort of self-regulated compared to today.  CAP and JCAHO for labs in general, AABB for blood banks, FDA for certian services, etc.  So that the AABBs standards were, and still are, thought by many as de rigueur for any inspection organization as far as Immunohematology goes. 

But that doesn't mean they copy or follow AABB standards precisely -- US federal CLIA standard requirements are not as comprehensive as AABB  (or CAP standards for that matter).

Scott

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16 hours ago, Dansket said:

I'm curious.  Do the TJC inspectors cite AABB standards when they see a deviation/variance or do they cite TJC standards? 

I ask this because when the State of California (also requires facilities to follow AABB Standards) inspects and finds deficiencies they cite CA regulations, not AABB Standards.  Also when HFAP inspects and finds deficiencies in a CA facility, they cite HFAP standards, but do not mention AABB Standards.

My point is that when non-AABB regulatory agencies require facilities to follow AABB Standards, it doesn't mean that they perform an "AABB" inspection nor do they follow the AABB Inspection Checklist form.

In other words, how does TJC determine, whether or not, if a facility is following AABB standards?

 

 

16 hours ago, SMILLER said:

Right.  My sense is that the standards for a particular inspection agency, like JCAHO or CAP, are specific for that agency, and those are what your facility is inspected by.  Having said that, I believe that when a Blood Bank area is inspected (in the US at least), the particular agency's standards are based on AABB guidelines.   (Likewise ALL agencies must follow, at a minimum, CLIA legislative requirements for all areas of the clinical lab.)

Scott

I agree with Scott's assessment. TJC standards for blood bank say that the blood bank should follow AABB guidelines, not necessarily be inspected by AABB. (I should have used the word guidelines, not standards.) I believe that they see AABB as the 'gold standard' that facilities should strive to follow. And of course, the AABB Stds are aimed at meeting FDA requirements.

I discovered long ago that if I made sure that I was following AABB standards as closely as I was able to, that I would have little to no difficulty in passing TJC and CLIA inspections. In addition, if I made changes based on new or revised AABB Stds, then I was going to be ahead of the game for new and changed CAP Stds.

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28 minutes ago, SMILLER said:

I think that originally in the US, (before a senator's wife endured a tragedy after a false-positive pap smear was reported by a 50-paps-per-hour histology aide causing the birth of CLIA) labs were sort of self-regulated compared to today.  CAP and JCAHO for labs in general, AABB for blood banks, FDA for certian services, etc.  So that the AABBs standards were, and still are, thought by many as de rigueur for any inspection organization as far as Immunohematology goes. 

But that doesn't mean they copy or follow AABB standards precisely -- US federal CLIA standard requirements are not as comprehensive as AABB  (or CAP standards for that matter).

Scott

CAP has been around since 1960s and TJC commission since 1951, causing lab staff grey hair for many years (in a good way). In the 1990's, CLIA put some bite in inspections because they brought a different type of quality focus into the inspection process, they verify inspections performed by other agencies, like CAP, and they cover labs that were not being inspected - like Drs offices.

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