Dansket

We do. Based on a poster at AABB Annual Meeting 2-4 years ago, can't remember exactly.

The US military has been a constant practitioner of the use of whole blood in trauma.

No adverse reactions to blood transfusion due to ABO mismatch or unexpected antibody undetected since implementation of electronic crossmatch in 1997.

Using the Meditech Emergency Release of Units routine will automatically issue the unit and automatically order a Type and Screen for whomever blood is issued.

Did you use Meditech's Emergency Release routine to issue these units?

See attached showing page 5 of product dictionary in Meditech 5.67. See sections titled Subsitute Prod and Subst Prod Grp. You can use these so that RN/MD can order general product but you can substitute any product based on you entries in these fields. substitute products.docx

Thanks, I'll update the chart.

This flow chart is not dedicated to electronic crossmatch but does address it in section B. ecxm flowchart.docx

Do you really read freezer temps to a tenth of a degree? A typical freezer temperature recorder chart cannot be read to a tenth of a degree nor can a refrigerator temperature recorder chart be read to a tenth of a degree.

see attached Blood returned unused.pdf

Some computer systems allow user to select the component from a list displayed on screen, very, very risky in my opinion. My approach requires user to select component from refrigerator and scan the barcoded DIN into the BBK Enter/Edit results routine. These same steps are done, whether a serologic or electronic crossmatch is indicated. The only difference is that a donor tubing segment must be removed from the blood container for a serologic crossmatch. Based on my reading of your reply, do I understand correctly that you have not personally configured or operated a computer system qualified for the computer crossmatch in a Transfusion Service? Prior to any "crossmatching" in a computer system, user must enter results of ABO, Rh and Antibody Detection testing on the patient and ABO/Rh confirmation testing on the rbcs from a donor tubing segment. This means results of anti-A, anti-B, anti-D, Rh control, A1 cells and B cells for the patient and anti-A, anti-B, anti-D, and anti-A,B (however it is done) on the donor rbcs are entered into the BBK Enter/Edit results routine. The user entered results are compared to "truth tables" and ABO/Rh interpretations are generated accordingly. It is simple process for the computer to "match" both patient and donor unit when both are ABO/Rh identical. It is more complicated for the computer to "crossmatch" when the ABO/Rh of patient and donor unit is not identical. "Crossmatching" is accomplished by another "truth table" that is configured by the user to allow selection of ABO/Rh compatible but not identical donor units for a patient. In my system, if a patient qualifies for a "computer crossmatch", the system automatically enters 'NP' as the results of the immediate-spin and IgG crossmatches. If a patient does not qualify for a "computer crossmatch", user must enter serological test results for the immediate-spin and IgG crossmatches. BTW, I believe your dates for article by Boral and Henry are incorrect. Their article was published in the journal Transfusion in 1984 and the AABB approved the concept of the Type and Screen in 1987.

The user (not the computer) in my facility selects a RBC component from the refrigerator for crossmatching. Are you restricting the definition of a crossmatch to include only serological methods? In 1987 the AABB allowed users to limit the serological crossmatch to the immediate-spin test if the antiglobulin antibody screen test was negative. Then, in 199?, the AABB allowed users to replace the immediate-spin crossmatch with a "computer crossmatch" to detect ABO incompatibility. Before this, the word "crossmatch" was prefaced with "major" and "minor". So the definition of "crossmatch" has undergone many changes over the years. The FDA allows Transfusion Services to use a qualified computer system to detect ABO incompatibility between donor and recipient in lieu of serological methods to detect ABO incompatibility, i.e., as stated by tricore, "Computerized Analysis of the Compatibility between the Donor’s Cell Type and the Recipient’s Serum or Plasma Type".

In the Meditech computer ecosystem, the crossmatch occurs when the user enters donor unit numbers into the BBK Enter/Edit results routine. Blood components are released for transfusion using the BBK Issue Units routine which is separate and distinct from the BBK Enter/Edit results routine.

See my Library file "Meditech Unit Confirmation".

Which computer system are you using? Are these "type the patient's sample for verification" being recorded in your current computer system?

We mix Alba-QCheck vial #4 thoroughly and add 40uL of ORTHO Bio-Clone Anti-D. Mix thoroughly and centrifuge. This will give a positive DAT and a positive Rh control on ProVue. We use it for 7 days.

Yes, if you are AABB accredited, then you must do an ABO determination (as defined in 5.14.1) on the initial blood sample and an ABO determination (as defined in 5.14.1) on the 'retype specimen'. FDA, CAP and other accrediting agencies do not prescribe how the 'retype' must be done.

It is a formalized process at our facility, Clot to Hold must be ordered in HIS and resulted in LIS. No charge. Based on internal data, we don't centrifuge prior to storage.

It depends. If your goal is accuracy in ABO typing then draw a second specimen. If your goal is patient safety, then it isn't necessary to type a second specimen because you routinely will select group O donor units and they will always be compatible. At my facility, 55% of patients with no previous ABO on file type as group O.

That is correct. We should be thinking in terms of calendar days not hours. A calendar day starts at 0000 and ends at 2359. A specimen collected at 0000 does not expire until 2359 of that calendar day.

AABB Standards 30th Edition 5.14.3.2 states, "The sample shall be obtained from the patient within 3 days of the scheduled transfusion in the following situations. Day 0 is the day of draw." The three conditions are 1)transfused in the preceding 3 months with blood component containing allogenic red cells, 2)pregnant within the preceding 3 months or 3) history of transfusion or pregnancy is uncertain or unavailable. I interpret this to mean that the blood component must be issued before the sample expires at 2359 on day 3. AABB Standard 5.28 Administration of Blood and Blood Components states, "There shall be a protocol for the administration of blood and blood components... The protocol shall be consistent with the Circular of Information for the Use of Human Blood and Blood Components. Standard 7.5 applies." I don't have a copy at hand but it may address blood being infused after blood sample has expired?

Electronic crossmatch requires 2 ABO types on file regardless of the initial ABO typing. Patients who don't qualify for the electronic crossmatch may be serologically crossmatched with ABO identical or ABO compatible RBC's regardless of the initial ABO typing. Meditech will prompt you that patient does not qualify for electronic crossmatch if no second ABO on file. I am not aware that you can override this requirement in Meditech regardless the patient's initial ABO typing.

I have been running the CAP Survey DAT for years on ProVue without any failures. CAP provides 3 samples in sealed vials. We thoroughly resuspend the contents of the vials and then pour the entire contents (2-3ml) of the vials into individually labeled tubes. Centrifuge the tubes for 15 seconds (in the same centrifuge we use for tube testing). Specimens are now ProVue-ready for testing.

To minimize the number of steps required to issue blood, we retain donor tubing segments as part of the ABO/Rh confirmation process on receipt of donor units from the donor center. I dislike trying to find the end of the donor tubing that is tightly rubber-banded together under any circumstance and certainly not when a nurse is standing beside me!

Please describe the appearance of the anti-A gel column when testing an A3 phenotype? Was the distribution of red cells in the gel column classic dual-population (rbc trapped on top, rbc button at the bottom, but no rbc within the gel column) or something else?