If a patient has a historical ABO/Rh on file where two determinations of blood type were made at that time, is it necessary to verify the ABO/Rh on a current sample prior to plasma/platelet/cryo transfusion?

We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.

Non-RBC products can rely on a historical type on file.

If there isn't a type on file, that's when you would require an indated specimen to test for issue (otherwise you would have to consider emergency releasing).

19 hours ago, pbaker said:

We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.

Same here.

Of course.  There is no link between a previous admission and a current one that is reliable enough to allow for transfusion of any product without at least confirming the ABO/Rh.  We have even had a few patients who have been admitted with a friend or relative's ID in order to piggy-back on insurance!

Scott

4 hours ago, SMILLER said:

Of course.  There is no link between a previous admission and a current one that is reliable enough to allow for transfusion of any product without at least confirming the ABO/Rh.  We have even had a few patients who have been admitted with a friend or relative's ID in order to piggy-back on insurance!

Scott

How often does this issue come up, and do you only recognize it when the typing is discrepant?

6 hours ago, SMILLER said:

Of course.  There is no link between a previous admission and a current one that is reliable enough to allow for transfusion of any product without at least confirming the ABO/Rh.  We have even had a few patients who have been admitted with a friend or relative's ID in order to piggy-back on insurance!

Scott

And Admissions sometimes selects the wrong patient's record to admit--usually someone with the same name.  You would hope that we have enough checks to catch this pretty quickly these days, but strange things happen.

Besides anecdotal reasoning to obtain a current admission sample, is there a requirement or standard addressing non-cellular products and historical vs current sample requirements prior to transfusion?

1 hour ago, rosi0017 said:

Besides anecdotal reasoning to obtain a current admission sample, is there a requirement or standard addressing non-cellular products and historical vs current sample requirements prior to transfusion?

See 30th Edition of the AABB standards page 37, 5.15.5.  This may have changed in the 31st Edition.

On ‎06‎/‎12‎/‎2019 at 1:12 PM, pbaker said:

We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.

so do we

On ‎06‎/‎14‎/‎2019 at 12:22 PM, Dansket said:

See 30th Edition of the AABB standards page 37, 5.15.5.  This may have changed in the 31st Edition.

I don't see how that standard answers the question.  What I see in AABB standards is 5.14 and 5.14.5 (31st edition):  allogeneic transfusion requires at least a current specimen type  (if there is a historical record).  If red cells are being transfused then an antibody screen is also required.  This is identical to the 30th edition. 

We only require this once/admission for non-red cell components.

2 hours ago, David Saikin said:

I don't see how that standard answers the question.  What I see in AABB standards is 5.14 and 5.14.5 (31st edition):  allogeneic transfusion requires at least a current specimen type  (if there is a historical record).  If red cells are being transfused then an antibody screen is also required.  This is identical to the 30th edition. 

We only require this once/admission for non-red cell components.

Agreed 5.15.5 is not relevant to rosi0017 post.

AABB Standards 30th Edition 5.14, "Pretransfusion tests for allogeneic transfusion shall include ABO group and Rh type.  In addition, for Whole Blood, Red Blood Cell, and Granulocyte components,  pretransfusion testing for unexpected antibodies to red cell antigens shall be performed."  I don't have access to the 31st Edition, is this wording above identical?

Components selected for transfusion to a patient, if not labeled Autologous must, by definition, be allogeneic.  It seems that the only difference between requirements for non-red cell components and red cell components as stated in 5.14 is that pretransfusion testing for unexpected antibodies (an antibody screen) to red cell antigens is explicitly required for red cell components only.  Therefore, pretransfusion testing for ABO and Rh on a current patient blood sample is required for both non-red cell and red cell components.

the wording is the same in the 31st edition.

I have to agree with you about a current specimen.    As I stated above, we get a current specimen and it is good for non-red cell transfusion for the duration of the admission.

2 hours ago, David Saikin said:

the wording is the same in the 31st edition.

I have to agree with you about a current specimen.    As I stated above, we get a current specimen and it is good for non-red cell transfusion for the duration of the admission.

My working definition of a current blood sample is a blood sample that was obtained from the patient within 3 days of the intended date of transfusion.

On ‎6‎/‎20‎/‎2019 at 4:33 PM, Dansket said:

Agreed 5.15.5 is not relevant to rosi0017 post.

AABB Standards 30th Edition 5.14, "Pretransfusion tests for allogeneic transfusion shall include ABO group and Rh type.  In addition, for Whole Blood, Red Blood Cell, and Granulocyte components,  pretransfusion testing for unexpected antibodies to red cell antigens shall be performed."  I don't have access to the 31st Edition, is this wording above identical?

Components selected for transfusion to a patient, if not labeled Autologous must, by definition, be allogeneic.  It seems that the only difference between requirements for non-red cell components and red cell components as stated in 5.14 is that pretransfusion testing for unexpected antibodies (an antibody screen) to red cell antigens is explicitly required for red cell components only.  Therefore, pretransfusion testing for ABO and Rh on a current patient blood sample is required for both non-red cell and red cell components.

The standard in 5.14 quoted above states that pre-transfusion requirement for any allogeneic component is an ABO group and Rh type.  It does not state that this has to be done within 3 days or on the current admission.  As we can see by the responses, some facilities are requiring confirmation on the current admission and others will go with historical ABO/Rh for a plasma/plt/cryo transfusion, and I can definitely see arguments for either side; bottom line is, this is not a regulatory requirement and must be defined by your facility.  There is a standard that requires the pre-transfusion testing within 3 days if transfused or pregnant (5.14.3.2) - but the entire section for 5.14.3 is regarding the antibody screen for WB/RBC/Gran transfusions, not the ABO/Rh only.

You are correct.  However, in a facility with a very low volume of transfusion <1000 units annually, we elected to standardize the criteria for collection of pretransfusion blood samples, i.e., collecting a blood sample within 3 days of the intended date of transfusion for both red cell and non-red cell transfusions.

We must have a current ABO/Rh done on the current visit.

On 6/21/2019 at 9:01 AM, David Saikin said:

the wording is the same in the 31st edition.

I have to agree with you about a current specimen.    As I stated above, we get a current specimen and it is good for non-red cell transfusion for the duration of the admission.

This is what we do. We are a smaller facility with an active Oncology treatment unit. We transfuse platelets and plasma with a type from the current admission.

Edited July 3, 20196 yr by AMcCord

On ‎6‎/‎21‎/‎2019 at 7:01 AM, David Saikin said:

I have to agree with you about a current specimen.    As I stated above, we get a current specimen and it is good for non-red cell transfusion for the duration of the admission.

This makes me look at Std 5.11.4 "Retention of Blood Samples: Patient samples . . . shall be stored at refrigerated temperatures for at least 7 days after transfusion."  Do you still have the specimen drawn on day 1 of admission 7 days after platelets were transfused on day 15 of admission?  We keep our specimens 17 days after last use due to our pre-op policies but I have never looked at their storage with FFP or platelets in mind.  I doubt that we think we are "using" the specimen when we issue platelets so we don't move it forward to the current day's rack so it gets saved for 7 more days.  Besides regulatory nit-picking, what is the risk to the patient if we no longer have the specimen (that we collected and typed early in the admission) 7 days after the platelet or plasma transfusion?

On 7/3/2019 at 6:48 PM, Mabel Adams said:

 Do you still have the specimen drawn on day 1 of admission 7 days after platelets were transfused on day 15 of admission? 

Excellent point!

that standard (5.11.4), I believe, is directed at rbc transfusions.  I do not keep a specimen for an FP or plt  transfusion. 

30th edition of the AABB Standard 5.11.4 states, "Patient samples and a segment from any red-cell-containing component(s) shall be stored at refrigerated temperatures for at least 7 days after transfusion."  Bold-face type is my emphasis.

3 hours ago, Dansket said:

30th edition of the AABB Standard 5.11.4 states, "Patient samples and a segment from any red-cell-containing component(s) shall be stored at refrigerated temperatures for at least 7 days after transfusion."  Bold-face type is my emphasis.

I felt that the section on segments surely applied only to RBCs.  Do you think that means the whole standard does?  To me it implied that the other parts applied to non-RBC containing products but I'll be happy to assume it is for RBCs only.

Does your investigation-of-an-adverse-reaction-to-blood-transfusion-protocol for non-cellular blood components require testing the pretransfusion blood sample?

I think this standard could stand an infusion of clarity.  I read it as 'Patient samples for all transfusions and a segment from any red-cell-containing component shall be stored at refrigerated temperatures for at least 7 days after transfusion.'

Maybe someone can get clarification from the AABB as to their intent for 5.11.4.