Is an ABO retype required if the specimen will NOT be used for transfusion purposes?  For example, when an ABO is ordered for prenatal testing, outpatients who just want to know their type, and newborn cord blood testing (we do not transfuse newborns at our hospital)?  AABB standards refer to "pretransfusion testing" but if the sample would never be used for transfusion purposes does it need to be confirmed?

I guess the question then becomes, if, in the future can an unconfirmed blood type be used as confirmation for a current T&S / XM?  

14 hours ago, John C. Staley said:

I guess the question then becomes, if, in the future can an unconfirmed blood type be used as confirmation for a current T&S / XM?  

And there in lies the danger.  Well said John.

AS an ex-Reference Laboratory Manager, I think that ALL results should be confirmed, ABO or otherwise.

Edited August 24, 2024Aug 24 by Malcolm Needs

We do not require a confirmation when no red cell transfusions are ordered - ie - prenatal testing, or just an ABO/Rh.

Most BB LIS systems will not "allow" the selection of ABO specific red cells if there are not TWO matching examples of the ABO on file with reactions.

As an example:  Our hospital just went to a new BB LIS (under duress).  The ABO interpretations came across to the new system but NOT the actual reactions.  Because of that we've had to perform a second 
ABO on essentially EVERY patient who we get a Type and Screen on - as this is the only test that allows for the selection of red cell containing products.  We also went to a new version of EPIC at the same time as the BBLIS switch and it has somehow been set up by someone to recognize all patients who DO NOT have 2 ABO's with reactions on file and it will automatically order the 2nd ABO for us.

Thanks for your answers!

Some of the draws I mentioned are drawn outside of our lab and sent to us for testing.  Am I to require a second draw for confirmation for those outpatients that are not drawn for transfusion purposes?  Currently, we just retype the same tube for all blood bank draws, but I'm trying to change that policy in order to start doing electronic crossmatch/issue.  There's no way for me to enforce a second draw on patients drawn outside of our lab.  And retyping the same tube obviously does not prove the correct patient was drawn, it only confirms the interpretation is correct.  That's why I would like to just cancel the retype on patient's not drawn for transfusion purposes.  When/if they return, they will have another draw.

Edited August 26, 2024Aug 26 by sstrong
clarification

Agree that if not for transfusion purposes, ABO types do not need repeating.  We don't do confirmations for potassiums or troponins either.

We don't do a second draw for confirming potassiums or troponins either, which, absent transfusion, are much more important than ABOs for whatever reasons they are asking for them.

One more reason to do a repeat on the specimen, either by redraw, or retest (whatever your policy says), is if a mistake was made on the Rh testing and the mom didn't get RhIg.

The problem with retesting the same sample is that you don't have a second sample drawn with a different venipuncture to confirm the patient's ABO and can potentially issue ABO incompatible blood no matter how the compatibility testing is performed.

1 hour ago, sstrong said:

Am I to require a second draw for confirmation for those outpatients? 

We have A LOT of outpatients.  Using our Outpatient Dialysis patients as an example - If we do not have a second type on them, we will give O units and do an ISXM on their first presentation.  Upon subsequent presentation for transfusion, another sample would be received at which time we will do a second ABO/Rh and barring any discrepancies - will then EXM units provided the screen is negative.

On 8/23/2024 at 5:32 PM, John C. Staley said:

I guess the question then becomes, if, in the future can an unconfirmed blood type be used as confirmation for a current T&S / XM?  

It does as far as our LIS is concerned.  We have Cerner Community Works (not Millennium).  That doesn't mean it's correct, just that the system allows it.

I figure the odds of the specimen collected for transfusion being the wrong patient and matching the blood type on record from an OP draw are extremely small.  If it doesn't match, we will recollect then for a tiebreaker. We use the Epic scan-print-scan for inpatients and our phlebotomists are very good at not overriding. 

The absence of a second sample leading to transfusing group O to everyone without a second sample is an example of why this practice is likely doing more harm than good in my view. Group O red cells are acceptable for all in an emergency, but they are potentially harmful to non-O recipients due to the presence of 20-30 ml, give or take, of incompatible plasma for A, B and AB patients.

There are case reports of severe hemolytic reactions in this setting.  Low level hemolysis that is not clinically evidence is present in some recipients and is associated with thrombosis, infection and organ injury in animal models. In experiments of nature such as sickle cell anemia/paroxysmal nocturnal hemoglinuria below visually apparent levels of free hemoglobin cause severe complications. 

 

Thus, contrary to long accepted practice, Group O is NOT universal  donor,  except in emergencies when the recipient's type is not known,  or the patient's own ABO type red cells are unavailable and there is life threatening bleeding or anemia. 

The routine use of group O red cells for everyone in routine transfusion is an unfortunate practice that has arisen due to convenience and erroneous assumptions of equivalent safety.  Not a good practice for patient safety.

On 8/27/2024 at 9:38 AM, Neil Blumberg said:

The absence of a second sample leading to transfusing group O to everyone without a second sample is an example of why this practice is likely doing more harm than good in my view

Neil - 

I understand your point - but, in our case, when we're looking at the total # of patients transfused vs the outpatients with no previous record needing transfusion - the number of O's given equates to barely a drop in the bucket.  We don't do it "willy-nilly" - only when delaying the blood to wait for a second sample would affect or delay patient care - some of our outpatient dialysis clinics or sister hospitals are counties away and that would not be good patient care.

Our prenatal TS come from outside clinics and are registered with outside referral medical record numbers that are different from the hospital medical record numbers (under which they would be transfused).  Because they are immunohematology  and not pre-transfusion, we do not require a second ABORH.

Prenatal referral records will be linked to hospital records, but the ABORH will not count as a second type on record in transfusion situations.

Edited August 28, 2024Aug 28 by Kelly Guenthner

We only require a second sample retype if there is no history prior to transfusion.  Our pre-natal outpatients are not required to have a second sample retype (no transfusion).  Once they come in for delivery, they get a Type and screen.  If they need blood, we have a blood type on history that we use as the confirmation type. 

If we have an new patient for transfusion (no history), we would draw the Type and screen for cross match.  Then, have a second PBT go and stick for a second sample retype to confirm blood type.  We will not issue this blood until that SSRET is done. (emergency release is an exception-they would get type O)

 

"only when delaying the blood to wait for a second sample would affect or delay patient care - some of our outpatient dialysis clinics or sister hospitals are counties away and that would not be good patient care."

That is my point, more or less. Transfusing group O to non-Os in non-emergent situations is inferior patient care, contrary to long standing dogma.  We don't know what damage is done, but there is almost certainly damage for some patients due to low level hemolysis and brisk hemolysis in rare patients.  That's avoidable by giving ABO type specific.  The administratively driven requirement for a second sample is the source of this inferior patient care.  No thought was given to the possible consequences to patients from hemolysis when requiring O red cells for patients without a second type available.  While rare patients got the wrong ABO type due to lack of a confirming specimen, every patient who isn't O who receives O red cells is at risk of hemolysis with rare exceptions.  We don't know the consequences because it has never been studied, but it's likely much worse than we think. 

Edited August 29, 2024Aug 29 by Neil Blumberg

On 8/23/2024 at 4:32 PM, John C. Staley said:

I guess the question then becomes, if, in the future can an unconfirmed blood type be used as confirmation for a current T&S / XM?  

Maybe I'm misunderstanding, but how is this any different rather the second type is being done the same day or 6 months later? Either way you're using that first type as a portion of the confirmation.

5 hours ago, James Spears said:

Maybe I'm misunderstanding, but how is this any different rather the second type is being done the same day or 6 months later? Either way you're using that first type as a portion of the confirmation.

If the original type is for "potential" transfusion purpose then it is confirmed and the history of that type has been validated. It can be added to the paranoid reducing comfort level in assuming  the current sample is from the same patient.  If, on the other hand, the original sample was ABO/Rh type for some other reason and obviously not confirmed with a 2nd type then your level of paranoid reducing comfort will not be there when the patient returns for "potential" transfusions purpose. 

I have never been a proponent of the required 2nd confirmation ABO/Rh type.  I would like to say it was for the same reasons Neil Blumberg listed above but back when I was living in the blood banking world we did not have the data he is noting.  I just could not really see the cost/benefit ratio being in anyone's favor.