I would like to get some feedback as to what kind of workup other facilities require when a transfusion reaction is suspected. Currently we do a full workup on all possible reactions but I would like to go to doing only the clerical check and pre- and post-DATs unless something in those shows a reason to do the full workup.

Can anyone tell me what procedures and guidelines you follow??

We do a clerical check, compare pre and post specimens for evidence of hemolysis, urine dipstick for blood with microscopic if positive, and pre and post DAT.

We were doing the clerical check, post DAT (unless post was positive, then we added the pre), check for hemolysis. Because of a CAP standard in the Dec 2004 checklist (TRM.41850) we are adding the post ABO/Rh as well. I have pasted the revised standard below.

**REVISED** 12/29/2004

TRM.41850 Phase II N/A YES NO

Does the immediate investigation of a transfusion reaction include all of the following?

1. Examination of patient identification, blood unit labels and all pre-reaction records for possible errors in patient or blood identification at the bedside and in the laboratory

2. Visual examination of post-reaction and pre-reaction (if available) serum or plasma for evidence of hemolysis

3. ABO/Rh and direct antiglobulin test on post-reaction patient (recipient) blood sample

Hope this helps!

Jane

We also routinely do a clerical check, a comparison of pre and post plasma for hemolysis and icterus, a post DAT and ABO/Rh. We do additional testing if any of these are positive, or if it is classified as a severe reaction.