Hello everyone,

There is a discussion where I work about washing donor units (cells from segs) before using them for a crossmatch. What is everyone's opinion on this--is this done routinely in your blood bank or not at all or is it left up to the tech to decide if they want to do it or not? Another piece of this issue is that being in the military we have some common SOPs from the blood program office. In the SOP to make a cell suspension they don't mention washing the cells. In the compability SOP I just wrote I referenced the SOP but also added in the step previous to wash the cells then make the suspension. My boss says that is wrong we don't need to wash the cells and since I referenced the cell suspension SOP I cannot add it as it would be going aganist procedure and then an error/variance report would have to be done on all the units that are washed. Thanks for everyones response.

We don't wash our cell suspensions before crossmatching. If there is a problem with the crossmatch, washing the cells could be done to trouble shoot in case there are some irregular proteins coating the cells causing interference. If the cells had to be washed for whatever reason, I do not see how this would be considered a variance though. In our department, we no longer wash our cell suspensions for cord bloods although there is one tech who still washes her suspensions. I think this is just a personal choice and I would not consider this a variance.

Maybe your boss's concern is in the reference to the other procedure for preparing a cell suspension. If you are going to wash the cells in one procedure then you would need to do it in the other to avoid confusion. What if you left the washing of the cells out of the procedure and put a comment in the notes to wash the cells if there is a problem with the crossmatch. I think that most institutions do not wash the cells first anymore but at least you would have it in the procedure notes as an option for problem solving.

We do not wash our segs before crossmatching unless there is a problem with the crossmatch. I can see your boss's concern about the discrepancy in the procedure, although I don't understand why it would require an error/variance to be slightly more strict in your requirements than everyone else.

Why do you want to add the wash step? Apparently the central command did not see it as a necessary step or they would have included it.

He feels that if you deviate from the SOP or policy even the slightest then an error/variance should be written and he wants us to conduct a root cause analysis on why it happened.

OK, would it be unkind to point out that if you have written an addendum to the procedure that it is by definition a procedure and not a variance? However, that does not address the discrepancy between what you want to do and what everyone else appears to be doing. Have you checked with other military facilities to see what they are doing?

We routinely prepare washed cell suspensions for crossmatching. It just saves some problems up front. The procedure should outline the minimum steps required; washing the red cell suspension could be an optional "extra" step that a tech could choose to do without being accused of not following the SOP.

He won't let us write an addemdum to the standarized procedure becasue it does not say that it has to be done in the AABB standards. He feels that if it is in the standards then it has to be done and if it is not in the standards or the Medical Command's SOPs then it should not be done at all and if it is then it is a variance and must be investigated. Thanks for the help.

We are still washing cell suspensions.

I would be interested in knowing what those of you who do not wash them,do about package inserts for anti-sera that state that the testing should be done on washed cell suspensions?

We do not routinely wash our segment blood prior to crossmatching. If there is a problem, that is one of the first options to perform. Also, dependent on the rare reagent antisera package insert, the suspension may or may not be washed.

Oddly enough this just came up yesterday at a meeting of the transfusion supervisors in our corporation. The albumin that we use in the rare occasion we use albumin does require the donor cells be washed prior to crossmatching so the sop will be modified to reflect this reagent requirement. Otherwise pre-washing is not something that everyone does routinely. It is currently left up to the individual sites and sometimes even the individual techs at the sites. I know in my facility pre-washing the donors cells only occurrs in the case of a problem. Otherwise we use them right out of the seg and make a suspension. In the olden days I used to always wash first but what I would do was to make a suspension, run a drop through the cell washer, add a drop of saline to the cell button, resupend and start testing. For some reason I got away from that and haven't done it for years. Not sure why.

Our SOP require to wash donor segs X3 before making a suspension. I know our tech do not wash 3X. Some may be washing X1. My concern is when we hav inspection and inspector is observing they have to wash 3X. I want to switch from 3X to 1X. DO you know any literature regarding that?

SInce our SOP says to wash X3 I need to validate new procedure that is to wash only once before making suspension. I am planning to do 20 immediate spin crossmatch using X3 washed cells and X1 washed cells. Any other thought????

If you are going to go that far in the validation why not also do a set where you don't wash at all? If there is no difference then think of all the time and effort you will save by washing only when there is a problem instead of with every crossmatch.

Thank you. I discussed my protocol with my boss and she suggested the same thing and now I am going to validate unwashed against X3 washed. I am going to try to include cold antibody or roulex if I find one.

Thank you again.

Kinda scary when us boss types start thinking alike. ;>)

You never know what we'll come up with next! Let us know how it comes out. I know I would be interested it what you discover.