How do you handle QNS specimens for Blood Bank? Do you begin testing on the sample or do you immediately request a recollect? And if you begin testing on the short draw sample, how do you handle a new specimen if it is drawn for additional crossmatches? Do you do a complete type and screen on the new specimen or just an ABOrh?

:)AABB requires that a blood type and antibody screen be performed on each sample that is used for pre-transfusion testing. How short is your sample? Unless you do an electronic crossmatch, there is no use to test a sample that cannot be used for a crossmatch. We evaluate each sample depending on the hematocrit of the patient and amount of plasma it yields.

I consider it to be a rather individual, personal decision, depending on many factors, as KKidd has discussed. Also, the urgency of the situation, likehood of how many crossmatches the patient will need, and the ease or difficulty of obtaining another specimen, etc., all play into the decision.

Donna

We have minimum specimen requirements throughout the lab. Anytime the minimums aren't met, the tech has the option of using it anyway, but must complete a "suboptimal specimen" form as a QA monitor.

Sometimes, it's all the blood you can get ...

We have minimum specimen requirements throughout the lab. Anytime the minimums aren't met, the tech has the option of using it anyway, but must complete a "suboptimal specimen" form as a QA monitor.

Sometimes, it's all the blood you can get ...

Just curious, I can see documenting "short-draws" (ie: low volume specimens) as a QA monitor if you have certain individuals who frequently submit suboptiomal specimens.

However, I would consider a phlebotomist who collects 2 mls from a patient from whom other individuals could not obtain any sample to be an excellent phlebotomist (not a QA problem.) Sure you have a way of separating these cases?

:)AABB requires that a blood type and antibody screen be performed on each sample that is used for pre-transfusion testing. How short is your sample? Unless you do an electronic crossmatch, there is no use to test a sample that cannot be used for a crossmatch. We evaluate each sample depending on the hematocrit of the patient and amount of plasma it yields.

Thank you KKidd. Would you be able to tell me where I can find the statement in the AABB manual that states a type and screen must be done on each sample used for pre-transfusion testing?

I greatly appreciate your help.

We consider a sample to include all tubes collected at the same collection event. Only one such tube needs to be tested for compatibility testing.

Our "short draw" policy is for techs who choose to use a sample that is considered suboptimal and does not meet minimal requirements. We generally ask for a redraw, unless we get additional information that suggests another attempt is futile or clinically unwise (i.e., trauma).

We consider a sample to include all tubes collected at the same collection event. Only one such tube needs to be tested for compatibility testing.

Thank you for your response. What I am really trying to determine is this: if a second tube is drawn (at a different time and possibly by a different person) because the doctor needs more units, do you repeat the antibody screen or just do the type on the second tube?

:ohmygod:

Thank you KKidd. Would you be able to tell me where I can find the statement in the AABB manual that states a type and screen must be done on each sample used for pre-transfusion testing?

I greatly appreciate your help.

Claudia, is my face RED. I can't find it in the standards. That doesn't mean it's not there.After 34 years, it is easy to remember things that may not be there. The way I have always looked at it is - what if the original sample was misidentified? I believe it goes back to patient identification and the audit trail from the beginning to the end.

Our policy is that a sample collected at a different time requires all pretransfusion testing if it is going to be used for crossmatching. We do not automatically reject a short sample; we try to look at all of the factors that L106 mentioned above before asking for a recollect. If there is any reasonable indication that we may need need sample than we get, then I prefer that my staff get a recollection rather than run the risk of running out of sample during a dynamic situation.

If the original sample becomes depleted, we redraw, reband, and start over from scratch with another T&S, etc. Our blood bank wristbanding system is a specimen identifier, not a patient identifier, so each sample gets a new wristband. The wristband number identifies which sample was used for the crossmatch.

Claudia,

As KKidd, I did a quick rifle-through and could not find it stated in the AABB Technical Manual that the ABO, Rh, and Antibody Screening must be repeated on a new specimen. (I wonder if AABB used to say that, since it seems to be so deeply ingrained in many of us.)

Nevertheless, we do what Lscmarz described above (and others in previous posts.) (ie: We do repeat the ABO, Rh, & Ab Screen on every new specimen.)

Donna

Claudia,

As KKidd, I did a quick rifle-through and could not find it stated in the AABB Technical Manual that the ABO, Rh, and Antibody Screening must be repeated on a new specimen. (I wonder if AABB used to say that, since it seems to be so deeply ingrained in many of us.)

Donna

As I am reading this thread, I'm saying to my self..."yes, AABB requires that each specimen is tested..." Like you I can't find it in the standards now. I think it was there, but I don't know when they dropped it. I don't remember a change.

Linda

Hi Claudia,

In the 25th edition of Standards, page 43...

"5.13 Pretransfusion Testing of Patient's Blood

Pretransfusion testing for allogenic transfusion shall include ABO group, Rh type, and and unexpected antibodies to red

cell antigens."

Hmmm, I'm not too sure how to interpret all these posts.

We are an AABB, CAP, FDA accredited Blood Bank. We have sailed through every inspection that I am aware of. Well, except for a "space issue" deficiency a couple years ago.

We do all the typical pretransfusion testing on the original armbanded specimen, but we do allow the redraw of a patient if more sample is needed for antibody workup, etc. without rebanding. We have the nurse/phlebotomist hand write the armband number on the new specimen(s). This practice ensures the original armband was verified at time of redraw.

I might get blasted for this post----but it works for us and all of our regulatory agencies. Obviously common sense is required by the BB tech to determine if such a scenerio is appropriate for a specific patient. Hopefully no one would have a tech working in the BB that couldn't do that!

Same process here. As long as we have the BB ID number set available in blood bank and the BB ID band is legible and complete redraws are acceptable when additional specimen is needed for testing. If a "second" specimen is collected at a different time to be used for testing then we repeat the ABO/Rh and IAT.

We do the same as jcdayaz.

Hmmm, I'm not too sure how to interpret all these posts.

We are an AABB, CAP, FDA accredited Blood Bank. We have sailed through every inspection that I am aware of. Well, except for a "space issue" deficiency a couple years ago.

We do all the typical pretransfusion testing on the original armbanded specimen, but we do allow the redraw of a patient if more sample is needed for antibody workup, etc. without rebanding. We have the nurse/phlebotomist hand write the armband number on the new specimen(s). This practice ensures the original armband was verified at time of redraw.

I might get blasted for this post----but it works for us and all of our regulatory agencies. Obviously common sense is required by the BB tech to determine if such a scenerio is appropriate for a specific patient. Hopefully no one would have a tech working in the BB that couldn't do that!

We do this too. Particularly on serologically difficult patients.

I really didn't have time to spend on this, but I couldn't stand it, so I looked through my "archives".

Back in 1999, Standards edition 19, I4.000 said, "Each blood sample consisting of one or more tubes drawn at one time and submitted together with a request ro transfusion... shall be tested for ABO group and Rh type and for unexpected antibodies..."

Then in 2000, Standards 20th ed, 5.12 said, "Blood submitted for compatiblilty test shall be tested for ABO...".

Then with the 25th ed. 2008, this became 5.13, "Pretransfusion testing for allogeneic transfusion shall include ABO..."

I review new edition of standards for changes (I thought), and this one gradually became less restrictive. I guess I just live in the past!