Hi Friends

How many pre-transfusion compatibility orders one technologist can perform at a time? Is batch work allowed? Is there any guidance from AABB/CAP/FDA/JC

We are allowing three orders at a time. Our medical director wants to change it to one. All the staff wants to perform 4-6 orders at a time.

Our pre compatibility testing includes

ABO, Rh, Antibody Screen and x-match (coombs phase/immediate spin) IS only for urgent case. All other AHG x-match.

Thanks

Prior to automation we allowed 3 samples at a time. IMHO 4-6 is too many, one is not enough to get the work done in a timely manner.

Hmmm...maybe you could negotiate a little with your medical director. If I read your post correctly you perform AHG crossmatches on every patient except urgent requests. This may not be required if you patient antibody screens are negative. Those AHG crossmatches are a lot of work. I agree with Likewine99, 4-6 may be too many to work on at one time. 2-3 samples at one time are manageable. Sounds like you may need automation.

Hi, Thanks, But I want to know if there are some directions from Joint Commission/AABB/CAP on this issue. Our hospital is going for Joint Commission International accreditation.

Yes Joanbalone, We have Tango, but due to poor support from manufacturer/distributor from one year we are unable to run it. As we are working with Gel from DiaMed, all of us prefer AHG cross match over IS. Here our Medical Director and I agreed with the staff.

I believe it's up to the comfort level of your techs. We have a separate bench area we had designed in the past when we were working with manual gel testing. One tech would do all type and screen and if positive pass it to the techs working on antibody ID bench. The tech who was doing type and screen used to set up even 10 to 12 specimen same time. But that time we had SA reader and reader was interfaced with our computer system so there was very little manual steps. (pipetting reagents). If you are reading cards manually I would have two techs read the card before entering the results in computer.

We have automation now so we do not have any restriction.

we do have limitation set up for IS crossmatches: four patients at a time and each patient should not have >4 units.

If I remember right, a couple of years ago JCHO (or what ever they are called now) was recommending that in the transfusion service we work on no more than 1 patient at a time. It was a safety thing based on the occasional mix up documented at the bench. It had not become a rule but I know they were leaning that way. Obviously it is one of those ideas that look much better on paper than in the real world. When tube testing I was comfortable with up to 4 patients but more than that was hard for me to keep track of. Besides the racks we used were designed for 4 patients.

We went ahead with the leaning The Joint Commission began and allow only one cross match be started at a time (per policy it is OK to stagger more than one at a time). Our volume is such that this does not usually cause too much trouble, but does decrease efficiency significantly. Manual gel here

I am assuming we are talking about manual techniques in this thread because automated analysis lends itself to multiple patients and even electronic release.

I will type and screen up to 12 patients because that is what the racks allow and provided you are allowed to focus (be undisturbed) then it is more efficient. However, with cross-matching (AHG technology) the ideal must be one patient at a time. When we were inspected by the MHRA that was what they wanted to see. In reality this is rarely a problem for us because the requirement for cross-matched blood has dropped significantly in the last 5 years as the emphasis for transfusing only when necessary has taken hold.

Steve

Thanks all of u.

I am considering to adopt 4 type and screen at a time, 4 IS cross match, and one AHG cross match at a time. I hope our medical director will agree for this also. It will meet Joint Commission requirement also? We have to face them with in a year or so.

May I ask to post or email me index of your Transfusion services and blood donation policies, so I shall be to cover all, JUST INDEX.

khalidm3@hotmail.com

With Manual method a tech can perform up to 4 AB Screens and 2 ABO Type because there are only 12 positions in the centrifuge. With Automation and other methods such as gel, a tech can perform a lot more than that. Attention to detail and a good process must be in place to avoid errors especially ABO typings. I would perform the number of AB Screen the incubator/centrifuge would allow BUT carefully perform my ABO Typing with caution and use the IS to confirm.

I am confused, a 12 postion centrifuge allows me to spin 12 forward groups followed by 12 reverse groups and then 12 antibody screens following their incubation stage.

Steve

:confused::confused:

I am confused, a 12 postion centrifuge allows me to spin 12 forward groups followed by 12 reverse groups and then 12 antibody screens following their incubation stage.

Steve

:confused::confused:

Now you got me confused...4 Patient AB Screens (3 Cell Screen cells each); 2 Patient ABO Type (3 tubes for Forward and 2 tubes for Reverse typing) with 2 extra positions.

Forgive me vilma_mt, I understand your confusion now. I use gel technology and of course 1 centrifuge position would be taken up by a cassette with a full forward group hence 12 forward groups in one spin. It follows the same for the reverse groups and antibody screens.

Regards

Steve

:)

We use DiaMed ID Gel Cards, ABO, (Anti A,B,D) Rh (Anti DVI-), Negative Control and reverse (A1, B cells) six microtubes in one card so 24,12 or 6 forward and reverse in one spin of 10 minutes. We have three choices in centrifuges 6, 12 and 24 cards.

For screening we use Liss coombs card, one card six microtubes, so two patients in one card (15 minutes incubation, 10 minutes spin)

At donor screening bench, we use pool cells so one card, six donors. Soon we shall shift to Tango

Services by DiaMed distributor are excellent and sharp, Tango services proved poor in the 1st year.