we are getting ready to implement a policy that allows us to draw patients up to 30 days before surgery if they have not been transfused or pregnant in 3 months. what i was wondering is how others handle patients in this catagory that have a positive ABS. also, if you use armbands, does it go home with the pt and you hope they bring it back or does it stay with the chart and get applied to pt day of surgery? thanks, jane :confused:

There was some discussion related to this topic on another thread here: http://www.pathlabtalk.com/forum/showthread.php?4857-Pre-surgical-testing&highlight=Pre-op. It might be of some use to you.

In short, we band our patients at the presurgical draw educating them that if the band is removed and not present the day of surgery, the surgical procedure will likely be delayed since we would repeat the entire blood bank workup. I might have one instance per year of band removal on average. OR nursing is great about checking for the band too.

If a pre-op patient has a positive antibody screen, we contact the physician to see if he wants blood crossmatched prior to the procedure. If not, we make sure that 2 antigen negative units are available. It seems like I am always contacting the same surgeon. WHen he hears my voice he says " Don't tell me he/she has an antibody."

As far as the length of time, our samples are only collected up to 5 days pre-op if they have not been transfused/pregnant in the last 3 months. The BB armband must be placed on their arm at the time of collection. I wouldn't count on some of my patients keeping track of the armband - they cant' seem to keep track of pre-ops orders.

Good Luck!

:meditate::meditate:

If we detect an antibody at pre-surgical testing, we identify it and get two antigen negative units and put them in a "hold" status until the OR day. Then we order more units if needed.

We also ID and put an appropriate number of units on 'hold'. When the patient is drawn, he/she is given a card with their name and Blood Bank ID# on it. They are required to bring this card back with them the day of surgery. Once they present the card, they are ID'd according to our normal patient ID protocol and armbanded with the ID number that matches what's on their pre-op card. They sign the card and the signature is matched to a form they signed when they were drawn preop, completing the ID process. No card = no blood until we redraw and redo the workup. We'be had a few patients send a family member out to the car or even home to get it, but very few of our patients have to be redone from scratch.

thanks everyone for your replies! on your patients that have antibodies, do you use the original specimen to crossmatch or do you re-draw on day of surgery and use that to crossmatch? i couldn't find anything that set a limit on how old a specimen can be and still be used for AHG crossmatching!

I would redraw theday of surgery.

Our policy states that if the patient was drawn <7 days prior to surgery and has signed our form that states he/she has not been transfused or pregnant within the last 90 days, we will perform the full workup and crossmatch on that original pre-surgical specimen at the time it is drawn. We would release those units for transfusion on the basis of that work. However, we always redraw the patient upon admission to ensure that we have a specimen less than 72 hours old. If more blood is required, we would use the new specimen to provide additional product (and yes, we would have to repeat the workup with that fresh specimen). If the surgery date is >7 days away or the patient has been transfused or pregnant, then we would draw a fresh sample the day of surgery and repeat testing.

I believe that the FDA says a specimen must be <72 hours old for performance of a serologic crossmatch. (Citation/corrections anyone?) If you are doing an electronic crossmatch with a negative antibody screen/history, obviously that is not an issue - a negative antibody screen would be valid on your pre-admit specimen. Because we are doing a serologic crossmatch with an antibody, a fresh specimen is required. Joint Commission requires that serologic crossmatches be performed with a specimen <72 hours old.

A sample for anyone who has been transfused or pregnant in the last 90 days has to be drawn within 3 days of the transfusion. If you have a patient with antibodies who has not been transfused or pregnant within the last 90 days, the rules are a little vague. I would recommend drawing a fresh sample for crossmatch so that you don't run into problems with the antibody activity fading from sample age and storage issues.

Your antiglobulin reagent instructions probably stipulate the allowed age of the serum/plasma specimen. I agree that antiglobulin xm should be done on a fresh sample which means either set up the units a long time in advance of surgery while the specimen is fresh enough, or get a fresh specimen nearer surgery. You will need it anyway if the patient needs more units during or after surgery.

For those that redraw on the day of surgery and repeat testing, do you charge for it?

For those that redraw on the day of surgery and repeat testing, do you charge for it?

Not for the testing we are actually repeating; only charge for "new" tests such as the crossmatch.

OK. I just read the MTS gel card instructions, the FDA 21CFR 606.151 ( (to which the gel card instructions refer) and the JC Stds QSA.05.06.01 & 05.24.01. None of them states a time frame for age of specimen unless the patient has been transfused in the prior 3 months. Back in the old days we used to worry about complement in a sample but since we use EDTA now and anti-IgG we obviously don't care about complement activity anymore.

I guess you could validate that your method does not lose reactivity in your chosen storage period, but I would want to use fairly weak human antibodies, not something contrived from reagents. If you can prove that most specificities and especially anti-Jka & Jkb hold up in storage then you can probably do an AHG xm on the sample even when it is older than 3 days. Remember that the AHG xm in these cases is to catch errors in antigen typing the units (thus must react with antibodies you have identified) as well as catch incompatibilities due to antibodies to low-frequency antigens which you may not have identified yet.

Not for the testing we are actually repeating; only charge for "new" tests such as the crossmatch.

Ditto....

On page 439 of the AABB Technical Manual, 16th edition it is stated:

......"hospitals have developed different mechanisms to identify patients whose specimens have been collectd several days or weeks before surgery, including.......the placement of the wristband used during specimen collection on the patient’s medical record. The wristband is attached to the patient on the day of surgery after accurate identification of the patient”

At our hospital we make out the blood bank band (name, MR#, birthdate, date/time drawn and phlebotomist’s initials) when we draw the presurgery specimen and clip the band to a form that has a sticky label with the patient’s name, MR#, birthdate, and a red unique blood bank number from the band. On the day of the surgery, we wait until the patient has been officially id’d and banded with the hospital id band, then we ask the patient their name and birthdate, we compare the name, medical record number and birthdate on the blood bank band with the same on the hospital band, then we band the patient. We document all of this on the form and keep the form forever. Only trained lab personnel are involved in the "delayed band" procedure and it is included in the annual competencies.

We do this “delayed band” procedure because our interpretation of the AABB manual is that it is okay and we feel pretty confident that we are banding the correct patient when we ask the patient to identify themselves and when we make sure the blood bank band matches the hospital band.

There is also an issue of confidentiality. Patients don't always want their community to know about their upcoming surgery. The bands are conspicuous even though they can be hidden under a long sleeve garment. I wore a band for several days to see how it held up with showers and other activities and many people stared at it and asked me about it. (One person thought it was an entrance id for a music festival.)

We draw up to 14 days in advance if not preg or transfused in last 90 days AND no known Ab Hx. If any one is a 'yes' then we draw no more than 72 hrs in advance (prefereably the day before). If an unexpected Ab is found in someone drawn more than 72hrs in advance we ID the Ab on that specimen and set antigen-typed units aside. That patient would be redrawn and repeated the day of surgery using those Ag-typed units.

In hopes that we can capture better what might be the standard of practice in the US for this situation, I have posted a poll under "polls" and would love for everyone to vote. That way we can maybe capture the input of shy people that don't post as well as sort of quantify the various approaches.

I realize that I did not include every possibility. I think I got the common ones expressed here. It was tough to squeeze these complicated questions into the character limits of the poll so I hope they make sense.