Here's the scenario...

 

We are a surgery hospital for the most part.

Patients scheduled for surgery always have pre admission testing done a week or so before their surgery date. If I get an antibody I can’t identify I send it to our reference lab, they then identify and send us units for surgery. The patient comes back in their day of surgery and gets another Type and Cross done. I do the screen and to no surprise get the same positive reactions that I once again cannot identify with the tools I have in house. My question is do I have to send it out to reference lab again to get the same results back or can I say no identification necessary because the patient has not received any blood products since the last antibody ID, and the screening cells are the same as before?

 

Thanks for your help!

My opinion - if it is within your timeframe for an acceptable preop specimen and you feel certain the pt has not been transfused since your previous specimen there is no need to send off another reference request.  Besides, you are going to be doing an antiglobulin xm with the new spec so - - - should be no problems.

I would probably be a little more cautious if the patient had been transfused during the several weeks before the first specimen was collected (in case he is still building new antibodies in response to a transfusion several weeks ago.)

 

Donna

Good point

I make sure the patient hasn't been recently transfused, then look for results consistent with the previous workup. If the patient has been transfused, I contact the surgeon and tell them that the patient must be drawn within 72 hours of the surgical procedure, but with enough time for me to send the specimen out to the reference lab. No cooperation - no blood (said nicely, of course).

we compare the result from previous work up, at least one panel and if no change and no transfusion no further workup required. 

If they have had no blood within 3 months (and haven't been pregnant) and the screening cell reaction and strengths is the same, we don't even repanel - just once a month.

I make sure the patient hasn't been recently transfused, then look for results consistent with the previous workup. If the patient has been transfused, I contact the surgeon and tell them that the patient must be drawn within 72 hours of the surgical procedure, but with enough time for me to send the specimen out to the reference lab. No cooperation - no blood (said nicely, of course).

For pre-op specimens obtained >72 hours prior to surgery, we document that the patient has not been pregnant nor transfused in the past 3 months. That is the only specimen we get pre-operatively, even if the patient has an antibody. When the patient is admitted, we use that same pre-op specimen for crossmatching. Once the patient is transfused, the pre-op specimen becomes subject to the 72 hour rule.