The new standard requires 2 blood types for all RBC transfusions. Has anyone been able to validate their process for using the same specimen for the 2 types? What other processes has anyone come up with when transitioning to have 2 samples collected for transfusion?

In the UK, where this "rule" originated (I think!), our Guidelines do not "allow" the grouping of the same sample twice (what is the point of that, if the sample was taken from the wrong patient in the first place?  It would mean that, for example, the sample would be grouped twice as group A, and would be found to be serologically compatible with group A units, even if the patient was actually group O - and so, dead!).  We have to have two samples taken at different times (preferentially by a different person).

Of course, we would certainly NOT stop blood being given in a situation where the patient is bleeding to death - but we WOULD only give group O blood until the second sample is received and typed (and the Rh type would depend upon sex and age) wherever we can (obviously, in the case of a major incident, we may have to modify this, but the Guidelines allow for such a situation).

A VERY intelligent gentleman (Dr. Brian McClelland MB, ChB, ND Linden, FRCP(E), FRCPath), former Consultant Haematologist to the Scottish National Blood Transfusion Service, Edinburgh, UK) once wrote, "Transfusion has risks, but bleeding to death is fatal."

Testing the same blood sample twice will not detect WBIT.  That is why we draw a second blood sample from a different venipuncture from patients who initially type not group O.  We are not AABB accredited.

Edited May 25, 20187 yr by Dansket
added additional information

We allow specimens collected through SunQuest Collection Manager to be used as the single specimen, which we will then type two times.

Of course there can be many workarounds for other techniques.  Double signatures - just collect the specimen and ask a friend to sign it.  Specimens collected at different times - collect two at the same time - put different times on them.

I heard of a local facility that the second tube was coded and provided by the blood bank.  That sounded fairly fool proof. 

 

23 minutes ago, Cliff said:

I heard of a local facility that the second tube was coded and provided by the blood bank.  That sounded fairly fool proof. 

 

Quite a few, but not all, hospitals in the UK use this method.  It is fairly fool proof, but, sadly, not entirely idiot proof.

4 hours ago, Malcolm Needs said:

Quite a few, but not all, hospitals in the UK use this method.  It is fairly fool proof, but, sadly, not entirely idiot proof.

As long as idiots exist in the world, they will thwart any solid plan we put in place to mitigate their recklessness.

14 hours ago, Cliff said:

As long as idiots exist in the world, they will thwart any solid plan we put in place to mitigate their recklessness.

People can be quite creative when it comes to finding an "easier" way to do their job.  That is one of the reasons I have always been a firm believer that complicating a process never makes it better or safer.  I know the rational behind the 2 types being required but I personally never bought into it being a practical solution the potential problems it is trying to solve because of the many more problems is has seemed to cause for the staff resulting in all the work arounds they manage to come up with.  For it to really work you would have to have 2 separate draws performed by two different people at different times.  (Both phlebotomists in the room drawing one immediately after the other defeats the purpose.) Then you need to have two different techs perform the testing, one for each sample.  This would be impossible in many smaller facilities, especially on evening and night shifts.  Of course the requirement came from people based in large, well staffed facilities.  I'm starting to ramble so I'll stop here for now.

I have one question, in the past the AABB rule was written that you had to have 2 sets of test results, the one you are currently performing and one on file to compare the current one to and if you did not have one on file then you needed the second test performed prior to issuing RBCs.    It that still the case?

22 minutes ago, John C. Staley said:

I have one question, in the past the AABB rule was written that you had to have 2 sets of test results, the one you are currently performing and one on file to compare the current one to and if you did not have one on file then you needed the second test performed prior to issuing RBCs.    It that still the case?

John, in the UK, as long as there is a historic group, and that this historic group was performed and interpreted by automated technology, then only one sample is required (obviously, as long as the groups match!).  If there is no historical group, or the group is so ancient that it was performed and interpreted "manually", then that is when a second sample is required.

The idea of issuing a second, empty tube, with a different coloured top is the best we have come up with to stop "cheats/idiots", but sadly, some of these empty tubes have "escaped from the custody of the laboratory" - or have been "liberated", and got into the hands of the "cheats/idiots".  WHEN (not if) theses cheats/idiots are caught, they will be reported to their superiors, which may or may not involved the British Medical Council,depending upon whether they are judged to have been cheats or idiots.

We try not to stick the patient a second time if at all possible.

If the patient has a historical type performed by one of our facilities we use that.

If no historical but the patient had another specimen that is suitable for ABRH testing i.e. a CBC, HH and was drawn at a different time than the current TYSC specimen we will obtain that tube and perform the testing on it.

If there is no suitable specimen we can put our hands on and the patient is highly likely to require transfusion then we will request another specimen be collected.

Until there is a second ABRH on file the patient receives group O RBCs.

We do 2 types on one specimen - 2 techs or 2 methods. We use a collect device for patient ID when specimens are collected and utilize a barrier method for transfusions (FinalCheck locks). The FinalCheck armband is applied after the patient is ID'd with the collection device and immediately prior to phlebotomy. Once we are live with 'computer crossmatches', that will require types on 2 different specimens. Serologic crossmatches will still be allowed with 2 types on one specimen.

An order for a second venipuncture is automatically reflexed by Meditech based on testing done on the initial blood sample collected for Type and Screen.  Our phlebotomists have no role in determining whether or not a second blood sample is required.

If there is no ABO on file and testing of the initial blood sample with anti-A,B yields a positive test result (patient is not group O), Meditech automatically creates a new order for an ABO verification test that requires collection of a second blood sample.  This results in printing of specimen collection labels on the Phlebotomy Label Printer.

Transfusion Services does not accept unsolicited blood samples collected for the ABO verification testing.

On ‎5‎/‎29‎/‎2018 at 6:19 AM, jalomahe said:

If the patient has a historical type performed by one of our facilities we use that.

If no historical but the patient had another specimen that is suitable for ABRH testing i.e. a CBC, HH and was drawn at a different time than the current TYSC specimen we will obtain that tube and perform the testing on it.

Until there is a second ABRH on file the patient receives group O RBCs.

We do this too.  in addition, if we don't have 2 types, the blood bank orders the retype and sends the floor a short pink top to use in drawing the retype, and we don't accept standard 7 mL pink tops for retypes (because people were drawing 2 upon admission and carrying them unlabeled in their pockets until they got the retype order).