Pre-Transfusion And Blood Bank, Sample Requirements

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Pre-Transfusion Testing

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1. Request for transfusion (blood order) and informed consent
2. ID of transfusion pt and blood sample collected
3. Testing of transfusion recipient's blood samples
4. Donor RBC unit testing
5. Donor RBC red cell unit selection
6. Compatibility testing (Crossmatch)
7. Label unit with recipients ID information
8. Release for admin

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What is done first: testing of transfusion recipient's blood sample or Donor RBC testing

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Testing of transfusion recipient's blood sample

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Once a Donor RBC unit is selected what testing is done

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Compatibility testing (crossmatching)

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Clinically significant antibodies can cause

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1. Decreased survival (or decreased lifespan) of transfused cells
2. Hemolytic transfusion reaction (HTR) - Immediate or delayed
3. HDFN

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Informed consent

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• Physician requests for transfusion
• Physician fully explains risks of transfusion to patient
• Patient must give signed consent for transfusion before any blood product is administered

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A request for a transfusion requires:

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A prescription

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WBIT

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Wrong blood in tube

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Pre-analytical error

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• Most common cause of mistransfusion worldwide

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The most critical step in pre-transfusion testing

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Positive Identification of recipient and sample is required

Proper labeling at beside

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Information Minimally Required on BB Samples

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• 2 Unique Independent Identifiers: name and unique identifying number
• Date of Sample collection

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If there are no errors

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the sample can be accessioned and processed

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In accessioning the first step

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• Check records for prior blood bank testing results on a patient
  

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If a patient history doesn't match

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• Patient/sample identification error
• Sample mix-up
• Non-ABO matched bone marrow transplant
• Identity Fraud/Theft

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Donor testing that must be done

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• Done by Collection center: Serology/virology
• Blood Bank will reconfirm (ABO)
• All must be completed before the unit is available for use

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Weak D is not required on

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recipients

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Is compatibility testing required

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yes

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What is not routine for other products

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crossmatch

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If the product has >2mls of RBCs contamination what do you do

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crossmatch

• granulocyte concentrates
• platelet only if visibly contaminated WBCs

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For adults samples will be obtained w/i

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3 days of scheduled transfusion if the patient was

• transfused w/i past 3 months
• Pregnant w/i past 3 months
• No history available

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If a person hasn't been transfused, pregnant in the past 3 months and a history has been given sample age can be

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5-14 days before transfusion

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How long are samples are post-transfusion

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7 days

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Why the 3 day limit

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limits delayed transfusion reactions

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Initial sample for a neonate to determine ABO and Rh

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• Use Anti-A, Anti-B, and Anti-D reagents only
• Forward grouping only

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Sample for neonate

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Cord blood or venous sample

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What sample is used in neonates for screening of anitbodies

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Plasma from neonate or Mom

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If a neonate has a negative antibody screening

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Crossmatch testing is not required for the remainder of the hospital admission

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Acceptable patient sample

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Serum or Plasma

• Purple- EDTA preferred for gel methods
• Pink top tube: Spray coated K2 EDTA
• Yellow tube top: ACD

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What does ACD do

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prevents detection of complement-dependent antibodies which are very rare

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If Ab screen is positive

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Panel ID --> Phenotype units--> full crossmatch