Implementation of a two‐specimen requirement for verification of ABO/Rh for blood transfusion

Abstract

Despite the lack of an instigating event, verification of blood type before blood transfusion was successfully implemented. An impact on resources and benchmark indicators such as TAT can be anticipated and managed. Further process improvement efforts will be needed to ensure safety (e.g., at time of blood transfusion) for patients receiving blood transfusions. ABO/Rh verification may be necessary even after future implementation of bar coding and/or RFID chips, because human errors continue to occur even with systems improvements.

Electronic patient identification for sample labeling reduces wrong blood in tube errors

“…This value is identical to the unadjusted rate found in an earlier study of 496 mislabeled (rejected) samples at a single center, 11 and supports the continued rejection of samples with even a minor labeling error. Furthermore, as WBIT errors were detected because of discrepancies in both ABO and D typings, our data support performing both of these typings when blood group confirmatory samples, sometimes called check type samples, 16 are submitted on patients without a historical ABO and D type. While most of the mislabeled (rejected) samples were collected on hospital wards, the subset of these samples that contained a WBIT error was relatively evenly distributed among patient wards, the emergency department, and the intensive care unit ( Fig.…”

“…After accounting for repeat sample numbers and silent WBIT errors (see Methods), the overall adjusted WBIT rate for sites using manual patient identification was 1:3046. The median adjusted WBIT rate for sites using manual identification was 1:4236 (range, 1:1287 to 1:9673; at one site [16], the WBIT rate could not be estimated since no WBIT events were reported). The remaining study sites collected some (Sites 18-20) or all (Site 17) samples using electronic patient identification.…”

Incomplete pretransfusion testing leads to surgical delays

“…A check type sample is also required before crossmatch‐compatible RBCs can be issued to patients without a historical ABO group on record. A check type sample is a blood specimen that is drawn separately from that used for the type and screen and is tested by the blood bank as a verification of the patient's ABO group 14 . It is the clinical team's responsibility to provide a check‐type sample when necessary; this is usually accomplished by calling the blood bank and inquiring if one is necessary at the time that the type‐and‐screen sample is drawn.…”

Using Blood Donor-Derived ABO and RhD Blood Groups Helps to Detect Wrong Blood in Tube Errors in Recipients

“…Based on the identified WBIT rate of 0.04% and an estimated 27% of samples from any two patients in Funen (patient ABO and RhD frequencies: O 42%; A 43%; B 11%; AB 4% and RhD 84%) by chance having the same ABO and RhD groups, the actual WBIT rate in Funen is approximately 0.06%, because some WBIT miscollections will have come from patients who are ABO-and RhD-identical to the intended recipient. Thus, these miscollections could not be identified as WBIT errors [4]. However, this is a limitation common to all check type samples unless extended RBC phenotyping or genotyping is concomitantly performed, which would not likely be the standard of care at most institutions.…”

“…However, this method only confirms the ABO group of the blood in the tube; it cannot confirm that a WBIT error had not been made. A more reliable method for ensuring the accuracy of the ABO group of a patient without a historical type is to collect a second sample at some point after their first sample was collected [4].…”