1
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Yen KT, Chen SY, Chen YJ, Chou YC, Er TK. Resolving unexpected ABO typing discrepancies in two patients. Transfus Med 2024; 34:74-76. [PMID: 38148510 DOI: 10.1111/tme.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/06/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Kuo-Tun Yen
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Si-Yu Chen
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Ying-Ju Chen
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Yung-Che Chou
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Tze-Kiong Er
- Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
- Deparment of Nursing, Asia University, Taichung, Taiwan
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2
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Sawadogo S, Nebie K, Kima D, Ouedraogo SKA, Nagnon PA, Koulidiati J, Traore C, Sawadogo S, Kafando E, Deneys V. Feasibility and performance of in-house red blood cell reagents to detect unexpected antibodies in immunized patients in Burkina Faso. Immunohematology 2023; 39:172-180. [PMID: 38179780 DOI: 10.2478/immunohematology-2023-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
In sub-Saharan Africa, antibody detection tests remain inaccessible because of the high cost and limited shelf life of red blood cell (RBC) reagents. This study aimed at investigating the feasibility and performance of locally prepared RBC reagents for antibody detection in Burkina Faso. We conducted an experimental study comparing commercial RBC panels and a local panel prepared from phenotyped blood donors in Ouagadougou, Burkina Faso. Antibody detection testing was performed by the indirect antiglobulin test using a gel card filtration column in a low-ionic-strength solution. Judgment criteria were the concordance rate and the kappa agreement coefficient of results generated by the two panels. A total of 302 blood donors were phenotyped for the major antigens of the RH, KEL, MNS, FY, JK, LE, and P1PK blood group systems. From this pool of donors, we designed an RBC detection panel that was used to screen for unexpected antibodies in 1096 plasma samples from 832 patients with a history of transfusion and 264 recently delivered or pregnant women with no history of blood transfusion. A positive antibody detection test was observed in 8.1 percent of the samples using the local panel versus 6.4 percent with the commercial panels. A total of 23 samples were negative with the commercial panels and positive with the local panel, while the findings were reversed for four samples. The concordance rate was 97.5 percent, and the kappa agreement coefficient was 0.815. Our results suggest that the development of local RBC panels can be an alternative to commercial panels in countries with limited resources. It could also be a cost-effective intervention, mainly for children under 5 years of age, women of childbearing age, and pregnant women, all of whom are most at risk for malaria and sickle cell disease complications. Blood services could develop and implement appropriate strategies to make phenotyped donor pools available for the design of suitable RBC panels.
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Affiliation(s)
- S Sawadogo
- biomedical and pharmaceutical sciences Lecturer/Medical Biologist, Laboratory of Hematology, University Joseph KI-ZERBO, 01 BP 7021 Ouagadougou 01, Ouagadougou, Burkina Faso
| | - K Nebie
- Lecturer/Medical Biologist, Laboratory of Hematology, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - D Kima
- immunology and biochemistry, Laboratory of Hematology, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - S K A Ouedraogo
- Laboratory of Hematology, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - P A Nagnon
- Laboratory of Hematology, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - J Koulidiati
- Lecturer/Hematologist, Department of Medicine, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - C Traore
- Lecturer/Hematologist, Department of Medicine, University Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - S Sawadogo
- Senior Lecturer/Biological Hematologist, Department of Biological Laboratories, University Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - E Kafando
- biomedical and pharmaceutical sciences, Professor/Medical Biologist, Laboratory of Hematology, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - V Deneys
- biomedical and pharmaceutical sciences, Professor/Medical Biologist, Catholic University of Louvain, Brussels, Belgium
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Desai P, Navkudkar A, Rajadhyaksha S. ABO blood group discrepancies in blood donor and patient samples at a tertiary care oncology centre: analysis and serological resolution. Hematol Transfus Cell Ther 2023:S2531-1379(23)00168-2. [PMID: 37690977 DOI: 10.1016/j.htct.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION In serological testing, determination of ABO grouping requires both antigen typing for A and B antigens and screening of serum or plasma for A and B antibodies. Lack of corroboration between the results of the cell and serum groupings identifies a discrepancy. Analysis of ABO blood group discrepancies was performed to determine the incidence of these discrepancies among healthy blood donors and oncology patients. MATERIALS AND METHODS ABO discrepancies found during testing of blood samples from blood donors and patients in an oncology centre in the period from January 2015 to December 2018 were analysed. ABO blood grouping was performed using the column agglutination test. Detailed serological workups were carried out to resolve discrepancies. RESULTS During the study period, a comprehensive analysis was conducted on a large dataset comprising 76,604 blood donor samples and 134,964 patient samples. Of these samples, 117 ABO discrepancies were identified with 13 occurring in blood donor samples and 104 in patient samples. The results demonstrated discrepancies caused by weakened/missing antibodies, weakened/missing antigens, panagglutination and miscellaneous factors in the blood donor samples, with percentages of 0%, 38%, 8%, and 31%, respectively. In patient samples, the percentages were 24%, 27%, 26%, and 15%, respectively. CONCLUSION Weakened/missing antigen discrepancies were the prevalent type in both blood donor and patient samples. For accurate blood group reporting and management of transfusion needs of patients, a complete serological workup is vital to resolve any blood group discrepancies.
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Affiliation(s)
- Priti Desai
- Tata Memorial Centre, HBNI, Mumbai, Maharashtra, India.
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How to improve issuing, transfusion and follow-up of blood components in Southern and Eastern Mediterranean countries? A benchmark assessment. Transfus Apher Sci 2022; 62:103616. [PMID: 36470725 DOI: 10.1016/j.transci.2022.103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/12/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
To determine the existence of guidelines regarding the appropriate clinical use of blood and blood components, transfusion requests, and blood issuing/reception documents and procedures. The different bedside transfusion organizations/processes and hemovigilance are also analyzed. The ultimate objective is to identify safe potential options in order to improve blood safety at the lowest cost. Data emanating from eight Arabic eastern/southern Mediterranean countries who responded to five surveys were collected and tabulated. National recommendations for the clinical use of blood components especially for hemoglobinopathies are lacking in some countries. In matter of good practices in the prescription, issuing and reception of BCs, efforts were made either on national or local basis. Procedures regarding patient information and ethical issues are still lacking. Almost all Mediterranean countries apply two blood testing procedures on each patient sample. Only Morocco, Tunisia and Algeria perform bed side blood group testing; Egypt and Lebanon perform antibody screen and antiglobulin cross matching universally. Automation for blood testing is insufficiently implemented in almost all countries and electronic release is almost absent. National hemovigilance policy is implemented in Tunisia, Morocco, and Lebanon but the reporting system remains inoperative. Insufficient resources severely hinders the implementation of expensive procedures and programs; however, the present work identifies safe procedures that might save resources to improve other parts in the transfusion process (e.g. electronic release to improve safety in issuing). Moreover, setting up regulations regarding ethics in transfusing recipients along with local transfusion committees are crucially needed to implement hemovigilance in transfusion practice.
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Sahu A, Prakash S, Das N, Routray SS, Naik A, Mukherjee S. Analysis of Blood Group Discrepancy in Healthy Blood Donors at a Tertiary Care Referral Hospital from Eastern India: A Retrospective Study. J Lab Physicians 2022; 14:247-252. [PMID: 36119418 PMCID: PMC9473936 DOI: 10.1055/s-0042-1742417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective
ABO typing constitutes cell grouping and serum grouping. The discrepancy may arise in ABO typing due to a mismatch in cell grouping and serum grouping. It may be due to technical errors, missing or weak ABO antibodies (type I), weak ABO subgroups (type II), Rouleaux formation (type III), or other miscellaneous reasons (type IV). This study was carried out to determine the prevalence and cause of ABO blood group discrepancy in donor samples at our center.
Methods
A retrospective study of ABO blood group typing of blood donors was conducted at our center. The blood group typing was routinely performed using gel cards and a microcentrifuge system (Tulip Diagnostics(P) Ltd, Goa, India). If any discrepancy in ABO typing was noted, the test was repeated using the conventional tube technique. After sorting clerical/technical error, the causes of discrepancy were analyzed and resolved using anti-A
1
, anti-H, anti-AB, and other immunohematological tests like antibody screening and identification, saliva inhibition test, adsorption-elution studies.
Results
A total of 12,715 (98.6% males and 1.4% females) donor samples were tested. The number of ABO discrepancies detected were 15 (0.12%). The discrepancies were characterized as type I (6 cases; 40%), type II (1 case; 6.7%), type III (0 cases; 0%), and type IV (8 cases; 53.3%). Three cases, each of anti-M and anti-Le
b
, were detected in the study population. A single case of A
3
, a subgroup of A blood group, was found during the study.
Conclusion
The prevalence of ABO group discrepancy was 0.12% at our center. Discrepancy arising during ABO typing of blood donor must be resolved before reporting ABO blood group to minimize the recipient's chances of transfusion reaction. The serum grouping is equally crucial as cell grouping for reporting the ABO group of an individual.
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Affiliation(s)
- Ansuman Sahu
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satya Prakash
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Niladri Das
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suman Sudha Routray
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Archana Naik
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somnath Mukherjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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6
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Yao MX, Hao X, Xia XX, Lai C, Diao XQ. Retrospective analysis of molecular biology mechanism of ABO blood group typing discrepancy among blood donors in Jinan blood station. Transfus Clin Biol 2021; 29:75-78. [PMID: 34217816 DOI: 10.1016/j.tracli.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To accurately identify ABO blood typing in pre-transfusion testing is very important to ensure blood transfusion safely, which is a major responsibility of blood station. METHODS Eighty-one blood donors samples with ABO blood group typing discrepancy was collected among 61952 donor samples in our blood station from January 2019 to July 2020. Blood group serological method was used to detect ABO blood group. DNA Sequencing was used to determine the genotype. The antibody screening test detects antibodies other than ABO. RESULTS In total, 61,952 donor samples were analysed for ABO typing discrepancies. The incidence among blood donors was 0.13% (81/61952). The most common reason of ABO typing discrepancies was due to specific antibody or non-specific agglutination (54.32%, 44/81), mainly anti-M antibody, cold autoantibody, anti-D antibody, anti-N antibody and anti-Lea antibody. The major cause of forward typing discrepancies among blood donors was ABO subgroups (25.93%, 21/81), including 10 cases of A subtype (1 case of A2, 2 cases of A3, 2 cases of Ax, 3 cases of AxB, 1 case of Ael, 1 case of Ahm), 6 cases of B subtype (2 cases of B3, 1 case of Bel, 3 cases of AB3), 2 cases of B subtype (A), 1 case of cisAB, and 2 cases of acquired B. The serum antibody was weakened in 16 cases (19.75%). CONCLUSIONS The blood types should be correctly identified by combining serology with gene sequencing to ensure the safety of clinical blood transfusion, when the forward and reverse typing discrepancies among the blood donors.
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Affiliation(s)
- M X Yao
- Jinan, 250000 Shandong, China
| | - X Hao
- Jinan, 250000 Shandong, China.
| | - X X Xia
- Jinan, 250000 Shandong, China
| | - C Lai
- Jinan, 250000 Shandong, China
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7
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Ramsey G. Landsteiner's legacy: The continuing challenge to make transfusions safe. Transfusion 2021; 60:2772-2779. [PMID: 33285006 DOI: 10.1111/trf.16205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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8
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Koenigbauer UF. Laboratory Detection of Blood Groups and Provision of Red Cells. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Karafin MS, Becker JL, Berg M, DeSimone RA, Draper NL, Hudgins J, Metcalf RA, Pagano MB, Park YA, Rossmann SN, Schwartz J, Souers R, Thomas L, Uhl L, Ramsey GE. Heterogeneity in Approaches for Switching From Universal to Patient ABO Type-Specific Blood Components During Massive Hemorrhage: An International Survey and Review of the Literature. Arch Pathol Lab Med 2021; 145:1499-1504. [PMID: 33720316 DOI: 10.5858/arpa.2020-0374-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— ABO mistransfusions are rare and potentially fatal events. Protocols are required by regulatory agencies to minimize this risk to patients, but how these are applied in the context of massive transfusion protocols (MTPs) is not specifically defined. OBJECTIVE.— To evaluate the approaches used by transfusion services for switching from universally compatible to patient ABO type-specific blood components during massive hemorrhage. DESIGN.— We added 1 supplemental multiple-choice question to address the study objective to the 2019 College of American Pathologists proficiency test J-survey (J-A 2019). We also reviewed the available literature regarding this topic. RESULTS.— A total of 881 laboratories responded to the supplemental question. Approximately 80% (704 of 881) report a policy for ABO-type switching during an MTP. Policies varied considerably between responding laboratories, but most (384 of 704, 55%) required 2 ABO types to match before switching from universal to recipient-specific blood components. Additional safety measures used in a minority of these protocols included reaction strength criteria (103 of 704, 15%), on-call medical director approval (41 0f 704, 5.8%), universal red cell unit number limits (12 of 704, 1.7%), or the presence of a mixed field (3 of 704, 0.4%). CONCLUSIONS.— This survey reveals that significant heterogeneity exists regarding the available approaches for ABO-type switching during an MTP. Specific expert guidance regarding this issue is very limited, and best practices have not yet been established or rigorously investigated.
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Affiliation(s)
- Matthew S Karafin
- From Versiti, Medical Sciences Institute, Milwaukee, Wisconsin (Karafin).,Karafin is currently located in the Department of Pathology at the University of North Carolina, Chapel Hill.,The Department of Pathology, Medical College of Wisconsin, Milwaukee (Karafin)
| | - Joanne L Becker
- The Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York (Becker)
| | - Mary Berg
- The Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Berg, Draper)
| | - Robert A DeSimone
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, New York (DeSimone)
| | - Nicole L Draper
- The Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Berg, Draper)
| | - Jay Hudgins
- The Department of Pathology, Los Angeles Children's Hospital, University of Southern California Medical Center, Los Angeles, California (Hudgins)
| | - Ryan A Metcalf
- ARUP Blood Services, University of Utah School of Medicine, Salt Lake City (Metcalf)
| | - Monica B Pagano
- The Department of Laboratory Medicine, University of Washington Medical Center, Seattle (Pagano)
| | - Yara A Park
- The Department of Pathology and Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill (Park)
| | | | - Joseph Schwartz
- The Department of Pathology, Columbia University Medical Center, New York, New York (Schwartz)
| | - Rhona Souers
- Statistics (Souers) and PT - Technical & Administration (Thomas), College of American Pathologists, Northfield, Illinois
| | - Lamont Thomas
- Statistics (Souers) and PT - Technical & Administration (Thomas), College of American Pathologists, Northfield, Illinois
| | - Lynne Uhl
- The Department of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Uhl)
| | - Glenn E Ramsey
- The Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Ramsey)
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10
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Wang N, Tian Y, Jia S, Shao L, Yu W, Fang M. A novel Bruton tyrosine kinase gene variation was found in an adult with X-linked agammaglobulinemia during blood cross-matching prior to surgical operation. Transfus Med 2019; 29:364-368. [PMID: 31115091 DOI: 10.1111/tme.12601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 12/01/2022]
Abstract
AIMS/OBJECTIVES To investigate the underlying molecular mechanism of the patient's ABO typing discrepancy. BACKGROUND ABO typing discrepancy was frequently seen in patients due to different causes. In this study, ABO typing discrepancy was found in a 24-year-old man with arthralgia, whose forward ABO grouping was O and reverse ABO grouping was AB. Primary immunodeficiency disease was speculated in this patient, especially X-linked agammaglobulinemia (XLA). METHODS Immunoglobulins of all isotypes were detected using a specific protein analyser. Lymphocyte subgroups were analysed by flow cytometry. All 19 exons and boundaries of BTK gene were amplified by polymerase chain reaction (PCR), and all PCR products were sequenced by a DNA analyser. BTK protein in the leukocytes and platelets was detected by Western blot. RESULTS No B lymphocytes could be detected in the peripheral blood of the patient. A novel BTK gene variation, c.817G>T, in the exon 9 of BTK gene was discovered. No BTK protein expression could be detected in the leukocytes and platelets of the patient. CONCLUSIONS XLA could be occasionally discovered by ABO typing discrepancy in some cases because of the deficiency of reciprocal IgM anti-A and/or anti-B antibodies in the serum of the patient. Humoral immunodeficiency is one of the causes of ABO typing discrepancy.
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Affiliation(s)
- N Wang
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Blood Typing Laboratory, Dalian Blood Center, Dalian, China
| | - Y Tian
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - S Jia
- Department of Hematology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - L Shao
- Department of Blood Typing Laboratory, Dalian Blood Center, Dalian, China
| | - W Yu
- Department of Blood Typing Laboratory, Dalian Blood Center, Dalian, China
| | - M Fang
- Department of Hematology, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Hematology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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11
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Transfusion Safety: The Nature and Outcomes of Errors in Patient Registration. Transfus Med Rev 2019; 33:78-83. [DOI: 10.1016/j.tmrv.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/18/2018] [Accepted: 11/28/2018] [Indexed: 11/23/2022]
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12
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TOPAL G, ŞAHİN İ, ÇALIŞKAN E, KILINÇEL Ö. Kan Transfüzyonu ve Reaksiyonları İle İlgili Sağlık Çalışanlarının Bilgi Düzeylerinin Araştırılması. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.461050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Kaufman RM, Dinh A, Cohn CS, Fung MK, Gorlin J, Melanson S, Murphy MF, Ziman A, Elahie AL, Chasse D, Degree L, Dunbar NM, Dzik WH, Flanagan P, Gabert K, Ipe TS, Jackson B, Lane D, Raspollini E, Ray C, Sharon Y, Ellis M, Selleng K, Staves J, Yu P, Zeller M, Yazer M. Electronic patient identification for sample labeling reduces wrong blood in tube errors. Transfusion 2018; 59:972-980. [DOI: 10.1111/trf.15102] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anh Dinh
- Department of Pathology and Laboratory MedicineChildren's Hospital of Philadelphia Philadelphia PA
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis MN
| | - Mark K. Fung
- Department of PathologyUniversity of Vermont Burlington VT
| | | | - Stacy Melanson
- Department of PathologyBrigham and Women's Hospital Boston MA
| | | | - Alyssa Ziman
- Department of Pathology and Laboratory MedicineUCLA Health Los Angeles CA
| | | | - Danielle Chasse
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | - Lynsi Degree
- Department of PathologyUniversity of Vermont Burlington VT
| | - Nancy M. Dunbar
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | - Walter H. Dzik
- Department of PathologyMassachusetts General Hospital Boston MA
| | | | - Kimberly Gabert
- Department of Pathology and the Institute for Transfusion MedicineUniversity of Pittsburgh Pittsburgh PA
| | - Tina S. Ipe
- Department of Pathology and Genomic MedicineHouston Methodist Hospital Houston TX
| | - Bryon Jackson
- Department of Pathology and Laboratory MedicineEmory University School of Medicine Atlanta GA
| | | | | | - Charles Ray
- Dartmouth‐Hitchcock Medical Center, Department of Pathology and Laboratory Medicine Lebanon NH
| | | | | | - Kathleen Selleng
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine Greifswald Germany
| | - Julie Staves
- Oxford University Hospitals Foundation Trust Oxford United Kingdom
| | - Philip Yu
- St. Paul's Hospital Vancouver Canada
| | | | - Mark Yazer
- Department of Pathology and the Institute for Transfusion MedicineUniversity of Pittsburgh Pittsburgh PA
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14
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Makroo RN, Kakkar B, Agrawal S, Chowdhry M, Prakash B, Karna P. Retrospective analysis of forward and reverse ABO typing discrepancies among patients and blood donors in a tertiary care hospital. Transfus Med 2018; 29:103-109. [DOI: 10.1111/tme.12506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/21/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R. N. Makroo
- Department of Transfusion MedicineIndraprastha Apollo Hospital New Delhi India
| | - B. Kakkar
- Department of Transfusion MedicineIndraprastha Apollo Hospital New Delhi India
| | - S. Agrawal
- Department of Transfusion MedicineIndraprastha Apollo Hospital New Delhi India
| | - M. Chowdhry
- Department of Transfusion MedicineIndraprastha Apollo Hospital New Delhi India
| | - B. Prakash
- Department of Transfusion MedicineIndraprastha Apollo Hospital New Delhi India
| | - P. Karna
- Department of Transfusion MedicineIndraprastha Apollo Hospital New Delhi India
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15
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Evaluation of the non-compliance with grouping guidelines which may lead to “wrong blood in tube”, an observational study and risk factor analysis. Transfus Clin Biol 2017; 24:47-51. [DOI: 10.1016/j.tracli.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 01/06/2017] [Indexed: 11/23/2022]
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16
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Mulvey JJ, Matnani R, Cushing MM. Historical ABO blood group discrepancy: a blessing in disguise to unravel a medical identity theft. Transfusion 2017; 57:1096-1097. [PMID: 28394425 DOI: 10.1111/trf.14052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/08/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J Justin Mulvey
- Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Rahul Matnani
- Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Melissa M Cushing
- Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
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17
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Laboratory Detection of Blood Groups and Provision of Red Cells. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Clifford SP, Mick PB, Derhake BM. A Case of Transfusion Error in a Trauma Patient With Subsequent Root Cause Analysis Leading to Institutional Change. J Investig Med High Impact Case Rep 2016; 4:2324709616647746. [PMID: 27231693 PMCID: PMC4871199 DOI: 10.1177/2324709616647746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/15/2022] Open
Abstract
A 28-year-old man presented emergently to the operating room following a gun-shot injury to his right groin. Our hospital’s Massive Transfusion Protocol was initiated as the patient entered the operating room actively hemorrhaging and severely hypotensive. During the aggressive resuscitation efforts, the patient was inadvertently transfused 2 units of packed red blood cells intended for another patient due to a series of errors. Fortunately, the incorrect product was compatible, and the patient recovered from his near-fatal injuries. Root cause analysis was used to review the transfusion error and develop an action plan to help prevent future occurrences.
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Ferrera-Tourenc V, Lassale B, Chiaroni J, Dettori I. Unreliable patient identification warrants ABO typing at admission to check existing records before transfusion. Transfus Clin Biol 2015; 22:66-70. [PMID: 25936944 DOI: 10.1016/j.tracli.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/20/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES This study describes patient identification errors leading to transfusional near-misses in blood issued by the Alps Mediterranean French Blood Establishment (EFSAM) to Marseille Public Hospitals (APHM) over an 18-month period. The EFSAM consolidates 14 blood banks in southeast France. It supplies 149 hospitals and maintains a centralized database on ABO types used at all area hospitals. As an added precaution against incompatible transfusion, the APHM requires ABO testing at each admission regardless of whether the patient has an ABO record. The study goal was to determine if admission testing was warranted. MATERIALS AND METHODS Discrepancies between ABO type determined by admission testing and records in the centralized database were investigated. The root cause for each discrepancy was classified as specimen collection or patient admission error. Causes of patient admission events were further subclassified as namesake (name similarity) or impersonation (identity fraud). RESULTS The incidence of ABO discrepancies was 1:2334 including a 1:3329 incidence of patient admission events. Impersonation was the main cause of identity events accounting for 90.3% of cases. The APHM's ABO control policy prevented 19 incompatible transfusions. In relation to the 48,593 packed red cell units transfused, this would have corresponded to a risk of 1:2526. CONCLUSION Collecting and storing ABO typing results in a centralized database is an essential public health tool. It allows crosschecking of current test results with past records and avoids redundant testing. However, as patient identification remains unreliable, ABO typing at each admission is still warranted to prevent transfusion errors.
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Affiliation(s)
- V Ferrera-Tourenc
- Établissement français du sang Alpes-Méditerranée, 506, avenue du Prado, CS 30002, 13272 Marseille Cx8, France.
| | - B Lassale
- Service d'hémovigilance et gestion des risques, hôpital Sainte-Marguerite, Assistance publique-Hôpitaux de Marseille, Pavillon 9, 270, boulevard Sainte-Marguerite, 13274 Marseille Cx9, France
| | - J Chiaroni
- Établissement français du sang Alpes-Méditerranée, 506, avenue du Prado, CS 30002, 13272 Marseille Cx8, France
| | - I Dettori
- Établissement français du sang Alpes-Méditerranée, 506, avenue du Prado, CS 30002, 13272 Marseille Cx8, France
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Bolton-Maggs PHB, Wood EM, Wiersum-Osselton JC. Wrong blood in tube - potential for serious outcomes: can it be prevented? Br J Haematol 2014; 168:3-13. [PMID: 25284036 DOI: 10.1111/bjh.13137] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
'Wrong blood in tube' (WBIT) errors, where the blood in the tube is not that of the patient identified on the label, may lead to catastrophic outcomes, such as death from ABO-incompatible red cell transfusion. Transfusion is a multistep, multidisciplinary process in which the human error rate has remained unchanged despite multiple interventions (education, training, competency testing and guidelines). The most effective interventions are probably the introduction of end-to-end electronic systems and a group-check sample for patients about to receive their first transfusion, but neither of these eradicates all errors. Further longer term studies are required with assessment before and after introduction of the intervention. Although most focus has been on WBIT in relation to blood transfusion, all pathology samples should be identified and linked to the correct patient with the same degree of care. Human factors education and training could help to increase awareness of human vulnerability to error, particularly in the medical setting where there are many risk factors.
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Affiliation(s)
- Paula H B Bolton-Maggs
- Serious Hazards of Transfusion UK National Haemovigilance Scheme, Manchester Blood Centre and the University of Manchester, Manchester, UK
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Kumar R, Gupta M, Gupta V, Kaur A, Gupta S. Acute Transfusion Reactions (ATRs) in Intensive Care Unit (ICU): A Retrospective Study. J Clin Diagn Res 2014; 8:127-9. [PMID: 24701502 DOI: 10.7860/jcdr/2014/7761.4027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. AIM To analyze the incidence and spectrum of ATRs occuring in critically ill patients. MATERIALS AND METHODS This was a retrospective review conducted from 1(st) April 2011 till 31(st) March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. RESULTS During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. CONCLUSIONS Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.
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Affiliation(s)
- Rajesh Kumar
- Associate Professor, Department of Immunohaematology and Blood Transfusion (IHBT), Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Manvi Gupta
- Senior Resident, Department of IHBT, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Varun Gupta
- Assistant Professor, Department of Surgery, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Amarjit Kaur
- Professor and Head, Department of IHBT, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Sonia Gupta
- Assistant Professor, Department of IHBT, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
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Nilsson K, Grankvist K, Juthberg C, Brulin C, Söderberg J. Deviations from venous blood specimen collection guideline adherence among senior nursing students. NURSE EDUCATION TODAY 2014; 34:237-242. [PMID: 23870690 DOI: 10.1016/j.nedt.2013.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/02/2013] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Despite considerable efforts to increase patient safety by supporting the use of best practice medical and nursing guidelines by healthcare staff, adherence is often suboptimal. Swedish nurses often deviate from venous blood specimen collection (VBSC) guideline adherence. We assessed the adherence to national VBSC guidelines among senior nursing students. METHODS We conducted a cross-sectional, self-reported questionnaire survey among 101 out of 177 senior nursing students consisting of web-based students in their fifth semester and campus-based students in their fifth or sixth semester out of six. In regard to the VBSC procedures, we asked about adherence to the patient identification, test request handling, and test tube labelling protocols that the students had learned during their second semester and practiced thereafter. RESULTS Guideline adherence to patient identification was reported by 81%, test request handling by 74%, and test tube labelling by 2% of the students. Students with no prior healthcare education reported to a higher extent that they operated within the guidelines regarding labelling the test tube before entering the patient's room compared to students with prior healthcare education. Using multiple logistic regression analysis, we found that fifth semester web-based program students adhered better to VBSC guidelines regarding comparing patient ID/test request/tube label compared to campus-based students. CONCLUSIONS Senior nursing students were found to adhere to VBSC guidelines to a similar extent as registered nurses and other hospital ward staff in clinical healthcare. Thus student adherence to VBSC guidelines had deteriorated since their basic training in the second semester, and this can impact patient safety during university/clinical studies. The results of our study have implications for nursing practice education.
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Affiliation(s)
- Karin Nilsson
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | | | | | - Johan Söderberg
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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Sharma T, Garg N, Singh B. ABO blood group discrepancies among blood donors in Regional Blood Transfusion Centre GTB Hospital, Delhi, India. Transfus Apher Sci 2014; 50:75-80. [DOI: 10.1016/j.transci.2013.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/02/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
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Karim F, Moiz B, Shamsuddin N, Naz S, Khurshid M. Root cause analysis of non-infectious transfusion complications and the lessons learnt. Transfus Apher Sci 2014; 50:111-7. [DOI: 10.1016/j.transci.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/27/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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Interventions to reduce wrong blood in tube errors in transfusion: a systematic review. Transfus Med Rev 2013; 27:197-205. [PMID: 24075096 DOI: 10.1016/j.tmrv.2013.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 11/21/2022]
Abstract
This systematic review addresses the issue of wrong blood in tube (WBIT). The objective was to identify interventions that have been implemented and the effectiveness of these interventions to reduce WBIT incidence in red blood cell transfusion. Eligible articles were identified through a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, Cinahl, BNID, and the Transfusion Evidence Library to April 2013. Initial search criteria were wide including primary intervention or observational studies, case reports, expert opinion, and guidelines. There was no restriction by study type, language, or status. Publications before 1995, reviews or reports of a secondary nature, studies of sampling errors outwith transfusion, and articles involving animals were excluded. The primary outcome was a reduction in errors. Study characteristics, outcomes measured, and methodological quality were extracted by 2 authors independently. The principal method of analysis was descriptive. A total of 12,703 references were initially identified. Preliminary secondary screening by 2 reviewers reduced articles for detailed screening to 128 articles. Eleven articles were eventually identified as eligible, resulting in 9 independent studies being included in the review. The overall finding was that all the identified interventions reduced WBIT incidence. Five studies measured the effect of a single intervention, for example, changes to blood sample labeling, weekly feedback, handwritten transfusion requests, and an electronic transfusion system. Four studies reported multiple interventions including education, second check of ID at sampling, and confirmatory sampling. It was not clear which intervention was the most effective. Sustainability of the effectiveness of interventions was also unclear. Targeted interventions, either single or multiple, can lead to a reduction in WBIT; but the sustainability of effectiveness is uncertain. Data on the pre- and postimplementation of interventions need to be collected in future trials to demonstrate effectiveness, and comparative studies are needed of different interventions.
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Ferrera-Tourenc V, Dettori I, Chiaroni J, Lassale B. [Organization of safe cost-effective blood transfusion: experience APHM-EFSAM]. Transfus Clin Biol 2013; 20:15-20. [PMID: 23523097 DOI: 10.1016/j.tracli.2012.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Blood transfusion safety depends on strict compliance with each step of a process beginning with the order for labile blood products and related immunohematologic testing and ending with administration and follow-up of the receiver. This process is governed by stringent regulatory texts and guidelines. Despite precautions, processing errors are still reported. Analysis of incident reports shows that the most common cause involves patient identification and that most errors occur at two levels, i.e. the entry of patient information and management of multiple regulatory crosschecks and record-keeping using different systems. METHOD The purpose of this report is to describe the collaborative approach implemented by the Établissement français du Sang Alpes-Méditerranée (EFSAM) and the Assistance publique des Hôpitaux de Marseille (APHM) to secure the blood transfusion process and protect interfaces while simplifying and facilitating exchanges. RESULTS Close cooperation has had a threefold impact with simplification of administration, improvement of experience feedback, and better management of test ordering. The organization implemented between the two institutions has minimized document redundancy and interfaces between immunohematologic testing and delivery. Collaboration based on experience feedback has improved the level of quality and cost control. CONCLUSION In the domain of blood transfusion safety, the threshold of 10(-5) has been reached with regard to the risk of ABO errors in the distribution concentrated red cells (CRC). In addition, this collaborative organization has created further opportunity for improvement by deploying new methods to identify simplification measures and by controlling demand and usage.
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Affiliation(s)
- V Ferrera-Tourenc
- Établissement français du sang Alpes-Méditerranée (EFSAM), 149, boulevard Baille, 13392 Marseille cedex 5, France.
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Seth M, Jackson KV, Winzelberg S, Giger U. Comparison of gel column, card, and cartridge techniques for dog erythrocyte antigen 1.1 blood typing. Am J Vet Res 2012; 73:213-9. [PMID: 22280380 DOI: 10.2460/ajvr.73.2.213] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare accuracy and ease of use of a card agglutination assay, an immunochromatographic cartridge method, and a gel-based method for canine blood typing. SAMPLE Blood samples from 52 healthy blood donor dogs, 10 dogs with immune-mediated hemolytic anemia (IMHA), and 29 dogs with other diseases. PROCEDURES Blood samples were tested in accordance with manufacturer guidelines. Samples with low PCVs were created by the addition of autologous plasma to separately assess the effects of anemia on test results. RESULTS Compared with a composite reference standard of agreement between 2 methods, the gel-based method was found to be 100% accurate. The card agglutination assay was 89% to 91% accurate, depending on test interpretation, and the immunochromatographic cartridge method was 93% accurate but 100% specific. Errors were observed more frequently in samples from diseased dogs, particularly those with IMHA. In the presence of persistent autoagglutination, dog erythrocyte antigen (DEA) 1.1 typing was not possible, except with the immunochromatographic cartridge method. CONCLUSIONS AND CLINICAL RELEVANCE The card agglutination assay and immunochromatographic cartridge method, performed by trained personnel, were suitable for in-clinic emergency DEA 1.1 blood typing. There may be errors, particularly for samples from dogs with IMHA, and the immunochromatographic cartridge method may have an advantage of allowing typing of samples with persistent autoagglutination. The laboratory gel-based method would be preferred for routine DEA 1.1 typing of donors and patients if it is available and time permits. Current DEA 1.1 typing techniques appear to be appropriately standardized and easy to use.
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Affiliation(s)
- Mayank Seth
- Section of Medical Genetics, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, 19104, USA
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Laboratory Detection of Blood Groups and Provision of Red Cells. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Callum JL, Lin Y, Lima A, Merkley L. Transitioning from ‘blood’ safety to ‘transfusion’ safety: addressing the single biggest risk of transfusion. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1751-2824.2011.01446.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seth M, Jackson KV, Giger U. Comparison of five blood-typing methods for the feline AB blood group system. Am J Vet Res 2011; 72:203-9. [PMID: 21281194 DOI: 10.2460/ajvr.72.2.203] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective-To compare the ease of use and accuracy of 5 feline AB blood-typing methods: card agglutination (CARD), immunochromatographic cartridge (CHROM), gel-based (GEL), and conventional slide (SLIDE) and tube (TUBE) agglutination assays. Sample Population-490 anticoagulated blood samples from sick and healthy cats submitted to the Transfusion or Clinical Laboratory at the Veterinary Hospital of the University of Pennsylvania. Procedures-Sample selection was purposely biased toward those from anemic, type B, or type AB cats or those with autoagglutination. All blood samples were tested by use of GEL, SLIDE, and TUBE methods. Fifty-eight samples were also tested by use of CARD and CHROM methods. The presence of alloantibodies in all cats expressing the B antigen as detected by use of any method was also assessed. Results-Compared with the historical gold-standard TUBE method, good to excellent agreement was achieved with the other typing tests: CARD, 53 of 58 (91% agreement); CHROM, 55 of 58 (95%); GEL, 487 of 490 (99%); and SLIDE, 482 of 487 (99%; 3 samples were excluded because of autoagglutination). Four of the samples with discordant test results originated from cats with FeLV-related anemia. Conclusions and Clinical Relevance-Current laboratory and in-clinic methods provide simple and accurate typing for the feline AB blood group system with few discrepancies. Retyping after in-clinic typing with the GEL or TUBE laboratory methods is recommended to confirm any type B or AB cats.
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Affiliation(s)
- Mayank Seth
- Section of Medical Genetics, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Ortega-Andreu M, Pérez-Chrzanowska H, Figueredo R, Gómez-Barrena E. Blood loss control with two doses of tranexamic Acid in a multimodal protocol for total knee arthroplasty. Open Orthop J 2011; 5:44-8. [PMID: 21552468 PMCID: PMC3087309 DOI: 10.2174/1874325001105010044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/23/2011] [Accepted: 01/24/2011] [Indexed: 12/13/2022] Open
Abstract
Average blood loss after total knee arthroplasty (TKA) usually ranges from 1500 to 1900 cc, including both the postoperative drain and hidden blood loss. This represents about 46% of TKA patients requiring postoperative blood transfusion. Not only the risks of disease transmission but also those of ABO incompatibility, infection due to immunosupression, increased procedure costs, and increased length of hospital stay, are potential problems that foster blood saving strategies. In this study, 71 unilateral TKAs using a multimodal protocol to decrease blood loss were compared to 61 historical cases. Patients in both groups underwent cemented TKA with the same system, surgical technique, and multimodal protocol (MIS approach, plug in the femoral canal, tourniquet removal after wound closure and compressive bandage, analgesic periarticular infiltration with vasoconstrictor, postoperative drain at atmospheric pressure, opened 2 hours after the end of the surgical procedure and removed after 24 hours). The study series incorporated intravenous tranexamic acid (TXA) infusion in 2 doses of 10-15 mg/kg, 15 minutes before tourniquet release and 3 hours later. Results showed no transfusion requirements in the TXA series (0%), with 23/61 (37.7%) transfusions in the control, with an average cost decrease of 240 euros per patient. Visible bleeding in 24h significantly decreased from 553.36 cc (range 50-1500) to 169.72 cc (range 10-480) in the TXA series. As a conclusion, implementing a TXA-based multimodal protocol produced significant decrease in the transfusion rate, visible blood loss, and cost per patient, thus proving effectiveness and efficiency in the surgical management of TKA.
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Murphy MF, Stanworth SJ, Yazer M. Transfusion practice and safety: current status and possibilities for improvement. Vox Sang 2010; 100:46-59. [DOI: 10.1111/j.1423-0410.2010.01366.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aulbach RK, Brient K, Clark M, Custard K, Davis C, Gecomo J, Ho JO. Blood transfusions in critical care: improving safety through technology & process analysis. Crit Care Nurs Clin North Am 2010; 22:179-90. [PMID: 20541066 DOI: 10.1016/j.ccell.2010.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A multidisciplinary safety initiative transformed blood transfusion practices at St. Luke's Episcopal Hospital in Houston, Texas. An intense analysis of a mistransfusion using the principles of a Just Culture and the process of Cause Mapping identified system and human performance factors that led to the transfusion error. Multiple initiatives were implemented including technology, education and human behaviour change. The wireless technology of Pyxis Transfusion Verification by CareFusion is effective with the rapid infusion module efficient for use in critical care. Improvements in blood transfusion safety were accomplished by thoroughly evaluating the process of transfusions and by implementing wireless electronic transfusion verification technology. During the 27 months following implementation of the CareFusion Transfusion Verification there have been zero cases of transfusing mismatched blood.
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Affiliation(s)
- Rebecca K Aulbach
- Cardiovascular and Transplant Nursing, St Luke's Episcopal Hospital, 6720 Bertner Avenue, MC: 4-278, Box 76, Houston, TX 77030, USA.
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Goodnough LT, Viele M, Fontaine M, Chua L, Ferrer Z, Jurado C, Quach P, Dunlap M, Arber DA. Quality management in the transfusion service: case studies in process improvement. Transfusion 2010; 51:600-9. [DOI: 10.1111/j.1537-2995.2010.02857.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pagliaro P. Errors in transfusion medicine are not only misidentifications of the recipient, but also pre-analytical and analytical errors. Clin Chem Lab Med 2010; 48:1053-4. [DOI: 10.1515/cclm.2010.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Powers A, Chandrashekar S, Mohammed M, Uhl L. IMMUNOHEMATOLOGY: Identification and evaluation of false-negative antibody screens. Transfusion 2009; 50:617-21. [DOI: 10.1111/j.1537-2995.2009.02464.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goodnough LT, Viele M, Fontaine MJ, Jurado C, Stone N, Quach P, Chua L, Chin ML, Scott R, Tokareva I, Tabb K, Sharek PJ. Implementation of a two-specimen requirement for verification of ABO/Rh for blood transfusion. Transfusion 2009; 49:1321-8. [DOI: 10.1111/j.1537-2995.2009.02157.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bennardello F, Fidone C, Cabibbo S, Calabrese S, Garozzo G, Cassarino G, Antolino A, Tavolino G, Zisa N, Falla C, Drago G, Di Stefano G, Bonomo P. Use of an identification system based on biometric data for patients requiring transfusions guarantees transfusion safety and traceability. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 7:193-203. [PMID: 19657483 PMCID: PMC2719271 DOI: 10.2450/2009.0067-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 01/16/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND One of the most serious risks of blood transfusions is an error in ABO blood group compatibility, which can cause a haemolytic transfusion reaction and, in the most severe cases, the death of the patient. The frequency and type of errors observed suggest that these are inevitable, in that mistakes are inherent to human nature, unless significant changes, including the use of computerised instruments, are made to procedures. METHODS In order to identify patients who are candidates for the transfusion of blood components and to guarantee the traceability of the transfusion, the Securblood system (BBS srl) was introduced. This system records the various stages of the transfusion process, the health care workers involved and any immediate transfusion reactions. The patients and staff are identified by fingerprinting or a bar code. The system was implemented within Ragusa hospital in 16 operative units (ordinary wards, day hospital, operating theatres). RESULTS In the period from August 2007 to July 2008, 7282 blood components were transfused within the hospital, of which 5606 (77%) using the Securblood system. Overall, 1777 patients were transfused. In this year of experience, no transfusion errors were recorded and each blood component was transfused to the right patient. We recorded 33 blocks of the terminals (involving 0.6% of the transfused blood components) which required the intervention of staff from the Service of Immunohaematology and Transfusion Medicine (SIMT). Most of the blocks were due to procedural errors. CONCLUSIONS The Securblood system guarantees complete traceability of the transfusion process outside the SIMT and eliminates the possibility of mistaken identification of patients or blood components. The use of fingerprinting to identify health care staff (nurses and doctors) and patients obliges the staff to carry out the identification procedures directly in the presence of the patient and guarantees the presence of the doctor at the start of the transfusion.
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MacIvor D, Triulzi DJ, Yazer MH. Enhanced detection of blood bank sample collection errors with a centralized patient database. Transfusion 2009; 49:40-3. [DOI: 10.1111/j.1537-2995.2008.01923.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Levy G. Le test d’agglutination n’est pas le test de référence du contrôle ultime. Transfus Clin Biol 2008; 15:318-21. [DOI: 10.1016/j.tracli.2008.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
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Daurat G. Oui, il faut conserver le test d’agglutination ABO dans le contrôle ultime au lit du malade. Transfus Clin Biol 2008; 15:322-6. [DOI: 10.1016/j.tracli.2008.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 09/05/2008] [Indexed: 10/21/2022]
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43
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Abstract
Several aspects of the management of an orthopaedic surgical patient are not directly related to the surgical technique but are nevertheless essential for a successful outcome. Blood management is one of these. This paper considers the various strategies available for the management of blood loss in patients undergoing orthopaedic and trauma surgery.
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Affiliation(s)
- R. Lemaire
- University Hospital (CHU du Sart-Tilman), 4000 Liège, Belgium
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Gonzalez-Porras JR, Graciani IF, Alvarez M, Pinto J, Conde MP, Nieto MJ, Corral M. Tubes for pretransfusion testing should be collected by blood bank staff and hand labelled until the implementation of new technology for improved sample labelling. Results of a prospective study. Vox Sang 2008; 95:52-6. [PMID: 18393947 DOI: 10.1111/j.1423-0410.2008.01049.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES The greatest risk in transfusion medicine is actually human error, resulting in the use of the incorrect blood component. The aim of our study was to identify and evaluate the risk factors involved in the collection and labelling of pretransfusion blood samples. MATERIAL AND METHODS We prospectively evaluated 6446 samples submitted to the blood bank for pretransfusion testing. Inappropriate samples were classified as 'mislabelled' or 'miscollected'. After 4 months of study, an educational approach was taken. RESULTS The frequency of inappropriately labelled samples was 6.45%. Such samples were associated with the use of addressograph labels (vs. hand-written labels) [23.4% vs. 1.4%, P < 0.0001], collection by clinical staff (vs. blood bank staff) [8.8% vs. 2.1%, P = 0.001] and emergency situations (vs. routine sampling) [10.1% vs. 6.1%, P = 0.005]. Following educational intervention, the percentage of inappropriately labelled samples decreased from 7.3% (pre-educational) to 5.8% (post-educational), P = 0.005. CONCLUSION Ongoing monitoring and analysis of labelling and collection should be mandatory in order to improve the safety of transfusion.
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Affiliation(s)
- J R Gonzalez-Porras
- Transfusion Service, Department of Hematology, University Hospital of Salamanca, Salamanca, Spain.
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45
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Abstract
Hemovigilance programs from around the world document that the greatest risk to recipients of blood transfusion is human error, resulting in transfusion of the incorrect blood component. Errors in transfusion care have strong parallels with errors in medication administration. Errors often result from 'lapse' or 'slip' mistakes in which details of patient identification are overlooked. Three areas of transfusion are focal points for improved care: the labelling of the patient's pre-transfusion sample, the decision to transfuse and the final bedside check designed to prevent mis-transfusion. Both barcodes and radio-frequency identification technology, each ideally suited to matching alpha-numeric identifiers, are being implemented in order to improve performance sample labelling and the bedside check. The decision to transfuse should ultimately be enhanced through the use of nanotechnology sensors, computerised order entry and decision support systems. Obstacles to the deployment of new technology include resistance to change, confusion regarding the best technology, and uncertainty regarding the return-on-investment. By focusing on overall transfusion safety, deploying validated systems appropriate for both medication and blood administration, thoughtful integration of technology into bedside practice and demonstration of improved performance, the application of new technologies will improve care for patients in need of transfusion therapy.
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Affiliation(s)
- Walter H Dzik
- Massachusetts General Hospital, Boston, MA 02114, USA.
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46
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Schmidt-Hieber M, Schuster R, Nogai A, Thiel E, Hopfenmüller W, Notter M. Error management of emergency transfusions: A surveillance system to detect safety risks in day to day practice. Transfus Apher Sci 2006; 35:125-30. [PMID: 17045844 DOI: 10.1016/j.transci.2006.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 05/25/2006] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
Acute hemolysis due to AB0-incompatibility caused by transfusion of red blood cell concentrates (RBCC) to the wrong recipient is one of the major causes of transfusion-related death. As part of our policy to improve quality and safety in emergency transfusion, we have developed a standardized surveillance system for supplying RBCC in emergency situations. This surveillance system involves the implementation of a standardized set of basic data transmitted from the requesting unit to the blood bank by phone and a scoring system to check for compliance with guidelines and errors in daily routines. Communication deficiencies and delayed pretransfusion sampling were the most common errors.
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Affiliation(s)
- Martin Schmidt-Hieber
- Medizinische Klinik III (Hämatologie, Onkologie und Transfusionsmedizin), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
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47
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Guyard A, Albarède S, Mannessier L, Rouger P, Burg E. [Red blood cell antibody screening: error analysis in a french interlaboratory comparison program survey]. Transfus Clin Biol 2006; 13:253-9. [PMID: 16997594 DOI: 10.1016/j.tracli.2006.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The French quality control is organized by the French Health Products Safety Agency. In 2005, the immuno-haematology testing control included the screening of an anti KEL 1 antibody. 17 out of 2639 laboratories (0,64%) answered 'negative screening'. All laboratories received a questionnaire in order to understand the failure. In this paper the authors present the detailed laboratories' responses and failure explanations.
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Affiliation(s)
- A Guyard
- Agence française de sécurité sanitaire des produits de santé, 143-147, boulevard Anatole-France, 93285 Saint-Denis cedex, France.
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48
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Figueroa PI, Ziman A, Wheeler C, Gornbein J, Monson M, Calhoun L. Nearly two decades using the check-type to prevent ABO incompatible transfusions: one institution's experience. Am J Clin Pathol 2006; 126:422-6. [PMID: 16880143 DOI: 10.1309/c6u7vp87gc030wmg] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To detect miscollected (wrong blood in tube [WBIT]) samples, our institution requires a second independently drawn sample (check-type [CT]) on previously untyped, non-group O patients who are likely to require transfusion. During the 17-year period addressed by this report, 94 WBIT errors were detected: 57% by comparison with a historic blood type, 7% by the CT, and 35% by other means. The CT averted 5 potential ABO-incompatible transfusions. Our corrected WBIT error rate is 1 in 3,713 for verified samples tested between 2000 and 2003, the period for which actual number of CTs performed was available. The estimated rate of WBIT for the 17-year period is 1 in 2,262 samples. ABO-incompatible transfusions due to WBIT-type errors are avoided by comparison of current blood type results with a historic type, and the CT is an effective way to create a historic type.
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Affiliation(s)
- Priscila I Figueroa
- Department of Pathology and Laboratory Medicine, Division of Transfusion, Medicine, the Cleveland Clinic, Cleveland, OH 44195, USA
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49
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Abstract
BACKGROUND AND OBJECTIVES Weak ABO variants may escape tests using unlicensed sera. MATERIALS AND METHODS Prior to transfusion, ABO grouping was performed using an automated system and in-house diluted sera, and manual and bedside test techniques. Genotyping and sequencing were performed using standard methods. RESULTS Initially, the red blood cells (RBC) of the first-time blood donor were typed as B, but pretransfusion testing carried out using the bedside test indicated the presence of an additional A phenotype. Serological re-examination confirmed the bedside test results, and the allele in question was identified, by genotyping, as a new weak A variant (Aw11). CONCLUSIONS The use of CE-marked and licensed antisera is recommended to avoid ABO mistyping.
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Affiliation(s)
- A Pruss
- Institute of Transfusion Medicine - Universitätsmedizin Berlin, Berlin, Germany.
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50
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Koshy R. Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety. Transfusion 2005; 45:189S-205S. [PMID: 16181403 DOI: 10.1111/j.1537-2995.2005.00619.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Standardized, seamless, integrated information technology in the health-care environment used with other industry tools can markedly decrease preventable errors or adverse events and increase patient safety. According to an Institute of Medicine (IOM) report released in 1999, preventable errors have caused between 44,000 and 98,000 deaths per year. Following the report, President Bill Clinton requested that the Agency of Healthcare Research and Quality, a government agency, look into the issue and fund, at the local or state level, processes that can reduce errors. Funding subsequently was made available for research that utilizes best practice tools in clinical practice to increase patient safety. The Joint Commission on Accreditation of Healthcare Organization has placed a great deal of emphasis on strategies to reduce patient identification errors. Fragmented systems tout the individual as well as enhanced safety applications. These applications, however, are related to prevention in specific conditions and in specific health-care settings. Systems are not integrated with common reference data and common terminology aggregated at a regional or national level to provide access to patient safety risks for timely interventions before errors and adverse events occur. Standardized integrated patient care information systems are not available either on a regional or on a national level. This article examines tangible options to increase patient safety through improved state-of-the-art tools that can be incorporated into the health-care system to prevent errors.
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Affiliation(s)
- Ranie Koshy
- University Hospital/New Jersey Medical School, UMDNJ, Newark, NJ 07103-2406, USA
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