Site content by Zac Bergner, Transfusion Medicine Division
Comments? email zbergne1@jhmi.edu
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SPECIMENS
What sample is needed for an ABO/Rh and Antibody screen?
- One (1) 6ml pink top tube (EDTA)
- Completed Pathology 11 Transfusion Medicine requisition including first and last name, medical record number, date, location, and physician name and provider code.
- Handwritten label with patient’s FULL name, history number, date, and location.
- REMEMBER: PHLEBOTOMIST MUST SIGN THE REQUISTION!!!
Where should I send the specimen?
Please send all specimens to Transfusion Medicine Lab, Carnegie 656. Tube station 026.
Super STAT samples should be hand-carried to the lab.
Why handwritten labels?
In order to prevent improperly identifying a patient, the specimen must be labeled at the bedside from the identity
bracelet, with handwritten labels, not stamped or computer printed. Handwritten labels are the closest thing we have
to a guarantee that labeling was done at the bedside.
Why is proper labeling so important?
The goal is patient safety. Proper labeling technique is enforced by JCAHO, the FDA and several other regulatory agencies.
Taken from a study done here at Johns Hopkins Hospital;
| The result of the study found that improperly labeled specimens were 40 times more likely to have the wrong blood type! |
Nowhere in pathology is the accurate labeling of specimens more critical than in the area of transfusion medicine, where specimen misidentification may result in the administration of incompatible blood components and may ultimately lead to the death of the recipient.
To address the problem of sample misidentification, blood banks frequently employ unique labeling requirements for patient specimens. These requirements are devised in an attempt to ensure that specimens are labeled immediately after being drawn, at the patient’s bedside and have proper patient identification. Here at Johns Hopkins Hospital, we require that all samples submitted for ABO/Rh typing and antibody screen, and crossmatching be identified by handwritten (not imprinted or automated) labels that contain the information present on the patient’s armband in its exact form, specifically the patient’s full name and history number.
Adherence to a strict specimen-labeling policy decreases the incidence of erroneous blood grouping of blood bank specimens.
J.A. Lumadue, J.S. Boyd, and P.M. Ness TRANSFUSION 1997; 37:1169-1172
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Why has my specimen been rejected?
Most specimens are rejected due to improper identification of the patient. The TM staff are responsible for notifying someone in direct care of the patient that the specimen was unacceptable and the reason for rejection. Please contact a TM supervisor for more information.
Can I relabel the tube?
No.
This does nothing to re-establish the true identity of the patient. It is only the PROCESS in which the specimen was collected that can ensure that the specimen is from that particular patient. Samples must come properly identified direct from the patient to the lab. If at any time the integrity of the sample is in doubt, it creates a risk to the patient and must be rejected.
How long does testing take (what is our turn-around time)? Why?
Stat specimens for ABO/Rh, Antibody screening and blood availability have a two-hour turnaround time.
Routine specimens with no requests for blood products typically have a 4-6 hour turnaround time. Many of these samples are processed on an automated analyzer.
A request for blood products added to a routine, unprocessed sample would then have a two-hour turnaround time.
Our turnaround time has been established from our very high volume of stat orders and the reasonable ability of the Transfusion Medicine staff to handle these requests in the best time possible.
How long can a sample be used for transfusion?
For Red Blood Cells:
Samples can be used for three days from the date of collection.
Example: A specimen submitted on Monday will expire Thursday night at midnight.
If Red Blood Cell transfusions are needed after three days, a new specimen must be sent to Transfusion Medicine.
For Plasma, Platelets, and related products:
A current specimen is not needed, only a previous type for that patient. ABO compatible products can be prepared without further testing.
If we do not have an ABO/Rh on file, the lab will request an ABO/Rh and Antibody Screen to be submitted so ABO group specific products can be prepared.
Why is a specimen available for crossmatch for only three days?
A patient that has been transfused with red blood cells can produce a clinically significant antibody to red cells in as little as three days. Several hospital regulatory agencies (JCAHO included) require patients to be tested for the presence of these antibodies within three days prior to Red Cell transfusion. Therefore, we require a new sample after three days so that the patient can be tested again for the presence of antibody. Only then can blood be considered compatible.
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