2nd pre-transfusion sample for ABO group confirmation. Is it feasible?

2nd pre-transfusion sample for ABO group confirmation. Is it feasible?
Proceedings from AMLS LABCON workshop on BCSH 2012 Guidelines
Quigley ,
John Sheehy (Chair), John Crumlish, Fionnuala Ni Chonchubhair, Bernie Quirke, Suzanne Traynor, Fabian McGrath
The Academy of Medical Laboratory Science (AMLS) Transfusion & Transplantation Science Advisory Body (TTSAB)
The third edition of the BCSH guidelines for Pre-Transfusion
Compatibility Procedures in Blood Transfusion Laboratories was
released in October 20121. The new guideline is a comprehensive
collaboration with 19 key recommendations, five relating to ABO
typing and compatibility, six to the detection of atypical red cell
antibodies while the remainder relate to processes within the
blood transfusion laboratory.
In April 2013, the Academy of Medical Laboratory Science (AMLS)
Transfusion and Transplantation Science Advisory Body (TTSAB)
organised a workshop at the AMLS conference in Kilkenny. The
focus of the workshop was to identify a more co-ordinated
approach to the implementation of the key recommendations of
this new guideline. Prior to the workshop a circular was sent to 51
blood transfusion (BT) laboratories in the Republic of Ireland with
a request for each laboratory to rank their top 3 recommendations
that would have most local impact. 14/51 (27.5%) of BT
Laboratories responded, representing the major transfusion
centres. Attendees of the workshop were divided into 6 groups to
discuss the recommendations.
BCSH Recommendation 12 received the most votes nationwide
and unsurprisingly this key recommendation dominated the
workshop. Recommendation 12 states: “Unless secure electronic
patient identification systems are in place, a second sample
should be requested for confirmation of the ABO group of a first
time patient prior to transfusion, where this does not impede the
delivery of urgent red cells or other components”. This
recommendation is to address the incidence of wrong blood in
tube (WBIT) which is estimated to be 1 in 2,000 samples2 and
consequently reduce the risk of an ABO incompatible blood
All participating groups believed that each laboratory should
conduct their own risk assessment to determine the requirement
to introduce this recommendation. Factors that were considered
included: legal implications, over usage of group O red cells,
impact of the additional workload on the laboratory and the impact
to hospitals should the IBTS implement this requirement.
Consideration of the blood transfusion laboratories to issue a
“confirmatory group check tube” was welcomed by most. However,
there was a general consensus amongst all participants that an ITbased solution was the key requirement to the implementation of
this recommendation with the introduction of phase 2 and 3 of the
Electronic Blood Tracking System (EBTS).
1 in 2000
1 in 10 previous untested
~50% O
~50% non -O
1/4 x 1/10 x 1/2,000 = 1/80,000
The risk of incompatible blood being selected is 1 in 80 000 3
1. Milkins, C., Berryman, J., Cantwell, C., Elliott, C., Haggas, R., Jones, J., Rowley,
M. & Williams, M. (2013) Guidelines for pretransfusion compatibility procedures
in blood transfusion laboratories. Transfusion Medicine, 23, 3–35.
2. Dzik, W.H., Murphy, M.F., Andreu, G. et al. (2003) An international study of the
performance of blood sample collection. Vox Sanguinis, 85, 40–47.
3. Wallis, J.P. (2013) Pre-transfusion compatability guidelines: a new edition.
Transfusion Medicine, 23, 1–2.
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