Transfusion Service Laboratory Research Articles

Analysis of the effect and influencing factors of a clinical competency-oriented prospective pre-job training programme on the comprehensive ability of new employees in the department of transfusion medicine.

The subject of pre-job training for transfusion service laboratory technicians is very important. The key is how to make a reasonable systematic training programme to improve the effectiveness of training. A prospective training programme was conducted and an assessment was performed at enrollment (baseline) and reassessment after 3-months training, using the same tools with a validated questionnaire. Clinical competency-oriented prospective pre-job training significantly improves the clinical transfusion-related comprehensive skills of new employees. The post-training assessment score was significantly affected by undergraduate major. This study provided a clinical competency-oriented training programme for new employees in the department of transfusion medicine that could effectively enhance their comprehensive abilities.

Radiofrequency identification tracking system (RFID) significantly improves blood bank inventory management and decreases staff work effort.

Before implementation of the radio frequency identification (RFID) system, there was a high loss rate of 4.0%-4.3% of red blood cell (RBC) units every year expiring on the shelf in our transfusion service laboratory. We introduced RFID technology to improve inventory management and the burden of work on the staff. The goal of this study was to evaluate the impact of RFID technology on the inventory management of RBC units and the staff workload in a transfusion service laboratory. Using an RFID system involves encoding RBC units with an RFID tag capturing information such as donor identification number, product code, blood type, expiration date, product volume, and negative antigen(s). Tag information is collected through retrofitted storage shelves linked to the RFID server. The study analyzed RBC usage by unit and by volume (mL) and staff work effort to carry out inventory management tasks before and after the implementation of the RFID system. Implementation of the RFID technology reduced the loss, or discard, of RBC units to less than 1% annually (a statistically significant change, p < .001). The RFID computer dashboard provides a constant visual update of the inventory, allowing technologists to have accurate product counts and reducing their work burden. Implementation of RFID technology substantially reduced RBC product loss, improved inventory management, and lessened staff work burden.

P‐LP‐1 | Tertiary Business Continuity Plan (BCP) for Network Access in a Transfusion Service Laboratory

P‐LP‐1 | Tertiary Business Continuity Plan (BCP) for Network Access in a Transfusion Service Laboratory

Obstetric and Newborn Weak D-Phenotype RBC Testing and Rh Immune Globulin Management Recommendations: Lessons From a Blinded Specimen-Testing Survey of 81 Transfusion Services.

Modern RHD genotyping can be used to determine when patients with serologic weak D phenotypes have RHD gene variants at risk for anti-D alloimmunization. However, serologic testing, RhD interpretations, and laboratory management of these patients are quite variable. To obtain interlaboratory comparisons of serologic testing, RhD interpretations, Rh immune globulin (RhIG) management, fetomaternal hemorrhage testing, and RHD genotyping for weak D-reactive specimens. We devised an educational exercise in which 81 transfusion services supporting obstetrics performed tube-method RhD typing on 2 unknown red blood cell challenge specimens identified as (1) maternal and (2) newborn. Both specimens were from the same weak D-reactive donor. The exercise revealed how participants responded to these different clinical situations. Of reporting laboratories, 14% (11 of 80) obtained discrepant immediate-spin reactions on the 2 specimens. Nine different reporting terms were used to interpret weak D-reactive maternal RhD types to obstetricians. In laboratories obtaining negative maternal immediate-spin reactions, 28% (16 of 57) performed unwarranted antiglobulin testing, sometimes leading to recommendations against giving RhIG. To screen for excess fetomaternal hemorrhage after a weak D-reactive newborn, 47% (34 of 73) of reporting laboratories would have employed a contraindicated fetal rosette test, risking false-negative results and inadequate RhIG coverage. Sixty percent (44 of 73) of laboratories would obtain RHD genotyping in some or all cases. For obstetric and neonatal patients with serologic weak D phenotypes, we found several critical problems in transfusion service laboratory practices. We provide recommendations for appropriate testing, consistent immunohematologic terminology, and RHD genotype-guided management of Rh immune globulin therapy and RBC transfusions.

The transfusion service laboratory in virtual reality.

Due to the global SARS-CoV-2 pandemic, in-person laboratory medicine clerkships were converted to distance learning. The remote clerkship format provided advantages of allowing participation of students from more locations and greater scheduling flexibility but provided new challenges of maintaining learner engagement and providing experiential content of the laboratory environment. Gamification of educational content is one educational modality that has shown effectiveness in a multitude of different contexts to increase learner engagement and retention. Therefore, we created an interactive, educational 360° virtual reality walkthrough tour using off-the-shelf commercially available 360° cameras and software of the Transfusion service and Microbiology Laboratories. The process consists of taking multiple 360° still-images within the space, color-correction, blurring the faces of staff or sensitive information, adding navigation buttons, and other interactive elements. The virtual tours were used for both recruitment and education with further plans to integrate the learning modality into the curriculum. The clerkship is likely to remain as partially or fully as remote learning so such walkthrough tours will continue to remain relevant. This technology can be applied globally to other departments and institutions for education or recruitment.

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

Wrong blood in tube (WBIT) errors are a preventable cause of ABO-mismatched RBC transfusions. Electronic patient identification systems (e.g., scanning a patient's wristband barcode before pretransfusion sample collection) are thought to reduce WBIT errors, but the effectiveness of these systems is unclear. Part 1: Using retrospective data, we compared pretransfusion sample WBIT rates at hospitals using manual patient identification (n = 16 sites; >1.6 million samples) with WBIT rates at hospitals using electronic patient identification for some or all sample collections (n = 4 sites; >0.5 million samples). Also, we compared WBIT rates after implementation of electronic patient identification with preimplementation WBIT rates. Causes and frequencies of WBIT errors were evaluated at each site. Part 2: Transfusion service laboratories (n = 18) prospectively typed mislabeled (rejected) samples (n = 2844) to determine WBIT rates among samples with minor labeling errors. Part 1: The overall unadjusted WBIT rate at sites using manual patient identification was 1:10,110 versus 1:35,806 for sites using electronic identification (p < 0.0001). Correcting for repeat samples and silent WBIT errors yielded overall adjusted WBIT rates of 1:3046 for sites using manual identification and 1:14,606 for sites using electronic identification (p < 0.0001), with wide variation among individual sites. Part 2: The unadjusted WBIT rate among mislabeled (rejected) samples was 1:71 (adjusted WBIT rate, 1:28). In this study, using electronic patient identification at the time of pretransfusion sample collection was associated with approximately fivefold fewer WBIT errors compared with using manual patient identification. WBIT rates were high among mislabeled (rejected) samples, confirming that rejecting samples with even minor labeling errors helps mitigate the risk of ABO-incompatible transfusions.

The importance of antibody screens after transfusions

The importance of antibody screens after transfusions

Transfusion Medicine in Sub-Saharan Africa: Conference Summary.

In November 2014, a 3-day conference devoted to transfusion medicine in sub-Saharan Africa was held in Kampala, Uganda. Faculty from academic institutions in Uganda provided a broad overview of issues pertinent to transfusion medicine in Africa. The conference consisted of lectures, demonstrations, and discussions followed by 5 small group workshops held at the Uganda Blood Transfusion Service Laboratories, the Ugandan Cancer Institute, and the Mulago National Referral Hospital. Highlighted topics included the challenges posed by increasing clinical demands for blood, the need for better patient identification at the time of transfusion, inadequate application of the antiglobulin reagent during pretransfusion testing, concern regarding proper recognition and evaluation of transfusion reactions, the expanded role for nurse leadership as a means to improve patient outcomes, and the need for an epidemiologic map of blood usage in Africa. Specialty areas of focus included the potential for broader application of transcranial Doppler and hydroxyurea therapy in sickle cell disease, African-specific guidelines for transfusion support of cancer patients, the challenges of transfusion support in trauma, and the importance of African-centered clinical research in pediatric and obstetric transfusion medicine. The course concluded by summarizing the benefits derived from an organized quality program that extended from the donor to the recipient. As an educational tool, the slide-audio presentation of the lectures will be made freely available at the International Society of Blood Transfusion Academy Web site: http://www.isbtweb.org/academy/.

A 13-question approach to resolving serological discrepancies in the transfusion medicine laboratory.

Laboratory professionals, consultants, and treating physicians may encounter discrepancies in serological testing results for numerous reasons; identifying the reason(s) for the presence of an unexpected antibody or antigen can be challenging. A question-based approach can be useful in identifying the underlying cause of the discrepancy. We describe a new approach to serological problems in a transfusion-service laboratory. The approach we outline herein is targeted towards a general transfusion medicine service, rather than a center that offers complex antibody investigations using specialized techniques. This question-based problem-solving approach considers patient factors including diagnosis, transfusion history, previous pregnancies, and medication history, along with serological test results: ABO and Rh groups, direct and indirect antiglobulin tests, reacting temperature of the antibody, effect of enzyme treatment of cells, strength of reactivity, and antibody reactivity with umbilical cord cells. We also demonstrate the usefulness of this approach through a case scenario.

Exponential error reduction in pretransfusion testing with automation

Protecting the safety of blood transfusion is the top priority of transfusion service laboratories. Pretransfusion testing is a critical element of the entire transfusion process to enhance vein-to-vein safety. Human error associated with manual pretransfusion testing is a cause of transfusion-related mortality and morbidity and most human errors can be eliminated by automated systems. However, the uptake of automation in transfusion services has been slow and many transfusion service laboratories around the world still use manual blood group and antibody screen (G&S) methods. The goal of this study was to compare error potentials of commonly used manual (e.g., tiles and tubes) versus automated (e.g., ID-GelStation and AutoVue Innova) G&S methods. Routine G&S processes in seven transfusion service laboratories (four with manual and three with automated G&S methods) were analyzed using failure modes and effects analysis to evaluate the corresponding error potentials of each method. Manual methods contained a higher number of process steps ranging from 22 to 39, while automated G&S methods only contained six to eight steps. Corresponding to the number of the process steps that required human interactions, the risk priority number (RPN) of the manual methods ranged from 5304 to 10,976. In contrast, the RPN of the automated methods was between 129 and 436 and also demonstrated a 90% to 98% reduction of the defect opportunities in routine G&S testing. This study provided quantitative evidence on how automation could transform pretransfusion testing processes by dramatically reducing error potentials and thus would improve the safety of blood transfusion.

Interdisciplinary Process Improvement for Enhancing Blood Transfusion Safety

We describe a multipronged, multidisciplinary effort to improve the safety of blood transfusion in our hospital. System-wide practices related to the ordering, delivery, and transfusion of blood products were addressed including: (1) appropriate selection of patients and utilization of blood, (2) accurate blood product labeling and tracking, (3) reliable transportation of blood products between the transfusion service laboratory and the bedside, (4) electronic verification of patients and products at the point of transfusion, and (5) documentation of transfusion events in the patient's medical record. By implementing new technologies and focusing LEAN process improvement techniques on the preanalytical, analytical, and postanalytical phases of the transfusion cycle, we have been able to significantly reduce the risk of transfusion error in our patient population.

Proteomics and transfusion medicine.

Proteomics is becoming an important research tool which, together with genomics, will, in the near future, presumably have an impact on disease diagnosis and prognosis as well as on further advances in the production and storage processes of blood-based therapeutics.

Phenotype Matching of Donor Red Blood Cell Units for Nonalloimmunized Sickle Cell Disease Patients: A Survey of 1182 North American Laboratories

The transfusion of donor red blood cell units (RBCs) that lack certain red cell antigens (such as C, E, and K) when the corresponding antigens are absent from the recipient's red cells has been shown to reduce the risk of red cell alloimmunization in sickle cell disease patients. However, data are limited regarding the extent to which transfusion services routinely perform red cell antigen phenotype testing of nonalloimmunized sickle cell disease patients, and then use that information to select donor RBCs lacking 1 or more of the red cell antigens that the patient's red cells do not express. To determine the extent to which transfusion services routinely perform red cell antigen phenotype testing of nonalloimmunized sickle cell disease patients, and then use that information to select donor RBCs lacking 1 or more of the red cell antigens that the patient's red cells do not express. An educational subsection of a College of American Pathologists Proficiency Testing Survey (J-C 2003) assessed transfusion service practices regarding performance of red cell antigen phenotype testing of nonalloimmunized sickle cell disease patients and how transfusion services use this information for the selection of donor RBCs. The data analysis of the survey included 1182 North American laboratories. Data from 1182 laboratories were included in the survey analysis, of which the majority (n = 743) reported that they did not routinely perform phenotype testing of sickle cell disease patients for antigens other than ABO and D. The other 439 laboratories reported that they did routinely perform phenotype testing of sickle cell disease patients for antigens in addition to ABO and D. The majority of these 439 laboratories (three fourths; n = 330) reported that they used these patient data for prophylactic matching with donor RBCs when sickle cell disease patients required transfusion. When phenotype-matched donor RBCs were used, the antigens most commonly matched (85% of the time) were C, E, and K. The majority of North American hospital transfusion service laboratories do not determine the red cell antigen phenotype of nonalloimmunized sickle cell disease patients beyond ABO and D. Those laboratories that do determine the red cell phenotype of nonalloimmunized sickle cell disease patients beyond ABO and D most commonly match for C, E, and K antigens when phenotype-matched donor RBCs are used.

A physician's guide to transfusion in autoimmune haemolytic anaemia.

Patients with autoimmune haemolytic anaemia (AIHA) frequently have anaemia of sufficient severity as to require a blood transfusion. However, it is impossible to find compatible blood when, as is frequently the case, the autoantibody in the patient's serum reacts with all normal red blood cells. Further, the autoantibody may mask the presence of a red cell alloantibody capable of causing a haemolytic transfusion reaction. Optimal patient management in this clinical setting requires special compatibility test procedures in the transfusion service laboratory. Equally important is that clinicians must understand the principles of the compatibility tests performed. Provided appropriate compatibility tests are performed, the indications for transfusion in patients with AIHA are not significantly different than for similarly anaemic patients without AIHA. Communication between clinicians and laboratory personnel are important to review the urgency of transfusion and the compatibility test methods used to select the optimal unit of red blood cells for transfusion.

False reactivity in GTI Pak Plus® ELISA kits due to the presence of anti-mouse antibody in patients’ samples

Abstract The development of commercially available ELISA kits (GTI, Inc., Waukesha, WI) that use antigens adhered to microtiter plate wells by the use of mouse monoclonal antibodies made it possible for hospital transfusion service laboratories to test for platelet- and/or HLA-specific antibodies without reliance on reference laboratories. However, human anti-mouse antibodies (HAMAs) may cause false reactions in ELISAs. We designed a study to determine the impact of HAMAs on these ELISAs. Samples from 210 patients were evaluated from January 1995 to April 2002; 79 (38%) were found to be positive for HLA- and/or platelet-specific antibodies. Thirty (38%) of these positive samples, as well as ten negative samples that served as controls, underwent HAMA neutralization/inhibition procedures before being retested by ELISA. One (10%) of the control samples was reactive after treatment. When the samples that were positive in routine testing were treated to neutralize/inhibit HAMAs, reactivity was unchanged in 20 (67%); reactivity was eliminated in eight (27%) of the samples tested.All of the specimens that showed a reduction or elimination of their reactivity after neutralization/inhibition had an initial optical density (OD) ratio &lt; 3.0 whereas those that remained unchanged in reactivity had an OD ratio &gt; 7.0 (p &lt; 0.05). Reactivity present only in the treated samples was observed in three (10%) of the positive samples tested; one was additionally reactive with HLA antigen only and two with glycoprotein Ia/IIa. The presence of HAMAs should be considered when antibodies against more than one plateletspecific glycoprotein are detected and if the optical density ratio is &lt; 3.0.

Evaluation and implementation of the gel test for indirect antiglobulin testing in a community hospital laboratory.

The gel test, developed by Lapierre in 1984, was designed to standardize antiglobulin testing while improving sensitivity and specificity of the method. Anti-human serum immunoglobulin G (IgG) mixed with Sephadex G100 (gel phase) in a microtube traps red cell-IgG agglutination complexes during migration through the gel in a centrifugation step. Agglutination complexes are visibly detectable at various levels in the microtube as an inverse function of antibody coated on red cells. Unsensitized red cells form a cell pellet at the base of the microtube. To determine if indirect anti-human globulin testing could be standardized and simplified by replacing the tube test with the gel test without compromising quality or increasing costs. A medium-sized community hospital. In a blinded retrospective study, we used patient sera (n = 40), which included 10 positive specimens containing 18 known antibodies. Sixteen antibodies were detected and identified with the tube method (1 anti-D and 1 anti-C not detected). By the gel test, 18 antibodies were detected and identified. All negative samples showed 100% concordance. Favorable results were obtained in a nonblinded prospective correlation study (n = 121). Our technologists found the gel test easier to read and more reproducible and reliable than the tube method; they also found increased sensitivity for detecting weakly reacting antibodies. We successfully introduced the gel test into our laboratory as the standard method for indirect antiglobulin testing. Following implementation, improved personnel management was achieved. The gel test is a reliable and advantageous method and is appropriate for routine use for detection and identification of alloantibodies in a community hospital transfusion service laboratory.

The NADPH oxidase: lessons from chronic granulomatous disease neutrophils.

Annals of the New York Academy of SciencesVolume 832, Issue 1 p. 85-92 The NADPH Oxidase: Lessons from Chronic Granulomatous Disease Neutrophils ARTHUR J. VERHOEVEN, Corresponding Author ARTHUR J. VERHOEVEN Central Laboratory of the Netherlands Red Cross Blood Transfusion Service Laboratory for Experimental and Clinical Immunology University of Amsterdam 1066 CX Amsterdam, The Netherlands.Address correspondence to: Arthur J. Verhoeven, Ph.D., Department of Experimental Immunohematology, CLB, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands. Phone, 31-20-5123317; Fax, 31-20-5123310.Search for more papers by this author ARTHUR J. VERHOEVEN, Corresponding Author ARTHUR J. VERHOEVEN Central Laboratory of the Netherlands Red Cross Blood Transfusion Service Laboratory for Experimental and Clinical Immunology University of Amsterdam 1066 CX Amsterdam, The Netherlands.Address correspondence to: Arthur J. Verhoeven, Ph.D., Department of Experimental Immunohematology, CLB, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands. Phone, 31-20-5123317; Fax, 31-20-5123310.Search for more papers by this author First published: 17 December 2006 https://doi.org/10.1111/j.1749-6632.1997.tb46239.xCitations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume832, Issue1Phagocytes: Biology, Physiology, Pathology, and PharmacotherapeuticsDecember 1997Pages 85-92 RelatedInformation

Unit Placement Errors: A Potential Risk Factor for ABO and Rh Incompatible Blood Transfusions

Policy at our institution requires the hospital whole blood and packed RBC inventory (approximately 400 units) to be stored in an orderly arrangement without crowding, with units of the same ABO/Rh grouped together and each group of units clearly segregated from the others. In spite of this policy, over a 38-month period, 112 of 96,581 units (0.12%) were placed into the inventory incorrectly (so called unit placement errors). Thirty-seven of these unit placement errors (0.04%) could have resulted in ABO incompatible crossmatches or transfusions, and an additional 20 errors (0.02%) could have resulted in Rh incompatible transfusions. These data demonstrated the need for our laboratory personnel to routinely perform a systematic check of the blood inventory to detect incorrectly located units and to carefully check the group and type on each unit at the time of its selection. Although these data were collected at a large and busy transfusion service laboratory, they may be representative of what occurs at small as well as at other large facilities. It might be prudent for hospital transfusion services to have a policy that both minimizes the occurrence of unit placement errors and allows for their routine detection, should they occur.

A Glucose-Dependent Panhemagglutinin

An agglutinin was identified in the serum of a non-transfused primiparous patient that reacted with all commercial red blood cells regardless of their antigenic makeup. The autologous control was negative. The agglutinin was directed against human red blood cells that had been incubated in media containing glucose and washed prior to testing. Red blood cells incubated in 2% glucose solution became agglutinable after 6 days at 4 °C or after 2h at 37 °C. These red blood cells gradually became non-reactive when washed and incubated in saline at 37 or 4°C. At 22°C the titer of the agglutinin was 128 (score 64) in LISS and 64 (score 56) in saline. The agglutinin was denatured by 2-mercaptoethanol, but remained active after 30 min of heating at 56 °C. Among various mono- and disaccharides tested, glucose was the only sugar that selectively inhibited the reaction. The presence of such an agglutinin may cause confusion in a transfusion service laboratory by mimicking an antibody directed against a high incidence antigen.