This is an update from the previous version posted to include low-titer group A FFP/FP24 and low ABO-titer group O whole blood.
This policy outlines steps taken to minimize the risk of data entry errors and is based on a dualistic approach: review of results by a senior technologist and/or supervisor and various computer safeguards built into the Medinfo Hematos IIG blood bank computer HIIG system. This policy also discusses the verification (here called authorization) and purge processes of HIIG.
- Review by senior technical, supervisory, or transfusion medical staff:
- Designated test procedures require review by a second technologist before authorization.
- Complex immunohematology testing and specimens showing aberrant results (e.g. ABO/D discrepancies) are reviewed by the supervisors or designates and ultimately a transfusion medicine physician before authorization.
- Computer system HIIG rules:
- System restricts which staff can perform specific tests
- Patient/donor identity:
- System asks end-users to verify patient/donor identity before starting any access to the patient/donor record.
- System performs historical database checking and flags any inconsistencies (e.g. historical ABO/D typing differences, etc.)
- Only selected staff have privileges to authorize or purge.
- ABO/D testing algorithms require entry of reactions, not interpretation of results and are compared to a truth table.
- Aberrant results require special review before ABO/D typing results can be authorized/purged.
- D-controls must be negative to allow D typing results to be authorized for liquid D-typing reagents.
- DAT results require appropriate controls to meet truth-table criteria.
- Eluates require last wash to be negative before authorization
- Blood components:
- Selection of RBC or plasma units requires two independent sample determinations within 72 hours of each other.
- ABO-incompatible RBC or FFP/FP24 transfusions are not allowed.
- Titer-based ABO blood group selection:
- Low titer group A FFP may be used as universal plasma like group AB.
- Group O whole blood with low anti-A and anti-B titers may be used for all ABO types.
- Acceptable titer threshold is specifically defined as parameters in Medinfo.
- Donors with any detectable clinically significant antibodies are permanently deferred.
- Depending on the patient’s antibody history, release of RBC units may require antigen-matched units. Examples:
- Mandatory matching (only antigen negative matched units allowed—no antigen positive or antigen-untyped units): Antibodies against H, D, c, K, k, Kpa, Kpb, Jsa, Jsb, Jka, Jkb antigens, anti-PP1Pk
- Priority matching (incompatible or untested can be approved by a transfusion medicine physician): C,E, e, Fya, Fyb, M, S, s
- Antigen matching not required: Lea, Leb, N
- Least-incompatible crossmatch require special authorization to release
- Protocols to force irradiation or other modified components can be setup in HIIG.
- Donor tests have same criteria as the same test used in patient testing for controls, etc.
- Donor demographics are read directly from the Ministry of Interior database—no manual entry (bar code only used).
- Workflows for Hematos IIG (1001 through 1005), 2013-2020
- Standards for Blood Banks and Transfusion Services, Current Edition, AABB, Bethesda, MD, USA
- Guidelines to the Preparation, Use, and Quality Assurance of Blood Components, European Committee (Partial Agreement) on Blood Transfusion (CD-P-TS), Current Edition