A rapid ABO and RhD test demonstrates high fidelity to blood bank testing for RhD typing

Background

The rapid provision of blood products is life-saving for patients with massive hemorrhage. Ideally, RhD-negative blood products would be supplied to a woman of childbearing potential whose Rh type is unknown due to the risk of D-alloimmunization and the potential for hemolytic disease of the fetus and newborn to occur if RhD-positive blood products are transfused. Therefore, there is a need for a test that rapidly determines her RhD type. This study compared the RhD type determined using a rapid ABO and RhD test to the RhD type determined by an immunohematology reference laboratory.

Methods

After receiving ethics review board approval, 200 random, unique, deidentified patient samples that had undergone routine pretransfusion testing in an immunohematology reference laboratory using column agglutination technology were collected and tested using a rapid ABO and RhD test (Eldoncard Home kit 2511). The RhD typing results from these two methods were compared to determine the accuracy of the rapid ABO and RhD test.

Results

The rapid ABO and RhD test produced results that were concordant with the transfusion service's results in 199/200 (99.5%) of cases, with a negative predictive value of 98.2% and 99.3% sensitivity. The single outlier was likely an RhD variant due to its serological characteristics.

Discussion

These data indicate that this rapid ABO and RhD test could be used for the rapid determination of a patient's RhD type, perhaps even in the emergency department, which could guide the selection of blood products provided during their resuscitation.     

Twenty‐five million liters of blood into the sewer

Laboratory medicine has evolved tremendously but not so much to the individual patient's benefit as far as the volume of blood samples is concerned. It can be calculated that with the current collection methods and the small amounts of blood or serum required by modern laboratory analyzers in the Western world alone each 25 million liter of patients’ blood is thrown into waste containers. That is four times more than the total volume of blood that is transfused each year. And this is not a trivial issue, as studies show that many patients develop ‘hospital acquired anemia’ due to blood collection and this is associated with an adverse outcome. It is time that collection methods for blood samples are adapted to the much smaller volumes that are required by new generation laboratory analyzers, in particular for vulnerable groups, such as hematology or oncology patients, critically ill patients, or children.     

血清分离胶真空采血管与普通促凝干燥管使用结果比较

目的观察两种采血管分离血清进行临床生化检验项目检测的结果是否存在差异。方法采用血清分离胶真空采血管（检测组）与普通促凝干燥管（对照组）进行随机采样,采集同一供血者的血样标本,一针两管,分离血清,即时进行临床生化指标的测定,并对测定结果进行分析比较。结果检测组与对照组分离血清在临床生化检验分析中差异无统计学意义。结论用血清分离胶试管与普通促凝干燥管分离的血清在临床生化检验指标上有较好的符合性,血清分离胶试管可为检验科提供最佳品质的检测标本,使检验报告更精确。     

Current performance of patient sample collection in the UK

Collection of the patient sample for pretransfusion testing begins a complex chain of events in the transfusion process. Hospitals in England and North Wales were surveyed to compare local policies against recommendations of the British Committee for Standards in Haematology (BCSH). Hospitals also measured the frequency of rejected and miscollected samples [designated as wrong blood in tube (WBIT)]. 185 of 360 (51.4%) hospitals returned questionnaires and 182 of 185 (98%) hospitals reported that a policy for sample collection existed. Apart from frequent omission of the gender of the patient, there was 96% compliance with all mandatory identifiers of the BCSH guidelines. Practice allowing additions or changes to labelling on sample tubes and request forms varied. 3.2% (14 114/445 726) of samples submitted were rejected for various reasons, the most frequent being incomplete or missing information (49.5% of the total rejected samples). The corrected mean frequency for WBIT in the 27 hospitals with one or more observed WBIT was 1 in 1501 samples (95% CI: < or =1129.09 to < or =1872.91), and the median corrected frequency for WBIT was 1 in 1303 samples. This study has identified great variation in the policy and practice for sample collection for pretransfusion testing. Regular tracking of the rates of sample rejection and WBIT could be used to identify poor performance in individual hospitals requiring investigation and action.     

Predictable and avoidable human errors in phlebotomy area - an exclusive analysis from a tertiary health care system blood bank

Error is a direct reflection of system deficiency. Errors occurring in the phlebotomy area are grossly unreported. Though most of these errors does not lead to catastrophic outcome yet indicate system failure. The aim of the study was to identify errors that took place in phlebotomy area, analysing and classifying them. A prospective audit was conducted during an observational period of 8 months, in an overall cohort of 11 260 donors. The incidence of errors was 3.1%. Fifty-five percent errors were technical and remaining 44.9% were clerical. Of all the technical errors, 57.7% were classified as minor, whereas remaining 42.3% were of major category. Similarly, majority of clerical errors (89.9%) were of minor category. The trained staff accounted for all major events (27.8%). In the minor category, technical errors (73.2%) were more commonly done by trained staff, whereas for clerical errors (58.5%), newly recruited staff was responsible. Errors in phlebotomy area are benign but can compromise donor safety. The study helped to develop a consistent and straightforward classification system for errors and to reduce them by basic interventions. Errors committed mostly by our trained staff indicate the need of regular competency testing and an active system for detection of these deviations.     

2012年大连市医院输血科（血库）输血相容性检测能力评价

目的：通过对大连市医院输血相容性检测的督导评价,进一步规范检测程序,提高检测水平。方法以现场检查和发放自制室间质评样本检测方式对大连市62家医院输血科（血库）输血相容性检测能力进行评价。现场检查包括设备、试剂、开展项目、操作规程和记录5个方面;室间质评项目包括ABO正、反定型,Rh（D）血型,受血者抗体筛选及交叉配血5项。结果督导评价合格医院42家,不合格20家;仅1家医院因未开展抗体筛查项目检测而判为现场检查不合格;二级医院室间质评结果不合格率最高（42．3％）;正、反定型和 Rh （D ）定型试验符合率为100．0％,抗体筛查和交叉配血试验不符合率分别为82．0％、77．4％。结论在保证相对固定人员配置同时加强培训提升检测人员鉴别分析能力是目前提高大连市医院输血科（血库）输血相容性检测能力的重要措施。     

某综合医院血培养标本送检状况调查

目的 调查某综合医院2011年第1季度血培养标本的送检状况,为规范化措施的制定提供依据.方法 记录1 879份血培养标本的采集时间、上机时间、送检瓶数、采血量以及培养结果等信息进行分析.结果 延迟2 h以上送检的有1 063份血培养标本,延迟送检率高达56.6%.抽查579份血培养标本中,采血量不足的占47.5%.整个病程单瓶送检率高达76.6%,血培养阳性率低,仅为6.7%,占第1位的分离菌是凝固酶阴性葡萄球菌.结论 血培养标本的采集和送检过程极不规范,需对血培养实验前的质量控制进行干预.     

血液标本采集过程中的护理缺陷分析与对策

回顾医院2003年12月～2005年12月发生的48例血液标本采集过程中的护理缺陷,分析发生的原因,主要是因为排班方式不科学,不能满足实际工作需要;护士采血前未严格执行查对制度以及缺乏专业理论知识等引起。通过改进血液标本采集工作流程,建立护理缺陷登记本;合理安排人力资源;协调好护理与相关部门的工作;提高护士的专业素质等措施,对血液标本采集的全过程进行安全管理,降低了护理缺陷的发生。     

Three years of preanalytical errors: Quality specifications and improvement through implementation of statistical process control

Abstract

Background: The objectives of this research were to show the most frequent preanalytical sample errors from two distinct patient populations and blood-drawing personnel, to calculate preanalytical quality specifications, and to demonstrate an improvement strategy for patients whose samples have been drawn in the primary health care center by means of a monthly preanalytical quality control report based on statistical process control (SPC). Material and methods: We collected preanalytical errors from the tests requested for hematology, coagulation, chemistry, and urine samples in both populations. To monitor an improvement strategy, we designed a set of indicators. The indicator results for 35 months were entered into the statistical software application, where they were statistically analyzed. The preanalytical quality specifications were calculated using the SPC control charts. The intervention consisted of the sending of a monthly preanalytical quality report to a pilot Decentralized Phlebotomy Center (DPC) and setting up a direct communication channel between the laboratory and the DPC. Results: Fewer errors were observed when the sample drawing was carried out by the laboratory personnel, showing distinct preanalytical quality specifications. Improvements were seen in the DPC after four months of the improvement strategy. Conclusions: We show a practical and effective methodology for the identification, monitoring, and reduction of preanalytical errors using the technology employed in daily total testing laboratory process.     

Perceived safety of donor blood and blood substitutes for transfusion: the role of informational frame, patient groups and stress appraisals

summary . Patients express concerns about the safety of donated blood. Do they have similar concerns about potential ‘blood substitutes’ and does the way information is presented on these options alter patients' perceptions? A two (informational frame: gain or loss) by four (transfusion type: human donor blood, human haemoglobin, bovine haemoglobin or perfluorocarbon emulsion substitutes) by three (patient group: adult haemophiliac/leukaemia patients, relatives/friends of haemophiliac/leukaemia patients and controls) between-subjects design was used. There were 82 patients, 118 relatives/friends and 263 controls from the UK. Blood substitutes were perceived as being significantly less safe than donor blood. Perceptions of safety were greater when transfusion information (regardless of transfusion type or patient group) was presented as gains rather than losses. Different demographic and psychological factors predicted perceived safety (e.g. sex) and perceived risk (e.g. age and experience).     

一次性真空采血针在婴幼儿颈静脉采血中的应用

[目的]探讨婴幼儿采血的新途径。[方法]将200例婴幼儿注射器股静脉采血(常规组)与200例婴幼儿一次性真空采血针颈静脉采血(改进组)的效果进行比较。[结果]改进组一次穿刺成功率、血液标本质量及采血时间等均优于常规组。[结论]采用一次性真空采血针进行颈静脉采血的方法简单、方便、快捷、易掌握。     

术前12h内自体储血在肿瘤患者手术中的应用

目的 评价术前12 h内自体储血在肿瘤手术中的作用.方法 选择行择期肿瘤根治术患者40例,随机分为对照组和实验组(自体储血组)各20例,实验组术前1日晚、麻醉后手术前肘静脉采集适量自体血,术中适时回输,酌情追加输注库血,对照组视手术出血量、病情需要输注库血.记录术前采集自体血总量、手术时间、手术期间血压、手术出血量、库血输注量、术前及术后Hb值、输注库血量,以及术后引流量.结果 两组手术时间、手术期间血压平均值、手术出血量、术前及术后Hb值、术后24 h引流量差异无显著意义(P＞0.05),对照组库血输注量明显大于实验组,排除输血影响,实验组推算若不输库血,术后Hb值明显大于对照组.两组均未出现输血并发症.结论 术前12 h自体储血用于肿瘤患者手术,有利于保持血红蛋白浓度,可明显节约库血,安全有效.     

赴海地执行紧急医疗救护任务的血液保障

目的总结中国赴海地医疗防疫救护队的血液保障经验,增强应急状态下的血液保障能力。方法血液保障采取以人员储备为主、实物储备为辅的模式。携行的20 UO型悬浮红细胞装在自行研制的运血箱中,以相变保温材料为冷媒。采用飞机运输,在运输途中每4 h观察一次血液温度。抵达海地后采用磁珠法快速分离血浆观察质量,并通过胶体金法快速检测血浆游离血红蛋白含量。撤回的血液在4℃继续储存,至d 35有效期时采用电镜观察红细胞形态。结果救护队从南京出发至海地太子港全程共计约90 h,从太子港营地返回至南京全程共计约62 h。尽管运输途中环境温度变化较大,但运血箱内血液温度始终处于1～10℃。磁珠法快速分离血浆及胶体金法检测显示运至海地的红细胞溶血指标没有超过标准。电镜检查显示,撤回的红细胞在继续储存至d 35时异常形态者增加,但与正常对照组相比并无明显区别。结论利用自行研制的运血箱和相变保温材料,悬浮红细胞经长时间运输后,温度和溶血指标均正常,圆满完成血液保障任务。     

血常规标本存放条件对血细胞计数的影响

目的 探讨血常规标本存放条件对检测结果的影响.方法 所有全血标本室温或4 ℃条件下存放,连续5 d应用Sysmex KX-21全自动血细胞分析仪进行检测,并进行统计学分析.结果 室温下存放标本,白细胞(WBC)于48 h、红细胞(RBC)于96 h、血小板(PLT)于24 h、血红蛋白(Hb)于120 h、血细胞比容(...     

惠州市无偿献血者血液检测结果分析

目的了解惠州市无偿献血者血液检测情况,为招募低危无偿献血者,保障输血安全提供科学理论依据。方法收集2007～2011年惠州市无偿献血者资料并对其检测结果进行统计分析。结果共检测210 675例,总阳性率为6.74%,丙氨酸氨基转移酶(ALT)异常率为4.41%,乙型肝炎病毒表面抗原(HBsAg)、丙型肝炎病毒抗体(抗-HCV)、人类免疫缺陷病毒抗体(抗-HIV)和梅毒螺旋体抗体(抗-TP)阳性率分别为1.13%、0.35%、0.06%和0.79%,各年度检测结果阳性率差异均有统计学意义(P<0.01)。结论近5年检测的阳性率有升高趋势,有必要进一步提高检测方法的准确度,加强献血招募前教育和筛查,加强血液质量监控,确保血液安全。