The following question was submitted on February 10th for discussion:

Frequently we are asked to type a recipient and/or potential directed donor prior to his/her donation in order to determine basic ABO/Rh compatibility. Since our Donor Room is next to the lab, this has not been a problem. However we are moving in the near future and our Donor Room staff will no longer have immediate access to the Blood Bank staff. How do other centers deal with the issue of pre-typing patients and/or donors?

The following replies were received in response to the question:

1. Our donor room is on the same floor as the Blood Bank. We will perform blood types on family/friends that are accompanying an autologous donor who has an unsuccessful donation (and the family/friend is willing to donate - this is a courtesy). For directed donors that must know their blood types ahead of time, we require a lab order for ABO/Rh from the M.D. and we collect these as outpatient lab specimens. The donor RN can get a copy of the report when the donor comes in to donate. This is our policy and has worked OK so far.

2. Samples are sent to the Center Lab from satellite locations, at the same time with blood and processing samples. Results are entered in the computer system and are available to staff collecting the donations. We only take directed donations at the main center and at 2 distant satellites.

3 In our center, if the potential directed donor does not know his/her blood Group/type, we offer to do it, for a charge that has to be paid in advance of the testing. If the directed donor does not know the blood group and type, we do not draw him/her. Besides, the patient must have a condition or be undergoing a procedure that uses blood.

4. We do not pretype donors or recipients. Our feeling is that it is more efficient for both the donor and the donor center to just draw the unit and type it later. If it is not compatible with the recipient, it is crossed over into the general inventory. Although a rare donor may complain about this, most people are satisfied when we explain that their unit will go to someone else in need and that by just donating the unit without pre-typing, they will save some time and a needle-stick. We likewise do not pre-type recipients in our donor center; however, if the recipient's physician orders a blood type, it will get done in the blood bank. I suspect that this goes on a lot, but we do not monitor it.

5. Even though the laboratory is just down the hall (we are a non-hospital blood center), we don't offer instant ABO/Rh testing for patients and potential designated donors. We register and pre-screen the donor, draw the tube if it appears s/he will be a viable donor, send it with a requisition to the laboratory and then call the donor or patient with the results. We don't promise results sooner than 24 hours, although we often have them the same day. I guess changing from an instant to a next day service would be your biggest problem - you'd have to communicate the change to ordering physicians, in-patient units, donors and patients. We charge for the test at the time of collection.

6. At our centers that do not have direct access to the lab we draw a test tube and send it to the lab for ABO. The donor has to return the next day to donate. Otherwise the donor can drive to the centers that have the ability to type on the spot.

7. At our blood center in Central California we collect a sample from a potential donor and type it in the Laboratory. Normally we ask for a 24-hour turnaround time. If needed on a STAT basis we have a 1 hour turnaround time and charge for the STAT workup.

8. At a famous blood bank that thinks a tree can be a mascot, they draw 2 capillary tubes for ABO Rh and charge $21. The results are available the next day after noon.

9. We are at a blood center and we dissuade directed donors from having pre-donation ABO/Rh typing by telling them that if they don't match their friend or family member there are other patients who still need their blood.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator