If the blood bank labeling policy requires use of a separate blood bank wristband, is it acceptable in certain instances to use a sample from another area of the laboratory?

A blood banker in Southern California asks the e-Network Forum to assume the following laboratory policy exists: Labeling requirements for blood bank specimens includes the application of a separate blood bank wristband with a unique blood bank number, applied when the specimen is drawn. The blood bank number is also applied to the patient's specimen tube and any donor units that are crossmatched to the patient. In addition, the number is entered into the laboratory information system (LIS), and becomes a required recipient identifier for crossmatched blood products that are issued for transfusion. This situation occurs: A patient specimen already exists in the laboratory, having been drawn for a CBC earlier in the day. It has all of the required information on the label for performing crossmatching, except for the unique blood bank number, because no blood bank wristband was applied to the patient at the time it was drawn. Question: Under what circumstances, if any, could this previously drawn (in-lab) specimen be used for the new (add-on) crossmatch order? Using it for the crossmatch order would necessitate adding a blood bank number to the tube and a blood bank wristband to the patient. "Circumstances" might refer to (1) difficult patient stick, (2) emergent patient condition, (3) attending physician's request. Would merely having a phlebotomist revisit the patient, confirm existing specimen's identity against patient's hospital wristband, and apply the blood bank number and wristband to the tube and patient be considered acceptable?

The following responses have been received.

ADDENDA Sept. 14, 2004

1. Editor's Note: Several blood bankers indicate that their local policy would NOT allow them to use a specimen for pretransfusion testing if the specimen had been collected for a different section of the clinical laboratory (such as the hematology or chemistry) and the specimen had not been labeled exactly as required by the blood bank section. Examples are given below.
   
   
2. A Transfusion Safety Officer in Alberta, Canada reports that they have made specimen collection for crossmatch a unique procedure which includes verification of labeling (including the blood bank wristband unique identifier #) at the bedside by a second individual. This is not the case with specimens collected for a complete blood count (CBC) and despite using dedicated phlebotomists for all blood sample collections, they still see occasional situations where CBC samples are labeled for the wrong patient. If the situation is of such urgency or difficulty that a properly collected crossmatch sample cannot be collected prior to the need for transfusion, the patient would be supported with group O Rh negative RBCs until a proper sample was available.
   
   
3. A US colleague reports that he works in a large hospital transfusion service with hundreds of phlebotomists (physicians, nurses, paramedics, patient care associates, etc) throughout the hospital. They detect at least 2-3 samples a day that are possible misdrawn samples which have been submitted for hematology testing. These suspect samples are detected when red cell indices do not agree with a previous sample. Suspect samples are tested for ABO and compared with historical records; some of those samples do not match the historical type and are obviously misdrawn. For this reason alone, the US colleague could not recommend using non-blood bank samples for pretransfusion testing.
   
   
4. A colleague in Virginia reports that they will use a blood sample that was submitted to a section of the laboratory other than the blood bank, but only for extended antibody workup if they run out of plasma. They would not use such a sample for routine pretransfusion testing.

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

W. Tait Stevens, MD
CBBS e-Network Forum Editor & Moderator

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator