CBBS: Methods for ensuring correct identification of patients who have pre-transfusion blood samples drawn before admission for surgery

A hospital in Arkansas uses a "Blood Bank Armband' on outpatients and pre-admission surgery patients who have pretransfusion samples drawn, go home, and then return within the next few days for their surgery. Occasionally one of these patients needs to have their pretransfusion sample redrawn when they return to the hospital, either without the blood bank armband or with the armband in place, but with the identifying blood bank number too smudged to be clearly readable. They are looking for an alternate means of patient identification for these pre-admission surgical patients, and the inquiring colleague is asking for suggestions on how others properly identify such patients upon their return to the hospital.

1. A colleague in Texas reports that at her hospital they also use "blood bank armbands" for such patients, but they do NOT require that the patient wear these bands while they are waiting to return for their surgery. Rather, they give the patient the bands in an envelope with specific instructions for the patient to bring the armband with them on the day of surgery and to have the bands attached to them when they get to the hospital. If the patient forgets their band at home, they require a new phlebotomy to obtain a fresh pretransfusion sample. At other hospitals she has visited Social Security Numbers are entered on the specimen tube label for identifying the patient. The Texan adds that since her hospital is in an area where identification bands are 'traded around' or 'shared' fraudulently between patients to acquire insurance coverage, they depend on the unique number on the blood bank armband.

2. A colleague in Colorado reports that because many of their patients come from outside their local area, for many years the hospital has allowed pre-surgical patients to come in for a type and screen up to 30 days before surgery. After the pretransfusion sample is drawn, the patients are sent home without being banded with an ID bracelet, nor are the patients given an ID band to take with them. The reporting colleague says that they have tried these approaches, and they did not work well. Instead, they have the patient sign a form documenting that they have not been transfused or pregnant in the last three months. An ID band is filled out just as it would be if the patient were in house and the band is placed on the patient's chart. Since the patient is awake and alert when they arrive for surgery, the patient is asked to verify their signature and the demographic information on the ID band. If the information is verified by the patient, the band is then placed on them. Using this approach, the Colorado facility does not routinely re-draw their pre-admission patients for another pre-transfuson sample. If there is any discrepancy at the time the patient is verifying their ID band information, they start over (like anyone else would!) and draw a new sample for pretransfusion testing. The Colorado colleague reports that this has worked very well for them for at least the last 20 years!

3. A Pacific Northwestern blood banker would like to ask the Colorado responder (#2 above) the following questions:

How do they store pretransfusion samples that are collected 30 days prior to the day of surgery?
What crossmatch technique do they use for patients with a negative antibody screen and with no history of antibodies?
How long before surgery do they crossmatch the units?

ADDENDA June 25, 2004

4. In response to the question posed by the Pacific Northwesterner (#3 above), the Colorado colleague (#2 above) reports on how his laboratory stores samples that are collected 30 days prior to the day of surgery and what crossmatch technique is used for patients with a negative antibody screen and no history of antibodies. They save all of their pretransfusion samples for a month (30 or 31 days). They use an immediate spin crossmatch when the antibody screen is negative. If the antibody screen is positive they call results to the ordering physician to recommend 'antigen negative', crossmatched units for transfusion. The surgeons are pretty well trained and are satisfied with the type and screen strategy since they know that the blood bank can move quickly in an emergency. Here is a copy of the policy (PDF) in use at the Colorado colleague's facility.

ADDENDA July 15, 2004

5. The Pacific Northwest colleague who submitted response #3 wishes to ask additional questions of the Colorado colleague. After reviewing their procedure, she interprets that pre-transfusion testing is completed within 24 hours. The procedure indicates that when blood is ordered for crossmatch, it will be held until 2 days post surgery.

Does this mean that a patient whose sample is collected 25 days prior to surgery has units set up and held for 25 days?
How are these patient samples are stored: at 4C or -18C?
Is the type and screen performed within 24 hours of sample receipt and the crossmatch performed 24 hours prior to surgery?

ADDENDA Aug. 5, 2004

6. The Colorado colleague responds that they do type and screen within 24 hours of specimen collection. They do the crossmatch as close as possible to the surgery. If the surgery is many days in the future, they hold the specimen for crossmatching closer to the day of surgery. Indeed the specimen may be held for up to 30 days, but they do the crossmatch as close to receiving the specimen as possible. How the specimens should be stored must be related back to the package insert on reagents used during the crossmatch ... if they are using gel or some reagent like that there may be specific storage and time limits attached to this reagent. The Colorado colleague holds specimens at 4C.

He concludes by saying that he hopes colleagues recognize that for a patient to be eligible for the above protocol s\he must not have a positive antibody screen/antibody identification and must not have been pregnant or transfused in the last 3 months.

ADDENDA Oct. 4, 2004

7. A colleague in Ohio reports that they have decided to extend the time limit for pre-transfusion specimens to 30 days from the date of the phlebotomy for patients with no history of transfusion or pregnancy within the previous 90 days. Most patients have their pre-surgical clearance performed 21 days in advance, so it is hoped that this new policy will help them to avoid last-minute 'type and screens'. For the pre-transfusion sample to be held for 30 days, a patient must sign a release to verify that they have had no transfusion or pregnancy within the previous 90 days. If a patient answers that they have been pregnant or transfused within the previous 90 days, or if the patient has a positive antibody screen, the Ohio colleague's hospital will require that a new sample be available for the day of surgery.