Bedside checks of ABO/Rh compatibility before transfusion of red cells

A Transfusion Nurse Specialist at a hospital in Seattle wonders if any medical centers require the transfusionist to compare the ABO/Rh specified on the Transfusion Tag attached to the red cell unit with the the following patient information before transfusing the unit:

• patient's historical ABO/Rh, if available
• in the case of a patient's first transfusion, with any other source document (e.g., type and screen results in electronic medical record)?

She asks these questions because she cannot find mention of these particular checking steps in the 14th Edition of the Technical Manual (pages 489 and 490) "Identifying the Recipient and Donor Unit."

A colleague in North Carolina who is very familiar with the AABB Technical Manual is of the opinion that there are several steps that serve as a check for the compatibility of the ABO/Rh type of the patient and a unit of red cells. These include the following:

• Crossmatch (serologic or computer) which would detect ABO incompatibility. He points out that a computer crossmatch should have logic to alert the user to discrepancies between the donor ABO group and Rh type on the unit label and those determined by blood group confirmatory tests, and to ABO incompatibility between the recipient and the donor unit (AABB standard 5.14.2.5)
• Comparison with previous records. He comments that according to AABB Standard 5.13.5, there shall be a process to ensure that the historical records identified in Standards 5.13.5.1 and 5.13.5.2 have been reviewed and compared to current records. Discrepancies shall be investigated and appropriate action taken before a unit is issued for transfusion.

The North Carolina colleague adds that in his opinion, In the United States, a final ABO/Rh comparison at the bedside is not the standard of care. However, it is in some countries (e.g., France or Germany), where a final confirmation of ABO incompatibility at the bed side is mandatory. For example, see the following references:

Migeot V et al Diversity of bedside pretransfusion ABO compatibility devices in metropolitan France. Transfus Clin Biol. 2003;10:26-36

Daurat G et al Validity of pretransfusion bedside agglutination tests for pretransfusional control. Transfus Clin Biol. 2002; 9::258-64

Migeot V et al Reliability of bedside ABO testing before transfusion.Transfusion. 2002: 42:1348-55.

Meinshausen E, Wendt M. (Introduction of a new card for the "bedside test") Anaesthesist. 1989;38::555-7.Erratum in: Anaesthesist 1990;39:340.

He cautions that it should be noted that bedside confirmation of ABO has its own set of reliability problems.

Finally, he suggests the review of an earlier e-Network Forum discussion on this subject.

ADDENDA Mar 10, 2005

The following comments have been received.

1. The North Carolina colleague wishes to add to this discussion. He says that it is worth noting that new monitoring technology, called radio frequency identification (RFID), is undergoing trials in several academic institutions. Patients wear wristbands that communicate their blood type by tiny radio signals. If sensors in the bed detect a difference between the signals coming from the wristband and from a microchip on the blood bag, ''Stop! No Match!" will flash in big red letters on a computer screen. This technology, is already widely used in industry to track products from the warehouse to consumers. A recent news article describes this method, which is currently undergoing evaluation at Massachusettes General Hospital.

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