[17] CHAPTER VIII LESSON 1 Flashcards
can be defined as the use of serologic principles and tests to ensure compatibility and prevent an immune-mediated hemolytic transfusion reaction.
Pretransfusion testing
defines blood components as pharmaceuticals because of the intent of their use to cure, mitigate, treat, or prevent disease.
Food and Drug Administration (FDA)
Under the auspices of the [?], the Centers for Medicare and Medicaid (CMS) have the authority to regulate pretransfusion testing.
Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88)
Facilities providing blood components and laboratory services are subject to. [?] by either entity at any given time.
inspections
In addition to maintaining regulatory compliance, many facilities participate in quality driven programs to achieve [?].
accreditation
The [?], now known simply as AABB, is an accrediting organization whose goals include enhancing the quality and safety of services provided by blood banks and transfusion services.
American Association of Blood Banks
Adequate pretransfusion testing does not guarantee [?] in the recipient’s circulation, but strict adherence to all facets of pretransfusion testing and donor unit selection is imperative to ensure safe transfusion therapy.
normal survival of transfused red blood cells
STEPS IN PRETRANSFUSION TESTING
1. Request for[?]
2. Identification of [?] and blood specimen collected
3. Testing of transfusion recipient’s [?]
4. Donor [?]
5. Donor [?]
6. [?] (crossmatch)
7. Labeling of [?] with the recipient’s identifying information and issue.
transfusion
transfusion recipient
blood specimen
RBC unit testing
red blood cell unit selection
Compatibility testing
blood or blood components
Testing of transfusion recipient’s blood specimen:
a. Evaluation of specimen for testing [?]
b. [?]
c. [?] (Weak D testing is optional when testing the patient)
d. Screening for [?] to red cell antigens
e. [?] if unexpected antibodies are detected
f. Comparison of [?], and any discrepancies shall be investigated and appropriate action taken before a unit is issued for transfusion
suitability
ABO group
Rh type
unexpected antibodies
Antibody identification
current and previous test results
- Donor RBC unit testing:
a. ABO group confirmation and Rh type confirmation for [?]
Rh-negative RBC units
- Donor red blood cell unit selection:
a. Selection of components of ABO group and Rh type that are compatible with the transfusion recipient and with any [?]
unexpected allogeneic antibodies
- Compatibility testing (crossmatch):
a. Serologic
b. Computer or electronic
SPECIMEN COLLECTION
Clerical errors and [?] continue to occur and have potentially serious, clinical consequences.
ABO-incompatible transfusions
- greatest threat to safe transfusion therapy
Clerical error
Clerical error Examples:
-misidentification of the recipient when the [?] is drawn
-[?] during handling in the laboratory
-misidentification of the recipient when the [?] is given
blood sample
mix-up of samples
transfusion
Errors include
phlebotomy and testing errors, administration to the wrong recipient, or issuance of the wrong donor unit.
continue to be a significant risk necessitating system to prevent failures in patient identification, specimen labeling, and administration.
Transfusion errors
In order to prevent patient misidentification and administration failures, most institutions require patients to wear a [?] upon admission until discharge
facility-generated ID wristband
facility-generated ID wristband must contain two unique identifiers, typically the
patient’s first and last names and date of birth or medical record number
require two unique identifiers to identify patients and ensure that correct medicine and treatment are administered.
Joint Commission’s National Patient Safety Goals
Prior to specimen collection, the phlebotomist must confirm the [?] is accurate and contains all required information.
wristband information
Common practice includes asking the patient to state his or her[?], if they are coherent.
name and date of birth
Once collected, the specimen must be accurately [?] at the bedside.
labeled
Patient information on the [?] must be in complete agreement.
label, wristband, and request
Furthermore, specimen draw [?] and the collecting individual must be traceable back to the collection of the patient sample.
date and time
are acceptable for pretransfusion testing.
Anticoagulated or clotted specimens
are often preferred due to ease of handling.
Anticoagulated specimens
are ideal for preparing a uniform cell suspension for testing.
Red blood cells from an anticoagulated sample
