By Pradeep K. Bhagat, MD, System chairman, Department of Pathology
The ABO/Rh Recheck policy has been developed as a risk reduction process at Main Line Health for several years to prevent transfusion from a misidentified sample. Per the American College of Pathologists (CAP), mistransfusion occurs from misidentification of the intended recipient at the time of collection of the pretransfusion testing sample, during laboratory testing and preparation of units to be issued, and at the time of transfusion. Misidentification at sample collection occurs approximately once in every 1,000 samples, and in one in every 12,000 transfusions the recipient receives a unit not intended for or not properly selected for him/her.
An ABO/Rh Recheck must be done on all patients with no historical record prior to transfusion. Main Line Health verifies the ABO group of the intended recipient of blood products by obtaining a second sample collected by a different phlebotomist at a different time to prevent these types of errors. Main Line Health Laboratory makes no exception to this process and in doubt will reject the specimen and will ask for redraw.
The Blood Bank and Nursing staff will work together to ensure that the ABO/Rh Recheck is performed STAT and that there will be no delay in the issuing of any blood products. In the event that the ABO/Rh Recheck sample cannot be obtained due to patient being in a critical situation, difficult stick or patient refuses, then only Group O red blood cells will be issued. In these cases, the Blood Bank should be notified immediately. This should be reserved for emergency basis only. The laboratory also monitors the effectiveness of the system and considers improvements in procedures and/or educational efforts as part of its program to reduce the risk of mistransfusion.
If you have any questions, do not hesitate to call Liz Klinger, Transfusion Service Manager at Main Line Health at 484-476-8409 or Dr. Bhagat at 484-476-3521.