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* Context.--Data collection and analysis of the College of American Pathologists (CAP) Interlaboratory Comparison Program (Proficiency Testing) J-Survey results provide insights into North American pretransfusion compatibility testing practices and trends. Objectives.--To assess current North American manual testing practices for ABO grouping, rhesus (Rh) typing, antibody screening, and crossmatching using CAP proficiency testing data. Design.--Analysis of the CAP Interlaboratory Comparison Program J-Survey data (2005-2010) to identify laboratory methods used for ABO grouping, Rh typing, antibody screening, and crossmatching. Data were ana lyzed by test method using Microsoft (Redmond, Washington) Excel software. Results.--The method used most often in ABO grouping and Rh typing was tube testing. Many laboratories also used tube testing for antibody detection and crossmatching, but during the study period, the proportion of laboratories using gel-based methodologies increased considerably. Conclusions.--Most North American CAP laboratories continue to use tube methods for ABO/Rh testing. Use of gel-based methodologies increased during the past 5 years for antibody screening and crossmatching. (Arch Pathol Lab Med. 2012; 136:294-300), Red cell, pretransfusion compatibility testing is performed to prevent incompatible transfusions that may result in immune-mediated, hemolytic transfusion reactions and to identify any patient whose fetus would be at risk [...]

* Context.--Hemolytic transfusion reactions due to platelet transfusions containing ABO-incompatible plasma (ie, group O platelets into a non-group O patient) have been reported in the literature. However, limited data describe the extent to which transfusion services manage such platelet transfusions or the methods used to limit the risk of such reactions. Objective.--To determine transfusion services' current practices regarding the use of platelets containing ABO-incompatible plasma. Design.--In a College of American Pathologists' Transfusion Medicine Proficiency Testing Survey, supplemental questions asked participants whether a policy existed for the use of platelets containing ABO-incompatible plasma and, if a policy existed, what elements were part of the policy. Results.--Of 3156 laboratories that transfused platelets, 3152 responded to the question of whether they had a policy. Of these respondents, 83% (n = 2623) had a policy. One or more elements were reported for transfusions in adults: only ABO-compatible plasma products (n = 1363); only ABO-compatible plasma and platelet products (n = 679); notification of medical director (n = 646); notification of ordering physician (n = 637); volume limit of ABO-incompatible plasma allowed (n = 255); volume-reduction of ABO-incompatible products (n = 168); screening for critical titer of anti-A or anti-B (n = 53). A total of 529 laboratories indicated that they did not have a policy. Conclusions.--A majority of laboratories have a policy, but most do not include a method to limit the risk of hemolysis if platelets containing ABO-incompatible plasma must be transfused. When such platelets are used, there does not appear to be consensus on a specific method to minimize the transfusion of anti-A or anti-B. (Arch Pathol Lab Med. 2007;131:909-916), Platelet transfusions are indicated in patients with clinically significant bleeding attributable to thrombocytopenia or abnormal platelet function. Alternatively, prophylactic platelet transfusions may benefit severely thrombocytopenic patients in whom even small [...]

* Context.--The more advanced we become, the more evident are the infectious and noninfectious risks of the blood supply. Infectious risks are somewhat straightforward and are addressed by implementing stricter donor criteria and testing. The noninfectious risks, however, are more complicated. Each step in the transfusion process, beginning with the physician who orders a transfusion to the actual transfusion of the component, is subject to adverse outcomes and increases the noninfectious risks of transfusion. The challenges to provide the safest blood possible with zero risk have resulted in the implementation of stringent standards from both the American Association of Blood Banks and the Joint Commission on Accreditation of Healthcare Organizations. Objective.--A series of case scenarios serve as the basis for discussion of the risks, which affect the safety and administration of blood components, inherent in the transfusion process. Data Sources.--Journals, textbooks, Internet. Conclusions.--The transfusion process is a complex multistep process with inherent risks. Infectious risks of transfusion are being adequately addressed such that the noninfectious risks of transfusion are becoming much more evident. Patient safety can be compromised if each step of the transfusion process is not completed according to established policies and procedures at each individual institution. (Arch Pathol Lab Med. 2007;131:690-694), Successful transfusion therapy depends on providing each patient who needs a transfusion with the right blood component, at the right time, and for the right reason. To achieve the foregoing [...]

* Context.--A blood bank can provide compatible blood for an elective surgical procedure, provided a blood sample is received by the laboratory with sufficient time to allow pretransfusion testing and [...]

Background: Kidd blood group antibodies are notorious for transient detection and hemolytic transfusion reactions. This report compares the rate of detection of anti-Jka when using gel column agglutination versus solid-phase red blood cell adherence (SPRCA) testing and documents the occurrence of hemolytic transfusion reactions in 17 recently transfused patients who developed anti-Jka that were detectable by SPRCA but were undetectable by gel.Study Design and Methods: Before April 20, 2011, the laboratory used gel column agglutination as the primary method for antibody screening and identification. From April 20, 2011, to August 12, 2013, SPRCA was adopted as the primary method for antibody screen with gel remaining the primary method for identification. SPRCA identification was also performed if sufficient sample was available. Medical records were reviewed for evidence of hemolytic reaction in patients whose anti-Jka was negative or inconclusive by gel, but clearly identifiable by SPRCA at the time the anti-Jka was first identified.Results: A total of 105 patients were discovered with anti-Jka from 88,478 SPRCA screens performed. In 32 patients, anti-Jka was initially discovered by SPRCA testing and concurrent gel testing was completely negative (n = 26) or inconclusive (n = 6). Seventeen of the 32 patients were recently transfused and of these six met criteria for delayed hemolytic transfusion reaction (DHTR), three had possible DHTRs, and eight had delayed serologic reactions; 13 of the transfused patients received Jk(a-) RBCs to avoid potential hemolysis.Conclusion: SPRCA testing significantly increased the discovery of clinically significant anti-Jka and facilitated the earlier use of Jk(a-) RBCs to avoid hemolytic transfusion reactions. [ABSTRACT FROM AUTHOR]

Objective: To examine non-specific red cell reactivity (NSR) on antibody (Ab) screening of obstetric inpatients.Methods: Observational study of 5438 obstetric inpatients (2009-2013). Ab-positive patients were identified and their records reviewed for NSR, other antibodies, transfusion reactions or hemolytic disease of the fetus/newborn (HDFN). Evaluation of NSR frequency by test era assessed the impact of an institutional change to solid-phase screening in 2011.Results: Of obstetric inpatients, 5.3% had at least one positive Ab screen; 1.6% had NSR. Of NSR-positive patients, 16.7% had identifiable Abs that pre-dated NSR; 25% had concurrent Abs and 8.5% had subsequent Ab identification. In 49.1%, NSR resolved during follow-up. The frequency of NSR was higher after the change to solid-phase Ab screening, but specific Ab frequency was similar in both testing periods. No transfusion reactions or cases of HDFN were noted in this cohort.Conclusions: NSR is found in 1-2% of obstetrical inpatients at our institution, and has more than doubled since the initiation of solid-phase screening. Although likely clinically insignificant by itself, NSR is commonly found in relation to other red cell Abs and may precede their development. [ABSTRACT FROM AUTHOR]