Note: Responses reflect Canadian practices, which vary from location to location.
At which two stages do most identification errors occur prior to transfusion?
Although misidentification can occur at many stages, most identification errors occur when collecting the patient's sample and when identifying the patient/donor unit prior to transfusion.
With regard to using a patient's records for blood transfusion, provide an example when it is
- clearly acceptable to do so for the patient's safety
- a patient with a record of a clinically significant antibody that is no longer detectable. Trusting the record and issuing antigen-negative donor units (that are crossmatched by antiglobulin test) protects the patient.
- clearly unacceptable to do so for the patient's safety
- Using historical ABO blood groups to issue RBC. In this case the record would NOT be trusted since misidentification and clerical errors occur fairly commonly and can result in life-threatening hemolytic transfusion reactions.
- open to the judgement of individual transfusion services
- Using historical blood groups for issuing platelets and plasma. This question relates to whether patients, once typed, require ABO and Rh typing on each admission. Without standards to address this issue, policies are set by individual transfusion services.
When collecting a blood specimen for pretransfusion testing, which of the following procedures conform to acceptable practice?
ACCEPTABLE (these conform to regulatory requirements and/or best practice)
- (A) The identity of the person drawing the blood sample must be documented.
- (D) The date and time of specimen collection must be documented.
- (E) When a patient's current blood group and historical blood group do not coincide, a new specimen should be collected and tested immediately.
- (F) If the patient is semi-conscious and cannot spell his or her first and last name, a responsible adult such as a relative, nurse or physician may identify the patient.
NOT ACCEPTABLE (these are dangerous and should NEVER be done)
- (B) Blood specimens can be prelabelled before entering the patient's room providing the patient has an identification band.
- (C) If there is a discrepancy between patient identity on the identification band and the requisition, the specimen can be collected and the discrepancy resolved later.
Whenever a discrepancy is found between a patient's current blood grouping results and historical record, why is it good practice to hold previously crosssmatched blood for all patients until the discrepancy is resolved or, alternatively, to issue group O Rh negative RBC if transfusions are urgently required?
These policies protect patients because, whenever one misidentified specimen has been drawn, there is a strong likelihood that a second error has also been made. If left uninvestigated, another patient could receive ABO-incompatible blood and experience a severe hemolytic transfusion reaction.
Why is correct patient identity crucial for pretransfusion testing?
Misidentification can result in transfusion of ABO-incompatible blood and a life-threatening hemolytic transfusion reaction. For example, see:
- Linden JV, Wagner K, Voytovich AE, Sheehan J.Transfusion errors in New York State: an analysis of 10 years' experience. Transfusion 2000;40(10):1207-13. [ Medline ]
- Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DB, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. Br Med J 1999;319:16-9. [ full text ]