What are some of the precautions related to use of records in the transfusion service?
Although records play a critical role in the transfusion service, there are some precautions associated with their use. Some records may be used without confirmation but most require current testing. For example:
- If a patient has a record of having a clinically significant antibody but the antibody can no longer be detected, antigen-negative donor units would be crossmatched. In this case there is a logical explanation for the discrepancy and trusting the record protects the patient.
- Historical ABO blood groups are never used to issue RBC. Misidentification and clerical errors occur fairly commonly and can result in life-threatening hemolytic transfusion reactions.1
Using historical blood groups for issuing platelets and plasma is not so clear. The difficulty arises as to whether, once typed, patients require ABO and Rh typing on each admission. Because there are no standards that address this issue, policies are set by individual transfusion services.
An advantage of typing each admission is that a crossmatch specimen would be readily available should red cell transfusion be required.
- ABO and Rh records on cards carried by patients are never used for transfusion purposes since they are totally unreliable. Cases exist anecdotally and in the literature of records being wrong. Examples (based on personal experience of author):
- A patient presented to her physician under a false identity (her girlfriend's) and was admitted to hospital for a therapeutic abortion under that identity; her ABO group disagreed with the record since her friend had been previously crossmatched.
- A patient was crossmatched due to a motorcycle accident and his ABO group did not agree with his record; patient was carrying an identity card of his older friend for the purpose of buying liquor in a bar, and the friend had been previously crossmatched.
- A patient's ABO group disagreed with her record based on testing two days ago; staff questioned why a new type and screen was ordered when a current valid sample existed but did the group anyway. Investigation revealed that an interning health professional was curious about his blood group and convinced a collector to take his sample under the identity of an existing patient.