What are some of the uses of records in the transfusion service?
Past records are invaluable to a transfusion service. Some of the uses of records include:
Preventing transfusion of incompatible blood due to patient misidentification
This is one of the major uses of past records and is what happened in this case. If patient AW did not have a record of being group O, the mix-up with the two patient samples would not have been detected until it was too late. Patient OP would have been transfused with group A RBC, since the crossmatch with AW's incorrectly labelled blood specimen was compatible.
Note:Whenever one misidentified specimen has been drawn, there is a strong likelihood that a second error has also been made.
Preventing transfusion of incompatible blood due to weak antibodies
Records can protect the patient who has a weak, undetectable antibody. Even when an antibody is detectable, records can save the transfusion service time in obtaining antigen-negative donor red cells.
Providing access to special transfusion requirements
Records increase transfusion safety by providing access to information regarding special transfusion requirements, e.g., the need for CMV-negative, irradiated, or washed blood components.
Identifying previous testing problems
Records providing access to information about previous testing problems such as ABO and Rh typing discrepancies and associated investigation and resolution.
Preventing extra work due to positive DATs
Records can save the transfusion service time in re-investigating patients with positive direct antiglobulin tests (DATs) that remain positive over time.
Note: Should the strength of the DAT change (and depending on the patient's underlying disease) further investigation may be warranted. For example, in a recently transfused patient, a DAT that was weakly positive microscopically (due to an autoantibody) that changes to 2+ macroscopic agglutination with mixed-field agglutination may signify a delayed hemolytic transfusion reaction.
Preventing nonhemolytic febrile transfusion reactions
Non-hemolytic febrile transfusion reactions due to white cell antibodies and/or cytokines can usually be prevented by the use of leukoreduced components (filtered prestorage or at the bedside). In Canada all whole blood donations undergo prestorage leukoreduction. However, in countries currently without universal leukoreduction, records can play a role in preventing further reactions.
Some laboratories use a history of two documented febrile reactions as an indication for transfusing leukocyte-depleted red cells or platelets.
Tracking transfusion-associated transmissible diseases
Patient records play a crucial role in tracking transfusion-associated transmissible diseases by facilitating tracebacks1 and lookbacks2.
- Traceback: The process of investigating a transfusion-associated infection in a patient in order to identify an implicated donor. The purposes are to determine whether any transfused donor blood is positive for an infectious agent, to notify consignees and recipients, and to retrieve implicated blood components.
- Lookback: The process of identifying current or previous donations from a donor confirmed positive for a transfusion-transmitted agent. The purposes are to identify and notify consignees and recipients and to retrieve implicated components.