LSB665 - Pre-Transfusion Testing Audit Report: Card Techniques

This report presents an audit of pre-transfusion testing using card techniques, highlighting deficiencies such as inadequate blood fridge temperature monitoring and failure to check reagent expiration dates and temperature. It suggests improvements including daily temperature monitoring, expiration date checks, and ensuring reagents reach room temperature before use. The report also acknowledges well-performed elements like PPE provision, cleanliness, and accurate patient detail recording. The reflection emphasizes the importance of addressing both intentional and unintentional errors in pre-testing phases. Critical control points in the vein-to-vein transfusion chain are identified, including donor details management, blood collection and preservation, and screening for transmissible infections. Desklib offers a wealth of resources, including solved assignments and past papers, to aid students in their studies.

Running head: TRANSFUSION AND TRANSPLANTATIONSCIENCE
Audit Report of Pre-Transfusion Testing Using Card Techniques
Name of the student
Name of the University
Authors note

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Table of Content
Introduction:..........................................................................................................................................3
Deficiencies observed through the audit...............................................................................................3
Suggested improvement method..........................................................................................................4
Well performed elements.....................................................................................................................5
Reflection..............................................................................................................................................6
Vain to vain transfusion chain critical control points:............................................................................7
Reference..............................................................................................................................................8

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Introduction:
Pre-transfusion testing refers to the laboratory testing required to ensure compatibility
between the blood of the transfusion recipient and the blood product intended for transfusion. This
process includes proper completion of the requisition, proper patient identification, collection and
labelling of the blood sample from the patient, laboratory testing to determine the patient’s blood
group and to identify the presence of red blood cell alloantibody, and compatibility testing1. Pre-
transfusion testing is completed when a compatible blood product is identified for transfusion to the
intended recipient. This report represents the performed audit on pre-transfusion testing using card
technique. The following section will include the Deficiencies observed through the audit, Suggested
improvement method and Well performed elements. The purpose of this audit is to improve the
existing pre-transfusion testing though finding and addressing the deficiencies as well as providing
appropriate recommendation for them.
Deficiencies observed through the audit
Blood fridge temperature were read and recorded properly
The temperature of the refrigerator to store the Red Blood Cell properly should be from
+2°C to +6°C, where the maximum tolerable point is +8°C2. In many cases, the lack of monitoring and
maintenance of the temperature causes several dilemmas in screening and crosshatching antibody
tests. As per the observation, the responsible personnel did not monitor or take the updated report
of the refrigerator’s effective temperature. It can cause severe damage to the RBC and even can
disable the RBC to react with the testing reagent chemicals. Therefore, a significant monitoring and
recording section is missing from this excising Pre-transfusion testing process.
Expiring date of test cell reagents are not checked before using

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Checking the expiring data of all the test cell reagents is essential before each use of reaction
testing in screening test. The commercial antibody testing reagents have specific expiring date
mentioned in its package. In the existing Pre-transfusion testing process, the responsible personnel
are not checking the expiring date of the reagents properly. In this situation, an expired reagent can
cause disputed test results and can waste the valuable RBC stock. Therefore, in the existing practice
of using the test cell reagents is not appropriate for antibody screening tests, which needs sincere
attention of the management.
Test cell reagents did not reach room temperature before being used
Before increasing the temperature up to 37 degree Celsius for 30 minutes for antibody
reaction, the test cell reagents should reach the room temperature that is 25 degree Celsius3. The
test cell reagents are stored in a very low temperature. Therefore, suddenly using them in a high
temperature can block the reaction rate through an adiabatic reaction buffer during the antibody
detection procedure. As per the audit observation, it has been found most of the the responsible
personnel are increasing the temperature of the reagents up to 37 degree for AHG phase taking
them directly from the refrigerator. In this situation, the antibodies can react differently with the
reagent resulting a disputed report.
Suggested improvement method
The following improvement procedures can be utilised to improve the quality of regular Pre-
transfusion testing process:
1. The blood/ red cell (RBC) storage should be monitored and recorded daily basis in order to
ensure the optimum temperature that should be from +2°C to +6°C. In some specific
situation, the temperature can go up to +8 degree Celsius. The management should develop
an operational checklist for the responsible personnel that will help them to keep track the
temperature of the blood/ red cell (RBC) storage refrigerator.

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2. The operational management should also ensure that the workers are checking the expiring
data of all the test cell reagents before using them in each of reaction testing in screening
test. The commercial antibody testing reagents have specific expiring date mentioned in its
package. To maintain the regular practice the operator can have a notification attached on
the reagent storage that will alarm the workers regarding the expiring data checking before
any usage.
3. The operational management should ensure that the test cell reagents are reaching the
room temperature that is 25 degree Celsius before increasing the temperature up to 37
degree Celsius for 30 minutes for antibody reaction. In order to implements this new
practice the operational management can execute several on job training programs to
develop the new skills of perfection among the workforce.
4. Event based training session could be effective, where the users will gain knowledge and
sincerity regarding the negative outcomes of these negligence and disputed operations.
Attractive and practical illustration about chemical reactions considering the external factors
such as time and temperature can increase the essentiality of these essential operations to
the responsible personnel.
5. Both direct and indirect monitoring on the regular operation can help to collect all the
information regarding how the trained personnel comply with all the essential consideration
successfully. Checklist, awareness poster, code of conducts for successful operations can be
also incorporated in regular system to remind the workforce all the necessary micro work
procedure.
Well performed elements
Appropriate PPE worn are provided regularly including lab coat, covered shoes and Google
were Cleanliness of work area and equipment were noticeable and the waste bins are also present.

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Patient details on the request form are similar to the patient sample due to appropriate patient
details recording system before doing tests. Exactly 0.8% red cell suspension prepared cell
suspension is prepared by dispenseing 1mL diluent LISS in a tube and add 10μL of packed red cells as
per the AABB standards. The cards are labelled with at least two patient full details and initials. At
the 2 coombs card is positively labelled 1-11 and with the 12 well A, along with 50μL ID-panelCell
added to the 1-11 labelled well. Apart from that, the ID-panel cells expiring dates checked and mixed
thoroughly before being used and 50μL patient cell is added to well 12(A). In the process, 25μL of
patient plasma is added to well 12(A) to check if the plasma fully dispensed in every wells. Only one
drop(25μL) of confirmation reagent is added to the wells.
Additionally, the cards are incubated in 37C for 15minutes and also centrifuged for
10minutes to use new cell suspensions in order to get more accurate result. For this the responsible
personnel make sure that the cards are balanced and spined for 10 minutes while the cards are
inspected front and back for positive and negative reaction. The test validated based on colour
change to blue/green (AHG cont cells/ confRgt) to be confirmed and validated by visualising colour
change. The final results are graded and recorded (IAT) on the antigen composition sheet
immediately after the testing where the negative results are also observed and considered first. The
antibody identification is performed based on the IAT reading and the rule out method is used to
identify the antibody with homozygous expression is considered as excluded. The RhK is card used
for phenotyping the patient and 50μL of 0.8% Patient sample added to each well. The result is
interpreted proficiently if there is a struggle interpreting the result.
Reflection
The auditing process is well executed where each and individual testing materials was not
altered for this process. I have also ensured that the responsible personnel of Pre-transfusion testing
process are not informed about investigation or auditing procedure. It helped me to identify the
actual problems in the regular activities performed by the workforce. I have also found that some

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mistakes are intentional and some are unintentional. Apart from that the major dilemmas are
present in the pre testing phase where the temperature and expiry dates are required to be
monitored carefully. I observed that the Blood Grouping, Antibody Detection Tests, Cross-matching
Tests are performed effectively. However, more in depth inspection could analyse these phases
more critically. IS-XM approach could be inspected with detail. The transportation procedure among
different rooms can be inspected to monitor any sudden physical temperament to the storage
system. The use of patient's serum and suspended RBCs of the donor can be inspected to find any
operational discrepancy. The AHG-XM and usage of anti-IgG could be inspected thoroughly.
Including these inspection in the auditing checklist could help me to analyse the existing
intermediary procedures as well. Moreover, in next audit phase the I will try to make the inspection
checklist more specific, viable and precise to develop more effective audit report.
Vain to vain transfusion chain critical control points:
The critical control points:
 Donor details management
 Collection of preservation of blood
 ABO blood group determined by both forward and reverse methods4
 Evaluating the performance of blood grouping reagents5
 Screening for pre-Transfusion Transmissible infection
 Recording and documentation

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Reference
1. Weng Y, Chiu Y. Comparison of efficacy and safety of exchange transfusion through different
catheterizations: Femoral vein versus umbilical vein versus umbilical artery/vein*. Pediatric
Critical Care Medicine. 2013;12(1):61-64. doi:10.1097/pcc.0b013e3181dbeb78
2. Roxby D. Current concepts in pre-transfusion serological compatibility testing. ISBT Sci Ser.
2012;6(2):265-269. doi:10.1111/j.1751-2824.2011.01499.x
3. Aysola A, Duque M, Williams P, Alissa R. Comparison of heel stick sample with placental blood
sample for pretransfusion testing. Transfusion. 2018;58(9):2227-2231. doi:10.1111/trf.14792
4. 4. Evanovitch D. A primer in pretransfusion testing. Transfusion and Apheresis Science.
2012;46(3):281-286. doi:10.1016/j.transci.2012.03.017
5. Anstee D. Red cell genotyping and the future of pretransfusion testing. Blood. 2012;114(2):248-
256. doi:10.1182/blood-2008-11-146860