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Thread: Manual blood grouping controls

  1. #1

    Manual blood grouping controls

    Dear all

    I have received the following email to me directly and I can forward it on to the Inspectors for comment, but I did wonder if anyone out there might be able to supply an answer or for it to spark a discussion.

    "Currently, we perform manual group and antibody screen controls every morning (on Ortho cards). As we now have two blood grouping analysers in use, the possibility of both analysers going down is slim. We would only perform a manual blood group in an emergency.

    Would you recommend continuing to set up manual controls daily, or only when you perform a manual group?"

    Any thoughts?

  2. #2
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    Currently in my lab we set up daily controls for our manual tube group. However as we will soon be moving form One Innova to two vision analysers we will also stop doing the daily controls. Like you we do not foresee using manual grouping very often. Just need it to set up urgent cross matches with the automated group being available before the cross match is complete. We would only go back to manual grouping if there were serious problems eg reagent supply issues and would go back to daily controls in these cases.

    On a related topic we recently had a UKAS finding: the inspector noted that we set up controls with manual cross matches but not with the automated cross matches. He indicated that we need to set up a positive control with each cross match, manual or automated.
    Have other people been having this finding? At the risk of appearing stupid has everyone else been doing this since forever?
    Our answer is to set up a tube of IgG sensitised cells (coombs control) as an additional donor against each patient to provide this positive control.
    Does this seem like a sensible approach or does anyone have a better solution to suggest?

  3. #3
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    Thanks for the helpful info Matt. We intend going live with our new Visions soon,and I was wondering how long it would take to do a STAT full group when the analyser is running worst case scenario at full capacity? We currently only issue group O red cells and A FFP/Plts for emergencies until an automated group is obtained .We are keeping our manual tube grouping technique mainly for resolution of ABO/D discrepancies, and will continue running daily controls.

    Regarding your UKAS issue, my thoughts are (and could be wrong!), that if we run weak antibody controls 2-3 or more times/day-, and this is acceptable for our samples which are not always tested in batches, then this controls the IAT test (dispensing vol, incubation temp and time, centrifugation), which is what the cross-match is except you are using unknown cells with screened patient plasma. So if it is ok to do this for the antibody screens, why would you need to do a control with each automated xm as the system is stable?

    With a manual xm, the control is essentially to address operator error with dispensing plasma- which may not even control the cell suspension if this is performed using pre-prepared OR1r cells with a weak antibody or using sensitised cells. These errors are much less likely with an automated system.

    Did the UKAS inspector actually cite this as a N/C?

    Best wishes
    Last edited by Rashmi; 5th Nov 2017 at 11:36 PM. Reason: correction

  4. #4
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    HI Rashmi. Sorry don't have a stat time for a group for the Vision, we haven't started using it routinely yet but people seem to think it may be slower than the Innova. Wont know until we get up and running hopefully early January.

    We did have a bit of discussion about the cross match control with the UKAS inspector, he did site it as an NC and as you know it is in the BCSH guidelines (7.3.5.An appropriate positive control should be set up with every crossmatch, e.g. a group O, R1r or R1R1 cell tested against a weak anti-D. This provides assurance that the overall process has been performed correctly.) I suspect like a lot of people we had only been applying this to manual cross match but he was pretty sure we should be putting up controls with every automated cross match as well. I will be brining this up at our next regional meeting so I'll report back if there is anything interesting from that discussion.

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