Clash of the Standards: An Institutional Approach to Fulfilling ABO Confirmation Mandates While Upholding Patient Blood Management Principles

Abstract

Introduction

IQMH standard VI.1 TM042 states there shall be a 2^nd check of the ABO group (ABOConf) either by testing of a second sample or identifying supportive prior records, because verification is a pre-requisite for the provision of group-specific blood (GSB) for transfusion. The use of GSB in turn is valued in inventory management by decreasing the unnecessary use of group O red cells for non-O patients. However, Choosing Wisely advises against sampling more blood than is needed. As such, when lacking historical data, ABOConf demands additional venipuncture, though from the ensuing 7-10 ml specimen, only a few drops of blood are used. Our twin goal was to reduce ABOConf collections while decreasing turnaround times (TATs) by using existing samples. Avoiding new collections is patient-centred by eliminating repeat venipuncture discomfort and leveraging available alternative specimens, as iatrogenic blood loss is a known driver of anemia in healthcare. Furthermore, retroactive leveraging in a laboratory environment was recognized as uniquely free from the possibility of premeditated bedside "double-draw" fraud.

Design and Methods

When an order for red cell transfusion is received, the laboratory information system assists in determining if ABOConf is required. This flag recruits a technologist to determine if, among previously-collected CBCs, there is a sample meeting Transfusion Medicine (TM) labelling requirements (ie- an independent collection in the last 3 days). If present, the sample is retrieved and re-processed in an ABOConf order under the Confirmatory Blood Type Medical Directive. The original collection information (collector/date/time) is documented in the Clinical Information System (CIS). The ABOConf order process includes documentation of the specimen number used for testing, with verification that the sample was a collection distinct from the original Type and Screen. Only if an appropriate CBC is unavailable will a new blood draw occur.

Results

Six months (Jul-Dec 2024) were reviewed. Surgical order locations (Main Operating Room and Pre-operative Clinic) were assessed separately as a group exempt from the lab-ordered ABOConf process, owing to distinct expedient transfusion-readiness concerns. Of 567 non-surgical orders, 364 new collections (2,548 mL) were averted (64%), vs only 5 saved collections in 533 surgical samples (Z 22.2, p< .00001). A 10 day audit showed a TAT decrease as well in the use of previously-collected samples (average 12 minutes vs 77 for new collections).

Conclusions

The use of previously collected samples for ABOConf testing reduced sample collection significantly in the non-surgical population with significantly decreased TAT, while satisfying IQMH standards and Choosing Wisely recommendations. Future goals are to reduce specimen volume when ABOConf draws remain necessary, and to expand this process to Surgical locations.