What is the proper procedure for ordering a blood type for a patient?

How to Order Blood Type

Blood samples for typing must be collected and labeled at the patient's bedside by appropriately trained personnel, with minimum patient identifiers including surname, forename, date of birth, and hospital unique identification number. 1

Patient Identification Requirements

All patients receiving blood transfusion must wear a patient identification band with at least two identifiers. 1 The following information is mandatory on both the transfusion request form and sample 1:

• Surname
• Forename
• Date of birth
• Hospital unique identification number or NHS number (or equivalent)

Positive patient identification is paramount to minimize wrong-blood-in-tube events and risks of ABO incompatibility. 1

Sample Collection Protocol

Blood samples must be collected and hand or electronically-labeled at the patient's side by appropriately trained personnel. 1 This bedside labeling requirement is critical for patient safety 1.

For Unknown Patient Identity

When patient identity is unknown, an alternative identification system must include 1:

• At least one unique identifier (e.g., randomly generated seven-digit number with prefix)
• Naming convention (randomly generated from edited phonetic alphabet)
• Date-of-birth system
• Patient's sex

Once the patient's identity becomes known, attach a new identification band and collect a new transfusion sample labeled with the patient's actual details. 1

Sample Validity Requirements

If a patient has received a blood transfusion or been pregnant within the previous 3 months, the sample is only valid for 72 hours from collection to subsequent transfusion. 1 For patients at risk of major blood loss undergoing surgery, ascertain whether they received transfusion at any other hospital within a three-month period 1.

Two-Sample vs. Single-Sample Requirements

Two samples are not always needed if the patient has a suitable 'historical' sample on file. 1 A historical sample may serve as the 'group-check' sample to allow issue of ABO compatible RBCs when 1:

• Patient identification is sufficient to assure the historical sample is from the same patient
• The historical group has the same patient identification and is transmitted electronically (with no manual intervention)

If these criteria are not met, two samples will be required. 1

Baseline Laboratory Tests to Order

For patients at risk of massive hemorrhage, order the following baseline tests 1:

• Full blood count (FBC)
• Prothrombin time (PT)
• Activated partial thromboplastin time (aPTT)
• Clauss fibrinogen (not derived fibrinogen, which is misleading)
• Cross-match

If available, undertake near-patient testing such as thromboelastography (TEG) or thromboelastometry (ROTEM). 1

Emergency Blood Issue Options

Standard Issue

Standard issue of red cells may take approximately 45 minutes and involves serological cross-match or electronic issue. 1

Group-Specific Blood

Grouping can be performed in about 10 minutes (not including transfer time), and group-specific blood can be issued without waiting for antibody screen results. 1 This is a higher-risk strategy depending on urgency 1.

Emergency Uncrossmatched Blood

Group O RhD negative is the blood group of choice for transfusion in emergencies where clinical need is immediate. 1 However, it is acceptable to give O RhD positive red cells to male patients to preserve O RhD negative stock. 1

For emergency patients with unknown blood type, transfusing O RhD positive red blood cells has a low risk (3-6%) of inducing anti-D antibodies. 2 This approach saves more than 10% of total O RhD negative demand and reduces overall population risk of anti-D allo-immunization 2.

Common Pitfalls to Avoid

• Never collect and label samples away from the patient's bedside - this increases wrong-blood-in-tube events 1
• Do not use samples older than 72 hours for patients transfused or pregnant within 3 months 1
• Avoid overdependence on group O RhD negative red cells - this adversely impacts blood stock management 1
• Do not assume two samples are always required - check for valid historical samples first 1
• Never use derived fibrinogen levels - these are misleading; always order Clauss fibrinogen 1