LINCOLN MEMORIAL UNIVERSITY

SCHOOL of NURSING and ALLIED HEALTH

MEDICAL TECHNOLOGY PROGRAM

 

MEDT 392:   INTERMEDIATE  CLINICAL  PRACTICE  II

2 Credit Hours       Spring Semester

Blood Bank Section

 

INSTRUCTORS:                 

 

Patricia Brown, M.Ed., MT (ASCP)                 Sharon Law, MT (ASCP), SBB          

Pineville Community Hospital Lab                     Baptist Hospital of East Tennessee                   

Telephone:  606-337-4288                               Telephone:  865-632-5133                                                 

                                               

Tommy Good, MT (ASCP)                              Christopher Hall, MT (ASCP)             

Lee Regional Medical Center                            Fort Sanders Regional Medical Center 

Telephone:  276-546-1440                               Telephone:  865-541-1117                                                              

Margie Lawrence, MT (ASCP)                        Conference Time:  Instructors will be

St. Mary’s Health System                                 available for 30 minutes after clinicals

Telephone:  865-545-7152                               for student conference as needed.

                                       

                                            

CO-REQUISITE:         MEDT 340--Immunohematology

 

 

COURSE DESCRIPTION:   This clinical practice focuses on application of material studied in MEDT 340.  The student learns to confidently perform routine procedures for ABO, Rh, direct and indirect antiglobulin, compatibility testing, and antibody identification.  Special Blood Bank procedures are included also.  Transfusion practices for RBCs, FFP, platelets, cryoprecipitate, and RhIG are keyed to AABB Standards.  Taught at the clinical affiliate.

 

 

TEXTBOOK:    The same textbook used for Blood Bank lectures will be utilized                                      

                             during clinicals also.

 

 

METHODS  OF  INSTRUCTION:     Students learn by performing actual procedures in the Blood Bank.  Discussion is provided to help correlate and interpret test results.  Challenging and stimulating Blood Bank problems are presented to prepare students to deal with abnormal as well as normal results.  In order to prepare students to deal with STAT situations, they are given work to complete on a  STAT basis.

 

 

 

 

MEDT 392--Blood Bank

                                                                                                                                                Page 2

 

 

COURSE OBJECTIVES:    Upon completion of the Blood Bank clinical rotation, the student will be responsible for attaining the following objectives:

 

      1.   Practice standard (universal) precautions at all times while in the Blood Bank; 

            maintain a neat, clean, and orderly work area in the lab.

 

         2.  Carefully double-check paper work and computer entries for accuracy.

 

      3.   Perform the following routine Blood Bank procedures with 100% accuracy:

            ABO, Rh, antibody screening, crossmatch, direct antiglobulin test, quality control,                      and sample identification.

 

      4.   Perform cord blood testing according to S.O.P., and be able to correlate ABO and                               Rh of the mother and infant with possible ABO and Rh of the father.

 

      5.   Exclude paternity by interpreting ABO, Rh, or other blood group antigen typing.

 

      6.   Resolve ABO discrepancies caused by subgroups of A, acquired B, cold                                         autoantibodies, hypogammaglobulinemia, and positive DAT.

 

      7.   Differentiate between monoclonal and polyclonal typing sera.

 

      8.   Discuss the active ingredients in the following vials of Blood Bank reagents:

 

              anti-A, anti-B, anti-A,B                       reverse group cells                             

                anti-D                                                     antibody screening cells                    

                anti-A1 lectin                                         panel cells                            

                antiglobulin reagents                          Coombs control cells

                LISS                                                        Anti-K, anti-Fya, etc.

 

      9.   Interpret direct antiglobulin tests to tell if cells are coated with complement  (C3),                                     IgG, or both.

 

    10.   Prepare sensitized red cells by in-vitro adsorption of IgG antibody (as in the                               preparation of Coombs Control Cells). 

 

    11.  Discuss the uses of monospecific vs. polyspecific AHG reagents, and give one                         advantage and one disadvantage of each.

 

    12.   Interpret positive and negative antibody screens to recognize possible antibodies                                   that may be present, based upon the antigram of the screening cells.

 

    13.   Analyze the causes of an incompatible crossmatch when the antibody screen is                           positive;  similarly, identify three reasons why a crossmatch may be incompatible                            yet the antibody screening is negative.

 

    14.   Recognize rouleaux interference in crossmatches, and identify a remedy.

 

                                                                                                                                                MEDT 392--Blood Bank

                                                                                                                                                Page 3

 

15. Evaluate results of antibody panels to recognize a single antibody, multiple                            antibodies, autoantibody, and cold agglutinins.                       

 

16. Resolve incompatible crossmatches by performing antibody panels, identifying                                 antibodies present, and typing the donors for corresponding significant                                            antigens.

 

17. Choose cells for a “selected cell panel,” and interpret to solve complex          

      antibody problems.

 

18. Discuss the AABB Standards requirements for packed RBCs,  frozen RBCs,                                  leukocyte-poor RBCs,  FFP,  random donor platelets, pheresis platelets, and                            cryoprecipitate with regard to the following areas:  

      a.     Transportation

        b.     Method of preparation

        c.     Storage temperature

        d.     Expiration date

        e.     Crossmatch requirement

 

19. Identify ABO and Rh of blood components that may be transfused in an emergency                

      when group-specific is unavailable.

 

20. When given the ABO and Rh of mother and baby, DAT results on baby, and                                  antibody identification results on mother:

      a.     Assess candidacy for RhIg.

        b.     Select appropriate blood for transfusion of infant in cases of ABO, Rh, or other  blood group              

       incompatibility.

 

21. Identify three conditions associated with a positive DAT on cord blood.

 

22. Perform a Fetalscreen procedure, and interpret the meaning of positive and negative                      results.

                                                                                                                                               

23. Determine when Kleihauer-Betke is indicated, and apply results of Kleihauer-Betke                         procedures to determine exact dosage of RhIG required.

 

24. Identify the special requirements for donor blood that  is to be transfused to                                    newborns (e.g., age of blood, CMV status, pretransfusion testing requirements, etc.).

 

25. Discuss the Blood Bank requirements for performing a therapeutic phlebotomy:

      a.     Before sticking the patient

        b.     The procedure itself

        c.     Records required

        d.     Post-phlebotomy requirements.

 

26. Explain how  administration of Win-Rho intravenous immunoglobulin affects                                     subsequent Blood Bank testing for the patient, and resolve the problem.

                                                                                                                                                MEDT 392--Blood Bank                                                                                                                                                      Page 4

 

27. Perform a transfusion reaction work-up according to S.O.P.

 

28. Give three diagnoses of patients who need therapeutic phlebotomies.

 

29. Describe how to calibrate a Blood Bank centrifuge and determine RPMs using a                  tachometer.

                                                                                                                                               

30. Discuss the procedure for checking Blood Bank alarms (refrigerator and freezer),                                 and keep appropriate records according to S.O.P.                                                                                                                                                             

31. Maintain Blood Bank inventory levels according to S.O.P.  Explain how the Blood                          Bank's maximum inventory level is determined.

                                                                                                                                               

32. Discuss the principle and use of the “pre-warm technique” in pretransfusion                         testing.                                                                 

 

33. Discuss the role of the Blood Bank in intraoperative blood salvage, and the               

      requirements as outlined in AABB Standards.

 

34. Attend MEDIC to observe collection and processing of donor blood, preparation of                        components, and  plateletpheresis  procedures.

 

35. The student must be able to perform a STAT blood type, antibody screen, and                                crossmatch for two units of RBCs within 45 minutes.   Failure to meet this                            objective will necessitate extra time in Blood Bank.

 

                        ********************************************

 

Achieving these objectives will require experience in Blood Bank procedures.  Consequently, the minimum requirements of this Blood Bank rotation are:

 

      A.  ABO and Rh Typing                                                     30 patients

      B.   Antibody Screenings                                                     20 patients

      C.  Crossmatches                                                               20 units of blood

      D.  Direct Antiglobulin Tests                                               15

      E.   Cord Bloods                                                                10

      F.   Daily Reagent Quality Control                           5 

      G.  Incompatible Crossmatch Investigation               3

      H.  Antibody Panels                                                           6

      I.   Fetalscreen and Postpartum RhIG                                  2

      J.  Antepartum RhoGam                                                     2

      K. Complete Rh Phenotype                                                2

      L.   Transfusion Reaction Investigation                                 1

      M.  Antibody Titer                                                   1

      N.  Absorption procedure                                                   1

      O.  Elution procedure                                                          1                                                                                                              

                                                                                                                                                MEDT 392--Blood Bank                                                                                                                                                      Page 5

 

A checklist for clinical evaluation is appended to this syllabus.

 

 

EVALUATION METHOD:    This  clinical rotation is graded as PASS or FAIL in accordance with departmental policy.  All objectives must be met before a passing grade will be assigned.  Any absence must be made up at the instructor's convenience.  Students are responsible for notifying clinical affiliates if they are unable to attend clinicals.   Telephone numbers are listed on the first page of this syllabus.

 

 

 

UNITS OF INSTRUCTION:

 

  I.  INTRODUCTION TO THE BLOOD BANK ENVIRONMENT

      A.    Procedure manual (S.O.P.)

        B.    Blood Bank refrigerator and freezer:  contents and acceptable temps

        C.    Reagents:  antisera and reagent red cells

        D.    Hollister (or other Blood Bank ID System) review

        E.     Inventory and disposition of blood

        F.     Record keeping

        G.    Critical values or Med. Alerts

        H.    Lab safety

      I.      Operation of centrifuge/ cell washer

        J.     Computer system

 

 II.  BASIC BLOOD BANK TECHNIQUES

      A.    Proper labeling of tubes and/or gel cards

        B.    Washing red cells

        C.    Preparing red cell suspensions

        D.    Grading agglutination  (1+  to  4+)

        E.     Recording results

 

III.  QUALITY CONTROL

      A.    Test anti-A and anti-B typing sera with known red cells.

        B.    Test anti-D with known Rh-positive and Rh-negative red cells.

        C.    Verify that the anti-human globulin reagent will demonstrate both                                                                                            positive and negative reactions; verify that check cells are working.

        D.    Check temperature charts and thermometers daily and initial.

 

IV.  ABO GROUP   &  RH

      A.    Direct cell typing

        B.    Reverse serum grouping

        C.    Subgroups of A

        D.    Other Rh antigens:   C    c    E    e

        E.     Discrepancies in cell and serum grouping

                                                                                                               

 

 

                                                                                                                                                MEDT 392--Blood Bank

                                                                                                                                                Page 6

  V.  CORD BLOODS

        A.    Proper washing

        B.    ABO group and Rh,  including weak D procedure if mother is Rh negative

        C.    Direct antiglobulin test

        D.    Follow-up on a positive DAT

 

VI.  DAT vs. IAT                       

      A.    Associate positive DAT with antibody coated on the red cells in-vivo.

        B.    Associate positive IAT with antibody present in serum (or anti-sera) reacting

                with red cells in-vitro.

 

VII.  COMPATIBILITY TESTING

      A.    Select appropriate units of blood.

        B.    Move units from uncrossmatched to crossmatched shelf. 

        C.    Perform a major crossmatch between patient's serum and donor's cells; practice  

              “immediate spin” only crossmatch, as well as “AHG” crossmatch.

        D.    Practice setting up an auto control and antibody screen at the same time as                                                                           X-match, especially when blood is ordered to be transfused.

        E.     Discuss the AABB Standards requirements for use of the computer crossmatch.     

        F.     Complete paperwork and/or computer work meticulously to ensure accuracy.

        G.    Process STAT or emergency requests in a timely manner, as defined by the SO

                of the clinical site.

 

VIII.  ANTIBODY IDENTIFICATION

      A.    Consult antigram chart for screening cells first for preliminary indication.

        B.    Antibody panels for ID of AHG-reactive alloantibodies: single and multiple

        C.    Selected cell panels

        D.    Uses of ficin, papain, PEG, Lewis substance, and chloroquine

        E.     Recognize and troubleshoot autoantibodies:  warm and cold

        F.     Identification of cold-reacting antibodies:  specific and nonspecific

       

 IX.  SIGNING OUT BLOOD FOR TRANSFUSION

      A.    M.T. must be present before blood can be removed from the Blood Bank.

        B.    Nurse must bring a request for blood showing the patient's name, two unique identification                                               numbers, and donor number.

        C.    Unit of blood is double-checked by nurse and lab for all identification

                information before it is signed out of Blood Bank.

        D.    Bar code is removed from bag of blood for MEDIC’s records.

        E.     Record keeping is performed to account for final disposition of the unit of blood,                                                                 and charges are issued for the transfusion.

                               

  X.   TRANSFUSION REACTION INVESTIGATION

      A.    Perform a thorough clerical check.

        B.    Draw a post-transfusion sample of blood; observe the serum for hemolysis, and perform a stat                                          DAT.  Compare results with pre-transfusion.

      C     If either of the first three tests is positive, further tests will be required.  Follow  procedure in the                                      S.O.P. manual  exactly.   This will require notification of appropriate  persons, a  thorough repeat                                 of ABO, Rh, crossmatch, andantibody screen on both the pre- and post-transfusion samples,                                                repeat donor typing, and any other procedures indictated by the S.O.P.

        D.    Discuss culture of blood remaining in donor bag in severe febrile reactions.

                                                                                                                                                MEDT 392--Bood Bank

                                                                                                                                                Page 7

 

    

XI.       NEONATAL AND OBSTETRICAL TRANSFUSION PRACTICE

            A.   Hemolytic Disease of the Newborn:  ABO,  Rh,  or  Other

                       1.  Identify the maternal antibody.

                       2.  Elute the antibody coating the infant's cells.

                B.   Selection of blood for exchange transfusion

                C.   Pretransfusion testing for the newborn

                D.   RhIG Candidacy:  Antepartum and Postpartum

                E.   Fetalscreen 

                F.   Discuss Kleihauer-Betke technique, and be able to interpret to calculate the amount of fetal                                                bleed (FMH) to determine exact dosage of RhIG needed.

 

XII.     SPECIAL DEMONSTRATIONS

            A.   Thawing FFP

                B.   Pooling platelets

                C.   Checking Blood Bank alarms

                D.   Blood donors at MEDIC in Knoxville--One day at MEDIC is required for

                       donor and component processing.  Rotation is scheduled individually or in pairs.

 

 

 

 

 

 

 

 

 

 

 

DATE OF REVISION:     January, 2004

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LINCOLN MEMORIAL UNIVERSITY

MEDT 392:  INTERMEDIATE CLINICAL PRACTICE II

BLOOD BANK CLINICAL CHECKLIST

 

 

STUDENT ____________________________  HOSPITAL _______________________

 

TO THE INSTRUCTOR:   Please check each item on this form as entry-level competency is achieved.  The list attached at the end is designed to help the student keep track of the Blood Bank  "quota"  by recording the date that each procedure is performed.   

 

 I.  Location and Purpose.   The student will be oriented to the hospital Blood Bank

      Environment by discussing the location and purpose of the following:

 

      (  )  Safety in the Blood Bank

      (  )  Policy and Procedure Manuals (S.O.P.)

      (  )  Temperature Charts and Records

      (  )  Reagents and Supplies

      (  )  Quality Control

 

      BLOOD PRODUCTS:

      (  )  Labeling Requirements by AABB Standards

      (  )  RBCs

      (  )  FFP

      (  )  Platelets

      (  )  Cryoprecipitate

 

II.  Review of Technical Procedures.   The student must be able to perform the         following tests according to the S.O.P Manual.

 

      (  )  Cell Washing

      (  )  Interpretation of Agglutination

      (  )  ABO Grouping

      (  )  Rh Typing  (to include D, C, E, c, and e)

      (  )  Other Antigen Typing at AHG Phase, with QC requirements    

      (  )  Other Antigen Typing at Room Temperature, with QC requirements

      (  )  Antibody Screening     

      (  )  Compatibility Testing

      (  )  Prewarmed Crossmatch

      (  )  Antibody Identification

      (  )  Direct Antiglobulin Test

      (  )  Elution

      (  )  Cord Blood Testing

      (  )  Type & Screen for Surgery

      (  )  Fetalscreen Procedure

      (  )  RhIG  Protocol:  Antepartum and Postpartum

      (  )  Therapeutic Phlebotomy Guidelines

 

                                                                                                        MEDT 392--Blood Bank Checklist

                                                                                                                                                                                         -2-

 

III.  Blood Bank Policies and Protocol.  The student must be familiar with the policies                         of the Blood Bank, and be able to apply them.

 

      (  )  Critical Values/ Med. Alert

      (  )  Retention of Records

      (  )  Collection, Handling, and Storage of Blood Specimens

      (  )  Release of Blood for Transfusion

      (  )  Handling of Donor Bags/Segments After Transfusion

      (  )  Return and Reissue of Blood

      (  )  Plan of Action in Complete Power Failure

      (  )  Ordering Blood and Determining Inventory Level

      (  )  Transferring Blood to Another Facility:  Paperwork and Packaging

      (  )  Collection of the Blood Sample from the Recipient:   Hollister or other                                  Blood Bank ID System  and Acceptable Age of Blood Sample

      (  )  Pretransfusion Testing of Recipients

      (  )  Selection of  RBCs When Type-Specific is NOT Available

      (  )  Selection of FFP When Type-Specific is NOT Available

      (  )  Guidelines for  Selection of Platelets

      (  )  Guidelines for Selection of Cryoprecipitate

      (  )  Emergency Blood Release Protocol

      (  )  Massive Transfusion

      (  )  Obtaining Blood in an Emergency Situation

      (  )  Releasing UNUSED Crossmatched Blood Back into the Inventory

      (  )  Transfusion Reaction Investigation

 

IV.  Quality Control.  The student must demonstrate working knowledge  of QC                                   in the Blood Bank.

             

      (  )  Daily Reagent Quality Control;  QC Requirements for Special Antigen Typing

      (  )  Daily Inspection of Blood and Components

      (  )  Repeat Testing of Donor Blood by Hospital Blood Bank

      (  )  Checking Temperature of Shipped Blood

      (  )  Proficiency Testing in the Blood Bank  (Internal and External)

      (  )  Records of  Unexpected Antibodies

      (  )  Temperatures According to the NIST Thermometer

      (  )  Maintaining Inventory of Blood and Components

      (  )  Maintaining Inventory of Reagents & Other Supplies

      (  )  Quarterly Alarm Checks

      (  )  Checking Centrifuge RPMs

      (  )  Checking Timers

      (  )  Centrifuge Calibration

      (  )  Review of S.O.P. Manual

      (  )  Blood Utilization Review/ Hospital Transfusion Committee

                                                                                                                               

                                                                                                                                MEDT 392--Blood Bank Checklist

                                                                                                                                             -3-

 

 V.  Clerical and Computer Functions.  The student must demonstrate accuracy  in                 reporting and recording Blood Bank results.

 

       LOGBOOK  and  COMPUTER ENTRIES:

      (  )  Recording Type and Rh

      (  )  Recording Antibody Screen

      (  )  Recording Crossmatches

      (  )  Recording Repeat Donor Typing

      (  )  Recording Cord Blood Results

      (  )  Recording Panel Results for Unexpected Antibody Identification

      (  )  Recording RhIG:  Ante-partum and Post-partum

      (  )  Recording Fetalscreen

      (  )  Recording DAT

      (  )  Recording Other Antigen Typing (Kell,  E,  Duffy,  etc.) with documentation of QC

      (  )  Recording Transfusion Reaction Work-ups

 

      BLOOD BANK INVENTORY BOARD:

      (  )  Incoming Blood Products Added to Inventory Board

      (  )  Crossmatched Section

      (  )  Uncrossmatched Section

      (  )  Removal of Transfused Units from Inventory Board

 

      INCOMING BLOOD PRODUCTS  RECORD  (Computer or Logbook):

      (  )  Incoming RBCs, FFP, and Platelets

      (  )  Confirmation of ABO group/Rh

      (  )  Transfused

      (  )  Transferred Out to Another Facility

      (  )  Returned to MEDIC

      (  )  Documentation and Disposal of Expired Blood Products

 

                                                                                                                               

INSTRUCTOR'S   COMMENTS:    __________________________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

I certify that this student has met all objectives of the Blood Bank clinical rotation, and has demonstrated entry-level competency in the Blood Bank.

 

______________________________________________       ____________________

                        Instructor's  Signature                                                          Date                                                               

Lincoln Memorial University

Medical Technology Program

Blood Bank Clinical Quota

Spring Semester

 

 

NAME ______________________________  CLINICAL SITE ____________________

 

 

Routine ABO and Rh Typing ...............................................................        30 patients

 

  1.  ____________________                         16.  ____________________

  2.  ____________________                         17.  ____________________

  3.  ____________________                         18.  ____________________

  4.  ____________________                         19.  ____________________

  5.  ____________________                         20.  ____________________

  6.  ____________________                         21.  ____________________

  7.  ____________________                         22.  ____________________

  8.  ____________________                         23.  ____________________

  9.  ____________________                         24.  ____________________

10.  ____________________                         25.  ____________________

11.  ____________________                         26.  ____________________

12.  ____________________                         27.  ____________________

13.  ____________________                         28.  ____________________

14.  ____________________                         29.  ____________________

15.  ____________________                         30.  ____________________

 

 

Daily Reagent Quality Control ..............................................................        5

 

1.  ____________________                           4.  ____________________

2.  ____________________                           5.  ____________________

3.  ____________________

 

 

Cord Bloods ............................................................................................      10

 

1.  ____________________                           6.  ____________________

2.  ____________________                           7.  ____________________

3.  ____________________                           8.  ____________________

4.  ____________________                           9.  ____________________

5.  ____________________                           10. ____________________

 

 

 

Blood Bank Clinical Quota                                                                                                 Page 2

 

Direct Antiglobulin Tests (DAT) .............................................................                 15

 

1.  ____________________                             9.  ____________________

2.  ____________________                           10.  ____________________

3.  ____________________                           11.  ____________________

4.  ____________________                           12.  ____________________

5.  ____________________                           13.  ____________________

6.  ____________________                           14.  ____________________

7.  ____________________                           15.  ____________________

8.  ____________________

 

 

Complete Rh Phenotype ...........................................................................   2

 

1.  ____________________                             2.  ____________________

 

 

Antibody Screens ......................................................................................    20

 

1.  ____________________                           11.  ____________________

2.  ____________________                           12.  ____________________

3.  ____________________                           13.  ____________________

4.  ____________________                           14.  ____________________

5.  ____________________                           15.  ____________________

6.  ____________________                           16.  ____________________

7.  ____________________                           17.  ____________________

8.  ____________________                           18.  ____________________

9.  ____________________                           19.  ____________________

10.____________________                           20.  ____________________

 

 

Crossmatches ............................................................................................    20

 

1.  ____________________                           11.  ____________________

2.  ____________________                           12.  ____________________

3.  ____________________                           13.  ____________________

4.  ____________________                           14.  ____________________

5.  ____________________                           15.  ____________________

6.  ____________________                           16.  ____________________

7.  ____________________                           17.  ____________________

8.  ____________________                           18.  ____________________

9.  ____________________                           19.  ____________________

10.____________________                           20.  ____________________

 

Blood Bank Clinical Quota                                                                                                                 Page 3

 

Incompatible Crossmatch Investigation ..........................................................          3

 

1.  ____________________                            

2.  ____________________

3.  ____________________

 

 

Antibody Panels .................................................................................................         6

 

1.  ____________________                           4.  ____________________

2.  ____________________                           5.  ____________________

3.  ____________________                           6.  ____________________  

 

 

Special Antigen Typing, with selection of proper cells to be used for positive and negative controls ..................................................................................................            2

 

1.  ____________________               (AHG-reactive typing sera)

2.  ____________________               (Room temperature typing sera)

 

 

RhIG  (RhoGam) 

 

Post-partum, with Fetalscreen ............................................................................        2

1.  ____________________

2.  ____________________

 

Ante-partum ........................................................................................................          2

1.  ____________________

2.  ____________________

 

 

Antibody Titer  ...............................................           1.  ____________________

 

 

Transfusion Reaction Investigation ..............           1.  ____________________

 

 

Absorption Procedure ....................................           1.  ____________________

 

 

Elution Procedure ...........................................          1.  ____________________