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
Telephone: 606-337-4288 Telephone: 865-632-5133
Tommy
Good, MT (ASCP) Christopher
Hall, MT (ASCP)
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
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
donor
and component processing. Rotation is
scheduled individually or in pairs.
DATE OF REVISION:
January, 2004
MEDT 392: INTERMEDIATE CLINICAL PRACTICE II
BLOOD BANK CLINICAL CHECKLIST
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