What is this document about?
This good practice guidance (GPG) document is based on existing UK guidance highlighting the importance of correctly understanding the reason for an ‘indeterminate’ blood group, resolving the blood group where possible and making the correct decisions for patient safety. This includes illustrative example cases based on previous reports to SHOT related to this issue.
Who is this for?
This guidance document is particularly aimed at hospital transfusion laboratory managers; transfusion IT (Laboratory Information Management System/LIMS and Electronic Patient Records/LIMS) providers; haematology medical staff and transfusion practitioners.
Why is this document needed?
Indeterminate ABO group on initial testing can lead to delays in transfusion and incorrect decisions in component selection. A UK NEQAS exercise and survey have highlighted gaps in practices and staff knowledge. This guidance document has been drafted to address issues identified. Policies, procedures and processes must consider the impact of communication, leadership, safety culture, human factors and ergonomics on safe decision-making.
How this has been developed?
Following a UK NEQAS Blood Transfusion Laboratory Practice (BTLP) exercise in 2023, this guidance document has been developed as a collaborative initiative by Serious Hazards of Transfusion (SHOT), United Kingdom Transfusion Laboratory Collaborative (UKTLC) and United Kingdom National External Quality Assessment Service (UK NEQAS).
Below are the three associated documents; Good Practice Guide for managing indeterminate ABO blood groups and support safe decisions, the complete UK NEQAS and SHOT report, and the UK NEQAS and SHOT summary infographic.
Good Practice Guidance for managing indeterminate ABO blood groups and support safe decisions 2024
The Good Practice Guide is an interactive document with detailed example cases including narrative and contributory factors, specific learning points and recommended resources, and a gap analysis to support compliance with good practice.
UK NEQAS and SHOT Report – Uninterpretable ABO report 2024
The report gives detailed analysis of the results of the UK NEQAS survey.
UKNEQAS and SHOT Summary infographic 2024
The infographic summaries the findings outlined in the report, and details recommended resources.
Key safety messages (applicable to every transfusion laboratory)
- Indeterminate ABO group on initial testing can lead to delays in transfusion and incorrect decisions in component selection for all patients including transplant
recipients - Policies and procedures in the transfusion laboratory for investigating and resolving indeterminate blood groups in all clinical scenarios should be aligned with UK
national/British Society for Haematology (BSH) guidelines - All discrepant blood group results must be fully investigated with an aim to explain the anomaly and define the blood group. This may require referral to a reference
laboratory. A full transfusion history including transplant history is essential when interpreting test results - The configuration of the LIMS must ensure that ABO incompatible blood components cannot be issued
- Indeterminate blood group scenarios must be included in the competency and training program for laboratory staff
- Assigning a ‘safe’ (group O) ABO group to a patient for transfusion purposes may have unintended catastrophic consequences for solid organ and haemopoietic
stem cell transplant recipients - Policies, procedures and processes must consider the impact of communication, leadership, safety culture, human factors and ergonomics on safe decision-making
Recommendation
All transfusion laboratories should review their policies, procedures and processes in relation to the management of samples with
indeterminate blood groups on initial testing. This includes testing, release of ABO compatible blood components, IT configuration and communication of results to the
end user. Transfusion laboratory managers to bring relevant issues to the attention of IT professionals including LIMS and EPR providers.