Adverse Event Investigation - Provincial

Discipline

Transfusion Medicine

Overview

Description

A post-transfusion specimen collected as soon as possible following the recognition of an adverse transfusion reaction, with the primary intent of ruling out an acute hemolytic transfusion reaction. If the sample is not received within a timely manner of reporting an adverse transfusion reaction to the Transfusion Medicine Lab, this specimen may be requested by laboratory staff.
A separate order for this test is not required from the Most Responsible Physician (MRP); the permission to draw this specimen is implied as a part of the order for blood transfusion, as its requirement is determined by the occurrence of an adverse transfusion reaction.

Alias

Adverse Event
Transfusion Reaction Investigation

Specimen Information

Specimen types accepted

Whole blood

Specimen collection container

EDTA (Lavender top)
- Specimen (Blood and Microtainer) Collection Tubes

Required volume

Optimal Volume: 4 mL
Minimum Volume: 1 mL
Pediatric Volume: 1 mL

Submitting the minimum volume makes it impossible to repeat the test or perform confirmatory/reflex testing. In some situations, a minimum volume may require a second collection.

Transport and stability

Store at 2-8ºC
Specimen stability varies depending on methodology (24 – 72 hours). Refer to local laboratory policies to determine specimen stability.

Rejection criteria

Lab Medicine Specimen Acceptance and Rejection Criteria

Testing Information

Relevant clinical history

Refer to TAER (Transfusion Adverse Event Report) form completion instructions in Guideline SK 18

Clinical interpretation

For immediate discussion and preliminary interpretation of results, contact the on-call Transfusion Medicine Physician.
Transfusion reaction investigation conclusions are reported by a Transfusion Medicine Physician into the patient permanent electronic record when the adverse event investigation is complete.

Performance

Methodology

Gel testing, tube testing or solid phase testing.

Days/times performed

Complex sites (RUH and RGH): testing available 24 hours/7 days a week.
Advanced sites: testing available; hours variable.
Basic sites: testing available; hours variable.
Current State Blood Drop Map

Maximum laboratory time

Routine:

Within 24 hours of receipt in Transfusion Medicine.

Urgent:

Within 4 hours of receipt in Transfusion Medicine.

STAT:

Within 1 hour of receipt in Transfusion Medicine.

Specimen retention time

5 weeks

Other information

Reflex Testing	As determined by type of reaction reported and results of initial testing, as dictated by internal lab policy. Appendix 10 - Adverse Rxn Workup Categories + Testing Protocol - Job Aid for TML (saskblood.ca).
Additional Comments	Bedside clinical staff must report adverse events immediately to the most responsible healthcare provider by phone for direction regarding patient management and necessary investigations. Notify the Transfusion Medicine Laboratory by phone of all transfusion adverse events. Adverse event information: SK Transfusion Resource Manual. Specimen collections must be accompanied by the Saskatchewan Transfusion Adverse Event Report Form. All fields of page 1 must be completed prior to submission to the Transfusion Medicine Laboratory. Refer to completion instructions in Guideline SK 18.
Forms Required	Facility specific Transfusion Medicine Lab Test Request Forms. In the absence of a facility specific form or for referral of specimens to designated sites for testing, use the SASK BLOOD RBC CROSSMATCH/ANTIBODY INVESTIGATION REFERRAL REQUISITION. Saskatchewan Transfusion Adverse Event Report Form.
Relevant Recent Medication History	Refer to TAER completion instructions in Guideline SK 18.

Last Updated: June 12, 2024