• Inventory and Processing
• Issuing and Proper Usage of Blood and Components
• Storage and Transportation of Blood/Components
• Quality Control/Quality Assurance
• Specimen Acceptability/Pretransfusion Testing
• Obstetrical Considerations
• Neonatal Transfusion Practices
• Transfusion Complications
• Molecular Diagnostic and Immunologic Assays

INVENTORY AND PROCESSING
The student will assist in obtaining and maintaining an appropriate inventory of blood and components.  She/he will gain experience in serologic testing, record keeping and component storage.  Upon completion of this unit, the student will be able to:
 

1. Document and report inventory levels to the blood supplier.
2. Place orders for and/or coordinate return of products based on established target inventory levels, anticipated usage, product availability, and product expirations.
3. Inspect donor units as received into inventory and prior to issue according to defined criteria.
4. Initiate quarantine and appropriate documentation for any nonconforming product.
5. Perform unit log-in/accessioning of donor units.
6. Perform confirmatory ABO and Rh typing, as appropriate.
7. Perform appropriate labeling of donor units.

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ISSUING AND PROPER USAGE OF BLOOD AND COMPONENTS
The student will learn and assist in the proper issuance of blood and components.  She/he will learn to evaluate proper blood utilization based on criteria established by the clinical facility.  Upon completion of this unit, the student will be able to:

1. Perform all record keeping procedures related to the issuance of blood and components for patient transfusion including:
2. Review of all patient and donor unit identification names and numbers
• Visual inspection of units
• Documentation of unit disposition
3. Discuss the return of products following dispense with regard to acceptance criteria for reissue.
4. State the procedure for the emergency release of uncrossmatched blood.
5. Select and pool platelets for transfusion.  Compare and contrast the storage conditions and expiration time of the products prior to and after preparation for transfusion.
6. Select and prepare fresh frozen plasma for transfusion.
7. Compare and contrast the storage conditions and expiration time of the products prior to and after preparation for transfusion.
8. Select and prepare cryoprecipitate for transfusion.  Compare and contrast the storage conditions and expiration time of the products prior to and after preparation for transfusion.
9. Select appropriate red blood cell products for transfusion and discuss how special requirements listed below impact product selection:
• Leukoreduced
• Irradiated
• CMV Negative
• Hgb S Negative
• Antigen Negative.
10. Explain why blood is irradiated for selected patients.
11. Identify which patient groups should receive CMV Negative products.

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STORAGE AND TRANSPORTATION OF BLOOD/COMPONENTS
It is important to remember that for the blood and/or components to provide maximum benefit to the recipient, the products must be maintained at the required temperature on the shelf or during transport.  Upon completion of this unit, the student will be able to:

1. Identify the different components that can be prepared from a single whole blood donation.
2. State the purpose and advantages of collecting and tranfusing platelets prepared from an apheresis instrument.
3. List the storage/transport conditions required for each component following manufacturing.
4. Identify the various packing material designed to maintain appropriate temperature during transportation of each product type.
5. Explain how transportation temperatures are periodically quality controlled.
6. Discuss how continuous monitoring of blood storage devices is conducted and documented.
7. State the acceptable storage temperature ranges for the following storage devices:
• Red cell refrigerators
• Plasma/Cryo freezers
• Platelet incubators
• Reagent refrigerators
8. Discuss how required periodic preventative maintenance is performed on each type of blood storage device.

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QUALITY CONTROL/QUALITY ASSURANCE
The student will learn all the various factors involved in quality control and quality assurance in the blood bank and will perform routine daily quality control procedures.  Upon completion of this unit, the student will be able to:

1. Differentiate between the terms "Quality Assurance" and "Quality Control."
2. Identify the key components of the Blood Bank's Quality Plan.
3. Define "control."
4. Give examples of how controls are used in Blood Bank testing.
5. Perform daily reagent Quality Control.
6. Explain how quality is verified and documented for critical equipment used in the blood bank laboratory.
7. State the AABB standards for the appropriate time interval records related to maintaining the following:
• Patient blood types
• Compatibility test record
• Units dispositions
• Patient antibody identifications
8. List factors that can minimize human errors and assure Personnel Quality Control.
9. Differentiate between the terms "Preventative Action" and "Corrective Action" as they relate to error management.

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SPECIMEN ACCEPTABILITY/PRETRANSFUSION TESTING
The student will learn and perform the various tests involved in compatibility testing.  He/she will also learn the follow-up procedures used when blood is incompatible.  Upon completion of this unit, the student will be able to:

1. Evaluate specimens submitted for pretransfusion testing with respect to defined labeling criteria, age of specimen, appearance of specimen.
2. Accurately perform and interpret all serologic testing procedures required to provide compatible blood for transfusion, including:
• ABO and Rh typing of patient
• Antibody screening
• Antibody identification
• Selection of appropriate donor units for compatibility testing
• Crossmatch testing
3. Recognize test reactions characteristic of the following situations and suggest or perform correct follow-up procedures:
• ABO cell-serum grouping discrepancies
• Rouleaux
• Cold reactive auto and/or alloantibodies
• Single/multiple blood group alloantibodies
• Warm autoantibodies
4. Identify when weak D testing must be performed as part of Rh typing (i.e. donor units, transfusion recipients, prenatal patients, neonates).
5. Given a patient sample with one or more clinically significant antibodies, be able to perform the following:
• Accurately identify antibody specificity(ies) with statistical confidence.
• Confirm identification by antigen typing patient red cells.
• Determine the number of units to select for antigen screening.
• Perform and document antigen typing of selected donor units using appropriate controls.
• Accurately label donor units as antigen negative.
6. Given a specimen with a positive DAT:
• Perform Direct Coombs testing using appropriate polyspecific and monospecific AHG reagents.
• Evaluate DAT results relative to patient diagnosis, medication, transfusion history.
• Perform an RBC elution when indicated.  Correctly identify antibody(ies) contained in an eluate.
7. Discuss and interpret results of special procedures for antibody testing/identification and resolution of incompatibility, such as:
• REST absorption technique
• Enzyme treatment of RBCs
• W.A.R.M. autoabsorption
• Homologous adsorption
• Neutralization techniques for Sda, Chido, Rogers antibodies
• Antibody titration procedures

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OBSTETRICAL CONSIDERATIONS
The student will perform and interpret tests on maternal blood samples as related to the issue of RhIG products and recognition of potential HDN.  Upon completion of this unit, the student will be able to:

1. Accurately determine the ABO blood group and Rh type of maternal blood samples, and interpret the results.
2. Recognize a mixed field weak D test due to a feto-maternal bleed.
3. Evaluate patient history and test results to determine the need for:
• antepartum RhIG
• postpartum RhIG
4. State the dose of RhIG in available RhIG products.
5. Perform a screening test for a feto-maternal bleed and evaluate results.
6. Perform and/or explain the principle of a quantitative test for feto-maternal bleeds.  In addition, from case histories determine the fetal bleed and calculate the required dose of RHIG.
7. Evaluate the antibody screen and antibody identification as to possible cause of HDN.
8. Demonstrate proper technique in performing an antibody titration.
• Interpret result as to titer and score
• Recognize a significant change in titer given a series of results on the same patient

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NEONATAL TRANSFUSION PRACTICES
The student will receive blood samples from neonates and perform tests as requested.  He/she will evaluate results and perform additional tests as indicated or directed by physician or instructor.  The student will assist in the selection and preparation of blood and components requested for transfusion therapy of neonates.  Upon completion of this unit, the student will be able to:

1. Define the neonatal period.
2. Demonstrate proper technique when determining the ABO Blood Group, the Rh type, the Direct Antiglobulin Test (DAT) on either cord blood, venous and/or capillary samples.
3. Distinguish ABO Hemolytic Disease of the Newborn (HDN) from HDN caused by maternal alloantibody(ies).
• Evaluation to be based on actual serologic findings or known case histories.
4. Select the most appropriate elution technique when evaluating a positive direct antiglobulin test.
5. Demonstrate the elution of an antibody (if applicable) using either the Lui-Freeze/Thaw or Acid Elution technique.
6. Discuss policies related to blood selection and compatibility testing requirements for neonates in need of:
• Routine transfusion
• Exchange transfusion
7. Demonstrate or describe the preparation of blood products for aliquot or exchange transfusion including:
• Packed red blood cells
• Modified whole blood
• Platelets
• Fresh frozen plasma

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TRANSFUSION COMPLICATIONS
The student will perform all necessary tests and clerical work necessary to work up a transfusion reaction.  Upon completion of this unit, the student will be able to:

1. Define the term "transfusion reaction."
2. Identify the signs and symptoms that may accompany hemolytic transfusion reactions.
3. Describe the protocol for the investigation of a transfusion reaction including initial and extended testing according to AABB Standards.  Arrange the steps in a post-transfusion work-up in the appropriate sequence.
4. State the most frequent cause of an acute hemolytic transfusion reaction.
5. List the characteristics of a delayed hemolytic transfusion reaction, including the etilogy and the usual clinical consequences of such a reaction.
6. Name the most frequent cause of febrile transfusion reaction.
7. Name other types of immunologic transfusion reactions (not including acute hemolytic and febrile non-hemolytic).
8. Name the nonimmunologic cause or causes of immediate and delayed transfusion reactions.
9. Given a pretransfusion specimen and post transfusion specimen, the student will perform serological techniques and interpret the test results in an acceptable amount of time to assist the physician to initiate appropriate therapy.
10. Discuss the features of graft-versus-host disease including etiology and prevention.
11. Name the diseases that can be transmitted through blood or blood components.
12. List the screening tests currently performed on donor blood to detect and prevent transfusion transmitted diseases.
13. Identify the limitations of infectious disease testing in relation to the "window period" of infection.
14. Explain how new technologies are impacting the "window period" of particular infectious diseases.
15. Explain the fundamental differences between infectious disease screening tests and confirmatory tests.
16. Define the current risk of disease transmission for HBV, HCV and HIV through blood transfusion.
17. Define the term "Look-back."

MOLECULAR DIAGNOSTIC and IMMUNOLOGIC ASSAYS
Objectives
Upon completion of this unit, the student will be able to:

1. List the assays and identify the analyte in the affiliate's laboratory that utilize molecular diagnostic techniques.
2. Explain the principle of each assay listed in #1.
3. For each assay listed in #1, discuss its clinical significance (e.g., impact on diagnosis or treatment of associated disease).
4. List the assays and identify the analyte in the affiliate's laboratory that utilize diagnostic immunologic techniques.
5. Explain the principle of each assay listed in #4.
6. Perform immunological assays offered by the affiliate.
7. For each assay listed in #4, discuss its clinical significance (e.g. impact on diagnosis).

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