What Type Are You?
Blood Typing: Expanding The National Database
The world of blood banking and how it effects process in the United States is nuanced and, oftentimes, overcomplicated. The ability for people to find out their blood type is concerning. Blood typing could be made easier. In this two-part article, I pose that we can simplify the blood typing process and minimalize the margin for fatal inaccuracies in blood transfusions in the United States through the expansion of a national database of blood types that includes information from all blood centers, including at clinics and hospitals. Furthermore, I posit that this national database would aid lab staff in informing individuals about their blood type.
National blood type database:
To understand the need for the expansion to a national database of blood types, we need to contextualize how these blood types are performed. Most blood typing in the United States is done at large donor centers, followed by other dedicated blood banking centers. If the blood typing is performed at a clinic or hospital it will only be added to their (large donor center) data base if the person is transfused. There are some variations to this pattern; but, this is the most common one. However, to reduce workload and worry for the clinical laboratory, many hospitals are performing electronic cross-matches.
In the process of performing electronic cross-matches, the blood bank computer system compares ABO and Rh types of the donor and recipient for compatibility. Note that computer cross-matches can only be used when the recipient has been tested on more than one occasion and when a computer system is used that is approved by FDA for this purpose and validated on site. In addition, you cannot use computer cross-matches under the following circumstances: 1) If the recipient or donor has a clinically significant antibody; or 2) If the recipient has an ABO discrepancy. In those settings, a serologic cross-match must be done instead. Still blood establishments must have standard operating procedures (SOPs) "to demonstrate incompatibility between the donor’s cell type and the recipient’s serum or plasma type" under the compatibility testing requirements in 21 CFR 606.151(c).
However, this process starts to get grey in that the margin for error increases when lab staff must verify a person’s type. Since giving blood of the wrong type can be fatal, accreditation organizations require this verification through past records or another cross-match to be performed independently. I have seen laboratories grab the blood from the previous test and just have a different Technologist perform the test. This can be a real tough thing to do when you are working alone on third shift. The best method that I’ve garnered from my years of experience on the bench is to repeat or restart the entire process over by going to the floor and redrawing the patient thereby removing any pre-analytic error (patient misidentification).
The downside of this preferred process is that patients frequently do not like the redraw and suspect you did something wrong such as lost their blood. The Technologist then repeats the typing and antibody screen on this blood. Again, this isn’t ideal and involves a fair amount of extra work, sometimes at a time when response is critical. In critical situations, a patient can be given O negative blood to quickly remedy blood loss; but, keep in mind once you start down that road, you may have to carry on with that type. Please consult your facility policy on administering O negative blood in emergent situations. This policy should have guidelines as to how many units given and length of time before you can start giving the patient their type specific blood. I further contend that the expansion of a national data base of blood types would remedy the usage of more O negative blood than necessary.
Blood banks and other clinical laboratories would begin to see a decrease in the margin of imprecision that leads to fatal inaccuracies through the creation of a national data base. This data base would comprise of information from all the various blood donor centers around our nation contributing their information to this register. The creation of a national database would often eliminate the need for the replicate process and would aid individuals in knowing their blood type, which is also desired beyond purely direct medical reasons. You could start with type-specific blood rather than tapping into our precious supply of O negative blood. I would like to pause and encourage readers, especially blood bankers today, to use this article as an entry point for useful conversation on simplifying the often complicated operational and communication processes surrounding blood donation and blood transference. Keep in mind I have been off the bench for many years so I am reaching into my senior citizen brain to write this article.
Another added benefit of a national database would ease the ability to communicate one’s blood typing to curious patients, which I discuss in the second section of this article.
How do I get to know my blood type?
Why is it so difficult to get your blood type done? How many times have we all been asked while drawing someone’s blood “Can you tell me my blood type?” The canned response is “If you donate blood to your local blood center they will tell you your type.” Not everyone can or will want to donate blood. These folks go to their doctor and ask if they can have a blood type done they will get that same canned response. One of the biggest obstacles to getting this done is that insurance will not pay. The billing code “Just curious” doesn’t exist to my knowledge.
Having this information about your blood type can be useful and more importantly reassuring for reasons unknown. The typing itself costs pennies to the laboratory (antibody screen a little more labor intensive and pricey). One facility I worked at years ago had Health fairs where we had a booth and did finger poke typing. We were literally mobbed with people wanting to know their type. Clinical laboratories could also offer blood typing to cover those who cannot or decide not to donate their blood. This would aid in growing this proposed national data base of blood types.
Conclusion
The world of blood banking and how it effects process in the United States is nuanced; and, as I posit in this article, more complicated than necessary. The expansion of a national database of blood types in the U.S. would aid in simplifying the blood typing process and minimalize the margin for fatal inaccuracies in blood transfers. A national database would not only aid lab staff in informing individuals about their blood type; but, lab staff could build this database through providing typing on a larger scale as well. The purpose of these suggestions are to encourage readers, especially blood bankers, to reflect on these ideas and use this article as an entry point for useful conversation on simplifying the often complicated operational and communication processes surrounding blood donation and blood transference.
Also, it seems that you’ve made it to the end of the article! Thanks for reading. Treat yourself to some bonus fun facts about blood typing below.
Fun Facts about Blood Typing
1. What’s in a name? Blood types are named after antigens that are found on the surface of your red blood cells. These antigens are simple chains of sugars, according to Stanford School of Medicine. "The A flavor makes the A sugar, and the B one makes the B sugar. It turns out that the O flavor doesn't make any sugar," according to Stanford. "Someone that's 'AO' will be type A, because the O flavor of the gene makes no sugar. This person only has the A sugar."
2. “O” really? It appears that mosquitos are on a low carbohydrate diet preferring type O blood to all others. The good news is people with type O blood are less likely to die of malaria (carried by mosquitos). There are some other advantages of being a type O. People with type O blood are the least likely to suffer from cardiovascular issues. People with type O blood are less likely to suffer from stomach cancer, gastrointestinal cancer and pancreatic cancer. They are also at lower risk of developing type 2 diabetes.
3. The luck of the draw! But O is not the only lucky blood type. People with Type A blood tend to have higher cortisol levels than those with other blood types. Cortisol is the stress-relieving hormone and blood Type B has 50,000 times the amount of friendly bacteria than blood types A and O do.
No matter what your blood type there is good and bad associated. So be proud and happy to B and know you’re A plus and the best O-round.
Laboratory Informatics Expert
4 年Do you envision a database also storing HLA type (if performed) for transplantation?