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Immunohematology Reference Laboratory (IRL) Services

Blood Centers of the Pacific – Reference Lab, 270 Masonic Avenue, San Francisco, CA 94118, Telephone: 415-749-6681 or 888-673-3522 (Toll Free), FAX: 415-749-6688

CA Clinical Laboratory License
Biologics License 2014
CAP Participant Number 2376901
AABB Accreditation
CLIA License #05 D0693508

Medical Director: Suchitra Pandey, M.D.
Manager of the Reference Lab: Debbie Warren, MT(ASCP)SBB

Immunohematology Reference Laboratory (IRL) provides testing and consultation services to assist hospitals in solving patients’ red blood cell (RBC) serological problems. The IRL also offers platelet compatibility testing to provide compatible single donor platelets for patients who are refractory to random donor platelets. The IRL at Blood Centers of the Pacific is accredited by the AABB for high complexity testing, and it is licensed by the State of California. The IRL performs proficiency surveys from the AABB and the College of American Pathologists (CAP). The IRL participates in the American Rare Donor Program (ARDP), which provides a nation-wide search service for rare blood that is not available locally.

The IRL is staffed 24 hours / 7 days a week. On-site staffing is available from 8:00 AM until 11:00 PM, Monday through Friday. On-call staffing is available for emergency testing after regular business hours, on weekends and on holidays.

Guidelines for Emergency Status

The following questions are designed to help identify which referrals should be elevated to an emergency (STAT):

1. Patient’s clinical symptoms:
  a. High output failure: heart failure-rapid beating with insufficient O2 delivery.
  b. Angina: coronary artery disease with persistent decrease in O2 delivery to the myocardial muscle.
  c. Impending stroke: cerebral vascular disease with persistent decrease in O2 delivery to the cerebrum.

2. Is the patient actively bleeding? Yes / No
Note: a rapid drop in hemoglobin (>1 gm/dL / 24 hours) places the patient at risk.

3. Does the patient require surgery during the next 24 hours?
Yes / No

4. Are all units incompatible? Yes / No

Emergency status should be considered for patients who:

demonstrate any of the symptoms listed in #1. –or—
answer “yes” to either question #2 and #4, or #3 and #4.

IRL Test Menu

The following is a list of the services offered by Blood Centers of the Pacific Immunohematology Reference Laboratory:

Tests Performed – Red Cell Serology
ABO Grouping (ABO Discrepancy)
ABO/Rh Grouping
Adsorption - Autologous
Adsorption - Allogeneic
Adsorption - RESt
Antibody Screen
Antibody Identification Panels (multiple techniques)
  • LISS
  • PEG
  • DTT
  • Enzyme
Antigen Typing
Direct Antiglobulin Test (DAT)
DNA Genotype for Human Erythrocyte Antigens
Elution
Extended Phenotype
Neutralization
Red Cell Extended Phenotype
Red Cell Separation
Red Cell Treatment
  • EGA
  • DTT
  • Chloroquine
Rh Discrepancy
Rh Phenotype
Titration Studies for HTLA
Tests Performed - Platelets
Platelet Antibody Screen
Platelet Crossmatch
HPA-1a Antigen Typing
Neonatal Study

IRL Sample Requirements

For red cell serological testing:
Sample: Submit at least 20-21 mL EDTA (purple top) of whole blood. Include a pre-transfusion specimen for typing, if available. Patient samples must be labeled with the 1) patient’s first and last name, 2) medical record identification number, 3) the date and time the samples were drawn and 4) the initials/name of the phlebotomist. Specimen labels MUST match the information on the request form. The request form must be completed as thoroughly as possible; including a list of the patient’s medications and the patient’s transfusion/pregnancy history. If the patient was ever transfused, the date of the most recent transfusion and the number of units transfused is critical.

Shipment: Samples for RBC serological testing should be shipped in a container that maintains a temperature between 1oC and 25oC, and tubes should arrive in the IRL within 24 hours after they are collected.

Please complete, as thoroughly as possible, the Reference Laboratory Test Request (50-LABREF01) and contact the Blood Centers of the Pacific laboratory personnel.

For Platelet testing:
Sample: Submit at least 10-14 mL EDTA (purple top) of whole blood. Patient samples must be labeled with the 1) patient’s first and last name, 2) medical record identification number, 3) the date and time the samples were drawn and 4) the initials/name of the phlebotomist. Specimen labels MUST match the information on the request form.

Shipment: Samples for serological platelet compatibility testing should be shipped in a container that maintains a temperature between 1oC and 25oC, and the tubes should arrive in the IRL within 24 hours after they are collected. If a sample is referred for platelet isolation and testing, i.e. testing for a possible platelet donor, the samples should be shipped in a container that maintains room temperature (18oC – 25oC).

Please complete, as thoroughly as possible, the Platelet Studies Request/Billing (50-LABREF02) and contact the Blood Centers of the Pacific laboratory personnel.

Turnaround Times (TAT) for Red Cell Testing

Depending on the complexity of the testing and the patient status, turn around times will vary. The following guidelines are used by Blood Centers of the Pacific:

Patient Status Turnaround Time for Verbal Report
Life Threatening Emergency 8 hours after the sample is received
Transfusion Needed
NOT life-threatening
24 hours after the sample is received
Not Urgent Minimum of 2 days after the sample is received

The turnaround times listed above are from the time the sample is received in the IRL. The times listed above are guidelines. The turnaround time for reporting results (verbally or by FAX) on a STAT request is, generally, within 8 hours after the sample was received. If the case requires more time, the referring hospital will receive progress reports.

Turnaround Times (TAT) for Platelet Testing

There is a significant delay in receiving crossmatch-compatible platelets. Platelets must be tested within the first 48 hours after they are donated; however, processing (including bacterial detection testing) regularly requires >48 hours to complete. (It is not possible to test platelets that are available for distribution.) After compatibility testing is completed, compatible platelets are tagged for distribution as soon as they are labeled.

Consequently, crossmatching is not performed on a STAT basis unless the patient’s physician and the blood center’s Medical Director agree that the patient should receive platelets with incomplete test results.

Requesting platelets from previously compatible donors: Sometimes it is possible to request the BCP Special Donations Department (415-749-6656) to recruit donors who were previously compatible with a refractory patient. This process requires advance planning to provide time for recruitment and testing, but it is especially helpful if the patient has an ongoing need for compatible platelets. The IRL provides lists of previously compatible donors to the Special Donations Recruiter, who schedules donations, as requested. This process only works if the list of compatible donors is adequate (>10 names) to allow successful recruitment.

Reporting and Billing

Preliminary reports (prior to final review) and billing information are Faxed when testing is completed. Final reports are mailed to the hospital after the final review has been completed. Billing for testing services is handled through the normal billing process at BCP.

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