TRAINING CHECKLIST FOR BLOOD BANK
This form should be completed by the TRAINEE
EMPLOYEE NAME:
DATE OF TRAINING STARTED:
1. Read the SOPs and Manuals specific to this training program. Document date completed with trainee
initials.
SOP NO:
SOP Title
Date Completed
Trainee
Initials
Yes
No
Yes
No
2. Please Tick the appropriate box to the right
Training Method
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Explanation Lectures
Demonstration
Practice
Computer based
Self study
Training Materials
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SOP
Manuals
Package Inserts
Book
Lecture Hand outs
Computer Program Handouts
Videotape (s)
Practice materials
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
Version 1
ULC/TCP/10F
Page 1 of 12
Training checklist
Training Element SOP:
Discussed
Observed
Performed
Proficiently
Blood and Blood Components
Temperature requirements during transport for RBCs
and blood components
Monitoring of transport temperatures
Inspection on receipt
o Visible abnormalities
o Expiration date
o screening platelet components for bacteria
o documentation of this process includes the following:
1) date of inspection
2) donor identifying number
3) description of any visual abnormalities
4) action taken
5) identity of the staff performing the inspection
Temperature requirements during storage
Monitoring of storage temperatures
Expiration date
Storage Processing
o Thawing FFP and Cryoprecipitated AHF
o Quality control procedure to indicate functions for
any thawing device.
Request for transfusion
Acceptance criteria for transfusion requests
o Recipient identification
o Kind and amount of blood component request
o Special requests eg. irradiation
o Physician name
o Phlebotomist identification
o Other information
Verbal requests
o When can be accepted
o How to be documented
Recipient’s Blood Specimens
Specimen labeling
o Two dependent patient identification
o Collection date
o Identical labeling of all tubes
o Phlebotomist identification
Compare information on the label and pretransfusion
request form.
o Should be identical
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
Version 1
ULC/TCP/10F
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Training Element SOP:
Discussed
Observed
Performed
Proficiently
o In case of discrepancy or doubt, another sample
should be obtained
Type of specimen
Type of specimen for neonates
Special considerations for incompletely clotted serum
specimens:
 False positive results
 Addition of thrombin or protamin sulphate
Specimen Age
Storage of blood samples:
Rrecipient samples and a segment from the donor red cell
containing component should be stored at refrigerated
temperatures for seven days after transfusion.
Testing of Recipient’s Blood Specimen
ABO group
 Principle
 Specimen
 Reagents
 Procedure for Testing RBCs
o RBC washing
o RBC suspension
o Preparation of 2-5%
o Type and size of tubes used for the test
o No. of drops of antisera to be added
o No. of drops of RBCs suspension to be added
o Mixing
o Centrifugation time & force (speed)
o The proper way of resuspending cell buttons to
examine for agglutination
o How to read and the grade result
o Interpretation of the result
o Recording the result
 Special Cosiderations for Testing Serum
o No. of drops of patient serum to be added
o No. of drops of reagent cells to be added
o Compare test results of forward grouping with those
obtained by reverse grouping
 Quality Control
 Interpretation
 Causes of Discrepancies between RBC and serum
tests
 Resolving ABO discrepancies
If discrepancy is detected and transfusion is necessary before
resolution only group O RBC’s shall be issued.
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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Training Element SOP:
Discussed
Observed
Performed
Proficiently
Tube test for Determination of Rh (D) Testing
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Principle
Reagents
Procedure
Control
Interpretation:
o D-positive
o Weak-D
o False positive reactions
o False negative reactions
Test for weak-D
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Principle
Reagents
o Reagent anti-D
o Antihuman globulin reagent
o IgG- coated red cells
Procedure
Type and size of tubes used for the test
Control
Interpretation
o In case of invalid interpretation of the weak D test
and if the specimen is from a potential transfusion
recipient, Rh-negative blood should be given. If the
specimen is from a donor, the unit should not be used
for transfusion.
o Causes of false- positive and false-negative indirect
antiglobulin tests
o Confirmation of negative test result.
Antibody Detection Test
Reagents
Type and size of tubes used for the test
Procedure
o Incubation at 37ºC
o LISS Indirect antiglobulin test
Test reaction:
o Reading
o Grading
o Recording
o Confirmation of negative IAT results
Quality Control:
o Daily check with weak examples of antibody e.g.
weak human IgG anti- C and weak human IgG anti- E
o Confirmation of negative LISS Indirect antiglobulin
test result.
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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Training Element SOP:
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Discussed
Observed
Performed
Proficiently
Action to be taken when clinically significant antibodies
are detected
Situations for the need to collect a sample from the
patient within three days of the scheduled transfusion
(Day 0 is the day of draw)
Special considerations for neonates
Direct Antiglobulin Test
Principle
Specimens
Reagents
Type and size of tubes used for the test
Procedure
Controls
Interpretation
The use of IgG coated RBCs
Causes of false results
How to resolve false results
The use of monospecific antihuman globulin (anti IgG)
and anti complement antisera.
Comparison of Current and Previous Test Results
 ABO grouping and Rh typing performed during the past
12 months
 Difficulty in blood typing, clinically significant
antibodies, significant adverse events to transfusion unit
& special transfusion requirements.
Gel Agglutination Technology
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Principle
Specimens
Materials
ABO Typing Procedure
Rh Typing Procedure
Antibody Detection Procedure
o Centrifugation of serum or plasma that has been
stored frozen
o Inspection of microtubes
o Preparation of 0.8% RBCs suspension
o The use of disposable calibrated transfer pipettes to
deliver red cell suspension and serum/ plasma
o Incubation of cards
o Centrifugation process
o Reading microtubes for agglutination
o Interpretation of test reaction ( negative result,
reaction grading & mixed reaction)
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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Training Element SOP:
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Discussed
Observed
Performed
Proficiently
o False results and interfering factors
Direct Antiglobulin Test Procedure
Compatibility Test Procedure
Testing of Donor RBCs
ABO Group Confirmation
Rh type confirmation for Rh negative RBC units
Discrepancies should be reported to KCBB and should be
resolved before issue of blood for transfusion purposes.
Selection of Donor RBC Unit and Components
ABO & Rh type of whole blood or RBC components to
be transfused to the patient
ABO group of RBCs free components
Special considerations for neonates
Selection of compatible blood and components in special
circumstances
o Leukocytes-reduced components
o Cytomegalovirus
o Irradiation (patient at risk of transfusion associated
graft versus host disease, donor is blood relative to
the recipient or the donor is selected for HLA
compatibility by typing or cross matching)
o Hemoglobin S negative RBC or whole blood
o Massive transfusion (patient has received an amount
of blood approximating the total blood volume)
Compatibility Testing (Crossmatch)
 Serologic
o Immediate spin (Its significance)
o Incubation at 370C
o IAT
 Type and size of tubes used for the test
 The use of autocontrol
 Crossmatch for urgent blood transfusion
 Interpretation of crossmatch results
 Causes for incompatible immediate spin crossmatch
 Causes for incompatible indirect antiglobulin crossmatch
 Causes for positive antibody screen and compatible
crossmatches, negative autocontrol.
 Electronic/computer crossmatch
Labeling of blood or blood components with the recipients identifying information
 Two independent identifiers for the intended recipient
 Donor donation identification number
 Interpretation of compatibility testing
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
Version 1
ULC/TCP/10F
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Training Element SOP:
Discussed
Observed
Performed
Proficiently
Issuing blood or blood components
 Final inspection of blood components and derivatives
before issue
 Presence of a final check of transfusion service records
and each unit of blood or component
o The intended recipient’s two independent
identifiers, ABO group and Rh type.
o The donor identification number, ABO group and
Rh type
o The interpretation cross match test
o Special transfusion requirements
o The date and time of issue
 The process to confirm agreement of the identifying
information, the records, blood or component and the
request.
 Resolving discrepancies
Reissuing Blood and Components
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Conditions for reissuing blood and components that have
been returned to the lab
o Container closure has not been disturbed
o All components maintained at the appropriate
temperature
o At least one sealed segment of integral donor tubing
has remained attached to the container. Removed
segments shall be reattached only after confirming
that the tubing identification numbers on both the
removed and the container are identical.
o The records indicate that the blood or component has
been inspected and that it is acceptable for reissue
Urgent Requirement for Blood Components
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RBCs ABO group to be transfused to the patient
o Recipients whose ABO group is not known shall
receive O RBCs
o If blood is issued before completion of compatibility
testing, ABO type of RBCs or whole blood Should be
compatible with the recipient’s ABO group that has
been determined
 The container tie tag or label: should indicate clearly
that compatibility and/or infectious disease testing was
not completed at the time of issue
 Compatibility testing:
should be completed quickly using a patient sample
collected as early as possible
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
Version 1
ULC/TCP/10F
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Training Element SOP:
Discussed
Observed
Performed
Proficiently
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Records:
should contain a signed statement from the requesting
physician indicating that the clinical situation was
sufficiently urgent to require release blood before
completion of compatibility testing or infectious disease
testing
 The transfusion service medical director and the
recipient’s physician should be notified immediately of
abnormal test results that may affect patient safety.
Quality Control
 Testing Refrigerator Alarms
 Testing Freezer Alarms
 Monitoring Temperature During Shipment
 Calibrating a Serologic Centrifuge for:
o Immediate Agglutination
o Washing and Antiglobulin Testing
MONITORING BLOOD UTILIZATION
 AUDIT PROCESS TO MONITOR TRANSFUSIONS
Transfusion Reactions
 Identification of a Transfusion Reaction
 Clinical Evaluation and Management of Transfusion
Reactions (Patient and Component-focused steps)
 Standard Laboratory Investigations of Transfusion
Reactions
1. Clerical check of the component bag, label, paperwork,
and patient sample.
2. Repeat ABO testing on the posttransfusion sample.
3. Visual check of pre- and posttransfusion sample to look
for evidence of hemolysis (hemolysis may not be visible
if <50 mg/dL of hemoglobin is present).
4. Posttransfusion sample direct antiglobulin test (DAT).
(If positive, DAT should also be performed on a
pretransfusion specimen)
5. Findings reported to blood bank supervisor or medical
director, who may request additional studies or tests.
 Additional laboratory evaluation may be required
when an HTR is suspected:
1. Human error must be ruled out, primarily in the area of
patient and sample identification. Repeat ABO and Rh
testing should be performed on the unit of blood or
available segment, pretransfusion specimen, and posttransfusion sample to exclude any clerical errors or
sample mix-ups.
2. Antibody detection studies should be performed on the
pre- and posttransfusion samples to look for any
previously undetected alloantibodies.
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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3. The crossmatch should be repeated with both pre- and
posttransfusion specimens using the indirect antiglobulin
test (IAT) method, which has increased sensitivity over
the immediate spin crossmatch.
4. When laboratory evidence of hemolysis is not evident,
demonstration of decreased red cell survival may aid in
the diagnosis. Serial hemoglobin levels may be adequate,
or red cell survival studies may be required in more
complex cases. Phenotypic differences be- tween the
donor and the patient can be identified and followed
using flow cytometry. The patient may be evaluated by
serial mea- surement of certain laboratory values such as
haptoglobin, lactate dehydrogenase (LDH), and
unconjugated bilirubin levels. An increase in bilirubin
may begin as early as 1 hour after the reaction, peak at 5
to 7 hours, and disappear within 24 hours if liver function
is normal.
5. Examination of the returned components may yield
important information concerning possible traumatic or
mechanical causes of hemolysis. Both the blood bag and
the administration tubing should be included in the
examination. Hemolysis in both the component container
and administration set could result from a process that
affected the unit of blood, such as inappropriate warming
of the unit. If the hemolysis was present only in the
administration set, a faulty infusion pump, if used, could
be the cause. The transfusion service must retain any
patient records that are related to transfusion reactions,
clinically significant antibodies, and special transfusion
requirements. Additional information regarding special
products, such as irradiated or washed components
required for a particular patient, may be retained by the
transfusion service as well.
 Specialized Laboratory Investigations for Selected
Reactions:
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Anaphylaxis: the patient should be tested for antibodies
to immuno- globulin A (anti-IgA). IgA-deficient patients
should be transfused with components from IgAdeficient donors. Washed cellular blood components may
be considered in these patients.
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Sepsis: Visual examination of the returned compo- nent
should be conducted in suspected cases of
posttransfusion sepsis, paying particular attention to any
color changes, especially brown or purple discoloration
in a red cell component, and bubbles, especially
frothiness in a platelet component. A Gram’s stain should
be performed on the returned compo- nent, and cultures
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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should be performed on both the component and the
patient’s post- transfusion blood sample.
Transfusion-Related Acute Lung Injury: In cases of
suspected transfusion-related acute lung injury (TRALI),
the collecting facility should be consulted to coordinate
the ap- proach to posttransfusion testing. Patient samples
should be obtained at the time of the reaction because
they may not be available at a later date. A serum sample
should be drawn for antibody studies, and an acid-citratedex- trose tube should be drawn for HLA typing. The
collecting facility may obtain a sample of the donor’s
serum to test for HLA and neutro- phil antibodies.
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Trainee Performance Evaluation
This part should be completed by the TRAINER
Please Tick the appropriate box to the right
Evaluation Method
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Yes
Result Of Evaluation
Satisfactory
Un
Satisfactory
Oral evaluation
Direct observation competency (If yes, complete the form)
Written competency
Unknown samples (If yes, include a copy of the result)
Other
Corrective Action If Needed
DATE OF TRAINING STARTED
DATE OF TRAINING COMPLETED
TRAINEE SIGNATURE
TRAINER SIGNATURE
SUPERVISOR SIGNATURE
DATE
: ……………………………
: ……………………………
: ……………………………..
: ……………………………..
: ……………………………..
: ……………………………..
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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No
Suggested Reading:
I.
Technical Manual, AABB, 16th edition (2008)
Chapters
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Chapter 2: Facilities, Work Environment, and Safety
Chapter 8: Infectious Disease Screening
Chapter 9: Storage, Monitoring, Pretransfusion Processing, and Distribution of Blood
Components
Chapter 12: ABO, H, and Lewis Blood Groups and Structurally Related Antigens
Chapter 13: The Rh System
Chapter 15: Pretransfusion Testing
Chapter 22: Perinatal Issues in Transfusion Practice
Chapter 27: Noninfectious Complications of Blood Transfusion
Chapter 28: Approaches to Blood Utilization Auditing
Methods
Section 1
General Laboratory Methods
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METHOD 1-1. SHIPPING HAZARDOUS MATERIALS
METHOD 1-1-1. MONITORING TEMPERATURE DURING SHIPMENT OF BLOOD
METHOD 1-2. TREATING INCOMPLETELY CLOTTED SPECIMENS
METHOD 1-3. SOLUTION PREPARATION PROCEDURE
METHOD 1-5. DILUTION OF % SOLUTIONS PROCEDURE
METHOD 1-6. PREPARING A 3% RED CELL SUSPENSION
METHOD 1-7. PREPARING AND USING PHOSPHATE BUFFER
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METHOD 1-8.
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READING AND GRADING TUBE AGGLUTINATION
Section 2
Red Cell Typing
METHOD 2-2. DETERMINING ABO GROUP OF RED CELLS AND SERUM—TUBE TEST
METHOD 2-4. INITIAL INVESTIGATION OF ABO GROUPING DISCREPANCIES PROCEDURE
METHOD 2-13. DETERMINING Rh (D) TYPE—TUBE TEST
METHOD 2-15. TESTING FOR WEAK D
Section 3
Antibody Detection, Identification, and Compatibility Testing
METHOD 3-1. USING IMMEDIATE-SPIN COMPATIBILITY TESTING DEMONSTRATE ABO
INCOMPATIBILITY
METHOD 3-2. DETECTING ANTIBODIES TO RED CELL ANTIGENS—INDIRECT
ANTIGLOBULIN TESTS
METHOD 3-2-1. SALINE INDIRECT ANTIGLOBULIN TEST PROCEDURE
METHOD 3-3. PREWARMING PROCEDURE
METHOD 3-2-3. LISS INDIRECT ANTIGLOBULIN TEST PROCEDURE
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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ULC/TCP/10F
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METHOD 3-4. DETECTING ANTIBODIES IN THE PRESENCE OF ROULEAUX—SALINE
REPLACEMENT
METHOD 3-6. PERFORMING A DIRECT ANTIGLOBULIN TEST
Section 6
Blood Collection, Component Preparation, and Storage
METHOD 6-12. THAWING AND POOLING CRYOPRECIPITATED AHF
Section 8
Quality Control
METHOD 8-2. STANDARDIZING AND CALIBRATING THERMOMETERS
METHOD 8-2-1. CHECKING LIQUID-IN-GLASS LABORATORY THERMOMETERS
METHOD 8-3. TESTING BLOOD STORAGE EQUIPMENT ALARMS
METHOD 8-3-1. TESTING REFRIGERATOR ALARMS
METHOD 8-3-2. TESTING FREEZER ALARMS
METHOD 8-5. CALIBRATING A SEROLOGIC CENTRIFUGE
II.
Standards, AABB , 25th Edition (2008)
Training and Competency Assessment Program/ Training
Effective Date: 31 May, 2011
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