GUIDELINES FOR REFERRAL
Annex 1: INSTRUCTIONS FOR THE REFERRAL OF BLOOD SPECIMENS
FOR CONFIRMATION OF REACTIVITY TO TRANSFUSION-TRANSMITTED INFECTIONS
(HBV/HCV/HIV/MALARIA) Version 3.5
(Effectivity: February 22, 2014) / (Date Revised: February 26, 2015)
1.
Purpose
This document provides the updated instructions for the referral of blood specimens for the
confirmation of reactivity to HBsAg (HBV), HCV, HIV and Malaria as well as instructions for the validation of
testing performance among the NVBSP Blood Service Facilities performing testing.
2.
Method
2.1
Scope
All blood units and components found reactive to HBsAg, HCV, HIV and Malaria shall be sent to
RITM TTI-NRL for confirmation in accordance with the following instructions:
2.1.1.
Segregate and label all reactive blood units and components found reactive to HBsAg, HCV, HIV,
and Malaria in a clearly designated and safe area. Keep refrigerated at 2-4oC.
2.1.2.
For separated blood components, send only the bag containing the plasma (e.g. platelet
concentrate, fresh frozen plasma or cryoprecipitate).
2.1.3.
For Malaria confirmation, send Giemsa stained Thick and Thin blood smear.
2.1.4.
HBV samples tested using the following kits with Optical Density (OD) or Sample / Cut off Value
exceeding the Cut-Off Points set by the TTI-NRL RITM should no longer be sent for confirmatory.
(See Annex 1: Department Circular No. 2012-0198).
NAME OF TEST KIT
CUT-OFF POINTS
Abbott Axsym HBsAg (S/CO)
Roche Elecsys HBsAg (S/CO)
Abbott Architect HBsAg (S/CO)
BIORAD Monolisa HBsAg ULTRA (OD/COV)
≥ 34.9
≥ 20.46
≥ 34.32
≥ 20.1125
Table 1. Cut-Off Points Summary
2.1.4.1. Service Facilities using the aforementioned test kits should accomplish and submit the
“HBV Quarterly Referral Report”. (See Annex 2: HBV Quarterly Report Form)
2.1.5
Blood units tested reactive to Syphilis should no longer be sent for confirmatory testing. (See
Annex 3: Department Circular No. 2013-0132)
2.1.6
Blood units tested reactive by methods that do not conform to the guidelines herein shall not be
accepted for further testing. (See Annex 3: Department Circular No. 2013-0132)
2.1.7
All Referring Blood Service Facilities are required to accomplish and submit the “TTI Quarterly
Report Form”. (See Annex 4: TTI Quarterly Report Form)
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2.2.
Document Requirements prior to Shipment
2.2.1.
Each specimen should be accompanied by a completely filled-out request form for proper
documentation. (See Annex 5: Confirmatory Request Form V3.2)
2.2.1.1. Ensure that the information on the request form matches the information on the blood
unit and blood smear.
2.2.1.2. HIV confirmed blood units and donors will be reported by the National Reference
Laboratory.
2.3.
Criteria for Sample Rejection
2.3.1
Specimens are considered UNACCEPTABLE for confirmation if they fall under any of the following
criteria. NOTE: TTI-NRL shall not test rejected samples.
2.3.1.1 General Criteria
2.3.1.1.1
Discrepant samples.
Aliquoted sample or blood bag labels SHOULD be IDENTICAL to those details
provided in the request form.
CORRECT LABEL
INCORRECT LABEL
Sample Label
2012-123456789
2012-123456789
Request Form
2012-123456789
12-123456789
Sample Label
J.D.C
J.D.C
Request Form
J.D.C
Juan dela Cruz
Sample Label
12345 (MGH) NVBSP
12345 (MGH) NVBSP
Request Form
12345 (MGH) NVBSP
(MGH) NVBSP 12345
Table 2. Example of Discrepant Labels
2.3.1.1.2 Sample labels not clear. (Refer to section 2.5.2.3 for Proper sample labeling);
2.3.1.1.3 Unreadable handwriting on request form. (Write legibly in BOLD letters).
2.3.1.1.4 Samples with Optical Density reading higher than the Cut off value set by the
TTI-NRL. (Refer to 2.1.4.)
2.3.1.2 Blood units and components
2.3.1.2.1 Spilled or damaged during storage and transport. (Refer to section 2.5 for
proper sample packaging);
2.3.1.2.2 Contaminated as a result of improper storage or spillage;
2.3.1.2.3 Aged (i.e. stored at 4 ºC for more than 1 month prior to receipt);
2.3.1.2.4 Blood Bags with intact needles.
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2.3.1.3 Aliquoted Sample
2.3.1.3.1 Broken glass test tube container. (Container may break during transport
especially when packed improperly);
2.3.1.3.2 Insufficient amount of plasma. (Aliquoted samples are required to be at least
10 ml).
2.3.1.4 Blood Smear (See Annex 6: Preparation of Blood films for Malaria Detection).
2.3.1.4.1 Poorly prepared blood smear;
2.3.1.4.2 Damaged blood smear;
2.3.1.4.3 Unstained smear;
2.3.1.4.4 Washed-out blood smear;
2.3.1.4.5 Broken glass slides
Grossly Hemolyzed Sample
Unstained Blood Smear
Washed-out Blood Smear
Spilled or Damaged Blood
2.4.
Blood Bags with intact needle
Timing of Shipment to RITM
As the quality of confirmatory testing is dependent on the age of the samples, send to RITM
within one (1) week as much as possible.
2.4.1.
Send blood units and components tested for HIV using Antigen-Antibody combination test kits
within five (5) days as HIV antigen deteriorates on storage. However, if a considerable delay is
anticipated, freeze an aliquot of 10.0 mL plasma at -20ºC or lower and send within two (2) weeks.
2.4.2.
For Regional Blood Centers, specimens may be sent within one (1) month; however, in this case,
separate an aliquot of 10.0 mL plasma. Keep plasma samples frozen at -20ºC or lower.
2.4.3
For specimens sent for malaria confirmation from Regional Blood Centers, Send Giemsa stained
Thick and Thin blood smear.
2.5.
Sample Packaging
The Blood Bank Staff must ensure that the specimens are properly packed during transport so that
it will arrive at RITM in good condition and that they do not pose any hazard to the person(s) handling the
specimens, the community, and the environment.
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Blood Units and Aliquoted samples should be arranged by requested examination (HIV first followed
by HBV, HCV, Malaria). Also, the request forms should be arranged as to how the blood units / aliquoted
samples were packed to facilitate a better, faster, safer and orderly receipt of the samples.
2.5.1.
Blood Units and Components
2.5.1.1 Make sure that needle(s) are removed from the blood bag(s) and that tubing is tightly
sealed to prevent possible leakage of blood.
2.5.1.2 Place each blood unit(s) or component in a plastic bag(s) and seal tightly. Label the plastic
bag with the name of the referring blood service facility and Requested confirmatory test
(HBV, HCV, HIV, Malaria).
2.5.1.3 Place in a cold transport container and surround with enough adequate frozen ice packs
depending on the size of the transport box to maintain a refrigerated environment (24ºC) during transport. Care should be taken to prevent hemolysis.
2.5.1.4 Place the request form(s) in a separate plastic bag to prevent it from being soiled or
contaminated. If possible, collate the request form(s), place inside a brown envelope and
attach securely outside the transport box.
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2.5.1.5 Document the shipment including the blood unit identification, date sent, name of
referring blood service facility, name of shipper, name of consignee, acknowledgement of
courier and receipt at RITM.
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2.5.1
Aliquoted Samples
2.5.2.1. Ensure that sample volume is at least 10.0 mL.
2.5.2.2. Secure the cap of the specimen tubes tightly and seal with Parafilm® (paraffin sealing
film) to prevent leakage.
2.5.2.3. Ensure that the tubes are clearly and legibly labeled with the Blood Bag
identification/code, Serial number, Blood type, date of collection and Requested
confirmatory test (HBV, HCV, HIV, Malaria). Ensure that the label or marking will remain
attached and secure under all conditions of storage and transport.
2.5.2.4. Insert specimen tubes in appropriate test tube racks to avoid disorientation of specimen
during transport.
2.5.2.5. Place the specimens in double plastic bag with enough absorbent material (e.g. Paper
towel, Gauze). Label with the name of the referring blood bank and date of referral.
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Telefax No.: (02) 808 - 2552  Trunkline: (02) 807 – 2628 local 229  Email: tti.nrl@gmail.com  Website: tti-nrl.com
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2.5.2.6. Place in a cold transport container and surround with enough frozen ice packs depending
on the size of the transport box to maintain 2-4⁰C during transport.
2.5.2.7. Place the request form(s) in a separate plastic bag to prevent it from being soiled or
contaminated. If possible, collate the request form(s), place inside a brown envelope and
attach securely outside the transport box.
2.5.2.8 Document the shipment including the blood unit identification, date sent, name of referring
blood service facility, name of shipper, name of consignee, acknowledgement of courier
and receipt at RITM.
2.5.2
Stained blood smears
2.5.3.1. Wrap slides in smooth textured clean paper (e.g. Bond Paper ) and place in a box or
envelope with enough packing material (e.g. paper sheets, paper towels) to prevent
slides from being broken during transport.
2.5.3.2. Label the wrapped slides with the Blood Bag identification/code, Serial number, Blood
type, date of collection.
2.5.3.3. Place the Request Form and Blood Smears in the same envelope.
2.5.3.4 Provide additional cushioning materials if slides will be sent through courier.
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2.6 Transport to RITM
2.6.1
Label the shipment container legibly with a permanent marker. The label should be clear, not
covered or obscured by any part or other attachments.
2.6.1.1 For Blood Banks in the National Capital Region, blood specimens are transported through
the Blood Express according to an arranged schedule. However, blood specimens may be
sent directly to RITM anytime during weekdays between 8am to 5pm. As much as possible,
do not send specimens beyond office work hours and Fridays, weekends and holidays.
Only authorized laboratory personnel of referring blood service facility are allowed to
transport / deliver samples to RITM for referral.
2.6.1.2 For Regional Blood Banks, ship the blood specimens through any accredited courier service
that can guarantee delivery to RITM within 24 hours.
2.6.2
Address the shipment to:
HEAD, TTI - NRL
Research Institute for Tropical Medicine
Research Drive, DOH Compound, Filinvest Corporate City,
Alabang, Muntinlupa City 1781
HEAD, TTI - NRL
Research Institute for Tropical Medicine
Research Drive, DOH Compound,
Filinvest Corporate City, Alabang,
Muntinlupa City 1781
2.6.3
Transport boxes should be securely fastened in the transport vehicle. A spill kit containing
absorbent material, disinfectant, gloves, mask and disposal container (or Biohazard Bag) should be
present in the vehicle.
2.6.4
For inquiries contact:
Ms. Rhoda T. Yu, RMT
Technical Supervisor
TTI-NRL
Telephone No.
(02) 807-2628 local 229
Telefax.
(02) 808-2552
Mobile No.
0921-5094339 (SMART)
0927-6625807 (GLOBE)
9002 Research Drive, DOH Compound, Filinvest Corporate City, Alabang, Muntinlupa City 1781 Philippines
Telefax No.: (02) 808 - 2552  Trunkline: (02) 807 – 2628 local 229  Email: tti.nrl@gmail.com  Website: tti-nrl.com
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