[Final bedside verification: results of a national survey of reagents and devices used in France]

Evaluation of Four Bedside Test Systems for Card Performance, Handling and Safety

SUMMARY: OBJECTIVE: Pretransfusion ABO compatibility testing is a simple and required precaution against ABO-incompatible transfusion, which is one of the greatest threats in transfusion medicine. While distinct agglutination is most important for correct test interpretation, protection against infectious diseases and ease of handling are crucial for accurate test performance. Therefore, the aim of this study was to evaluate differences in test card design, handling, and user safety. DESIGN: Four different bedside test cards with pre-applied antibodies were evaluated by 100 medical students using packed red blood cells of different ABO blood groups. Criteria of evaluation were: agglutination, labelling, handling, and safety regarding possible user injuries. Criteria were rated subjectively according to German school notes ranging from 1 = very good to 6 = very bad/insufficient. RESULTS: Overall, all cards received very good/good marks. The ABO blood group was identified correctly in all cases. Three cards (no. 1, no. 3, no. 4) received statistically significant (p < 0.008) prominence (mean values shown) concerning clearness of agglutination (1.7-1.9 vs. 2.4 for no. 2). Systems with dried antibodies (no. 2, no. 4) outmatched the other systems with respect to overall test system performance (2.0 vs. 2.8-2.9), labelling (1.5 vs. 2.2-2.4), handling (1.9-2.0 vs. 2.5), and user safety (2.5 vs. 3.4). Analysis of card self-explanation revealed no remarkable differences. CONCLUSION: Despite good performance of all card systems tested, the best results when including all criteria evaluated were obtained with card no. 4 (particularly concerning clear agglutination), followed by cards no. 2, no. 1, and no. 3.

[Diversity of bedside pretransfusion ABO compatibility devices in metropolitan France]

To prevent the occurrence of the ABO incidental incompatibility, the bedside pretransfusion ABO control is mandatory in France since 37 years. If the quality of the reagents is regularly controlled, no technical specification exists concerning the type of support. To describe the different types of devices used by the French hospitals, a brief questionnaire was sent, from December 2000 to March 2001, to each hemovigilance correspondent working in the 1782 hospitals with transfusion activity in 1999. Every participant had to send back the device used in his establishment. The rate of replies was 29.4%, varying from a region to another. The devices distributed by laboratories were the most used (67.4%) vs. 25.6% for the devices provided by the regional establishments of the French Establishment of Blood and 6.7% for the devices manufactured by hospitals. The presence in the region of a local office of the French Establishment of Blood providing some devices was the only factor determining the choice of the device type (p < 10(-8)). Almost half of the hospitals (46.8%) declared to have renewed their devices after 1996, most often in favor of a device provided by a laboratory (p < 10(-8)). We evaluated 30 different devices taking into account the general presentation, the available information on the device. The results of this survey showed a large disparity and heterogeneity in the quality of the devices used by the French hospitals in the context of a lack of standardization.

Reliability of bedside ABO testing before transfusion

BACKGROUND

Previous studies of bedside transfusion compatibility tests have shown high rates of erroneous transfusion decision, due to defective techniques and poor user performance. An experimental study was conducted to evaluate the error rate obtained with a new ready-to-use device (Vu-Test, Medigis), in comparison with the most popular bedside card used in France (Safety-Test ABO, Diagast Laboratories).

STUDY DESIGN AND METHODS

A stratified random sample of nurses performed, in the clinical departments where they worked, cross-matches on 12 randomly and blindly selected paired donor-recipient blood samples with Safety-Test ABO and Vu-Test. The nurses detected agglutination, interpreted compatibility, decided whether to transfuse, and gave their opinion of the two devices. Three independent experts reviewed photographs of each test result.

RESULTS

Thirty-five trained nurses and 10 student nurses carried out 268 tests with each device. One-hundred ninety tests (70.9%) performed with Safety-Test ABO and 177 tests (66.0%) performed with Vu-Test were entirely error-free (p=0.23). The risk of erroneous detection of agglutination was not different between the devices (p=0.69), but was significantly lower when the nurse had experience in transfusion (p < 0.001). According to the experts, Vu-Test was significantly better than Safety-Test ABO.

CONCLUSION

Although the experts considered Vu-Test to be better than Safety-Test ABO, error rates were high with both devices.

[Ultimate pre-transfusion control: evaluation of seven appliances]

The transfusion unit of the Institut Gustave Roussy has tested seven pre-transfusion ABO control devices registered at the Agence française de sécurité sanitaire et des produits de santé. Determination of the optimal plan to replace the existing plan in our institution was the primary objective of this study. A significant heterogeneity was observed among tested devices. None of the tested plans fulfilled all the desired quality criteria.