RELIABILITY OF THE PRETRANSFUSION BEDSIDE COMPATIBILITY TEST - ASSOCIATION WITH TRANSFUSION PRACTICE AND TRAINING

BACKGROUND: The utility of a pretransfusion bedside blood compatibilit y protocol to decrease immunohemolytic accidents has been questioned f or years. STUDY DESIGN AND METHODS: The reliability of a standard beds ide ABO compatibility test was evaluated with a stratified random samp le of 48 nurses who performed agglutination testing by using Bristol c ards, interpreted compatibility, and decided whether to transfuse red cells for 12 randomly and blindly selected donor and-recipient blood s ample pairs. An expert judged technical performance and the interpreta tion of each card. RESULTS: Erroneous decisions occurred in 18.2 perce nt of 576 tests, including 12 decisions to transfuse incompatible bloo d. Errors involved both testing protocols and the interpretation of co mpatibility. Anti-A and anti-B were detected with 92.8-percent sensiti vity and 95.9-percent specificity. The expert judged 17.7 percent of t ests to be technically inadequate, most often because of the applicati on of excess blood to the card and a lack of rotation of the card. Tes ting errors (16.1% of tests) were significantly linked to infrequent t ransfusion activity by the nursing service, inexperience, and insuffic ient training. Compatibility misinterpretation occurred in 14.6 percen t of the tests and was significantly linked to the nurses' infrequent transfusion activity, inexperience, insufficient training, lack of pra ctical experience, and con; fusion regarding the use of ABO-compatible but not identical blood. CONCLUSION: Bedside pretransfusion compatibi lity determination should not be considered a reliable supplemental sa fety procedure in the hands of inexperienced and insufficiently traine d operators.