Transfusion - Pre-compatibility Testing —
Training activity: 2

Details

Perform, interpret and report ABO, extended Rh and K typing on patient samples

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• ABO typing techniques – manual and automated
• Extended Rh and K typing – manual and automated

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to performing, interpreting, and reporting ABO, extended Rh, and K typing.
• Consider how the learning outcomes apply, specifically those which relate to selecting techniques, identifying algorithms, describing limitations, practicing according to guidelines/procedures, performing acceptance testing, and proposing resolutions for anomalous results.
• What specific steps or criteria define accurate typing, correct interpretation, and appropriate reporting?
• What results would be considered anomalous and require further investigation?
• Discuss with your training officer to understand the expected turnaround times and the level of detail required in reporting, especially for complex cases.

What is your prior experience of this activity?

• Think about what you already know about the genetics and serology of ABO, Rh, and Kell systems. What are the principles of the techniques used in your laboratory e.g., tube, gel, column?
• Consider possible challenges you might face e.g., weak or missing reactions, rouleaux, cold autoantibodies, variants. And think about how you might handle these.
• Recognise the scope of your own practice for this activity. When would you need to seek advice regarding discrepant or anomalous typing results?
• Acknowledge how you feel about performing these fundamental tests, recognising their critical role in transfusion safety.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in performing serological techniques accurately and troubleshooting issues.
• Identify specific insights you hope to gain into the complexities of blood group genetics and the clinical significance of different antigens/antibodies.

What additional considerations do you need to make?

• Consult actions identified following previous experience with blood typing that could improve your technique or interpretation.
• Identify important information you need to consider before embarking on the activity, such as current laboratory SOPs for typing, QC procedures, potential patient history affecting results, or the availability of antisera for extended typing.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing the typing?
• Are you encountering situations such as:
  • Weak agglutination reactions or unexpected antibodies interfering with typing, challenging accurate interpretation
  • A discrepancy between forward and reverse grouping (ABO discrepancy) requiring immediate further attention
  • Unexpected difficulty in interpreting certain Rh phenotypes or weak K reactions

How are you reacting to the unexpected development?

• How is this impacting your actions? Did you adapt or change your serological technique or interpretation approach in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately troubleshooting or adapting your approach to resolve weak reactions or discrepancies
  • Cross-checking forward and reverse groups meticulously to confirm the anomaly
  • Seeking immediate guidance on interpretation or discrepancy resolution from a senior colleague
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge to interpret anomalous Rh phenotypes? Is it affecting your confidence in justifying the reported type?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully troubleshooting common issues, or needing support because the discrepancy is complex (e.g., suspected acquired B) and requires further testing?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the principles of red cell antigen typing and potential sources of error?

 

On action

What happened?

• Begin by summarising the process of performing, interpreting, and reporting ABO, extended Rh, and K typing. What were the results you obtained?
• Consider specific samples that presented challenges during testing or interpretation, such as weak reactions, unexpected results, or ABO discrepancies. How did you feel when faced with these results?
• Include any ‘reflect-in-action’ moments where you had to adjust your technique or interpretation based on preliminary results. What specific findings triggered these adjustments

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the nuances of ABO, Rh, and K typing, including potential sources of error. What strengths did you demonstrate, such as skills in interpreting serological reactions and applying sequential testing algorithms? What skills and/or knowledge gaps were evident e.g., unfamiliarity with specific antibodies or weak phenotypes?
• Compare this experience against previous typing experiences. Has your ability to interpret complex results improved? Did you successfully apply lessons from previous attempts?
• Identify any challenges you experienced e.g., technical issues, difficult interpretations and how you handled them.
• Did you need to seek advice or clarification on interpreting results? Did you ensure you were working within your scope of practice when reporting the results?
• Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in performing, interpreting, and reporting typing results.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to improve your understanding or skill, especially for challenging typing cases. Do you need to review theory on specific blood group systems or interpretation algorithms?
• What will you do differently the next time you encounter a sample with weak or discrepant typing results?
• Do you need further practice in interpreting serological reactions or using specific techniques?

Beyond action

Have you revisited the experiences?

• Reviewing your past experiences performing, interpreting, and reporting ABO, extended Rh, and K typing, what specific actions for development did you identify in previous reflections?
• Have you focused on improving your technical skills, understanding of common discrepancies, or interpretation of results in different patient populations?
• How ready are you to apply this enhanced knowledge and skill in performing accurate and reliable blood typing?
• Have you engaged in professional storytelling or discussions with colleagues or supervisors about unusual or difficult blood typing results? Did these conversations provide new insights that have altered your perspective on interpreting complex typing patterns or troubleshooting technical issues?

How have these experiences impacted upon current practice?

• How does your accumulated experience and reflection on blood typing prepare you for assessments such as a DOPS performing testing to resolve blood grouping for samples with anomalous initial results or an OCE reporting results?
• How has your understanding of blood group systems and your ability to perform and interpret typing tests developed and deepened over time?
• Are you more confident in recognising potential errors or unexpected results during typing?
• Can you now more readily identify situations where expert input is needed for complex typing issues, ensuring you are working within your scope?

Relevant learning outcomes

#	Outcome
# 1	Outcome Select suitable and valid techniques for transfusion pre-compatibility testing.
# 2	Outcome Identify sequential testing algorithms appropriate to the samples under investigation for pre-compatibility testing.
# 3	Outcome Describe the limitations of methods used in pre-compatibility testing including sources of error and sample issues.
# 4	Outcome Practice in accordance with guidelines and procedures relevant to pre-transfusion testing.
# 5	Outcome Perform acceptance testing of samples requiring pre-transfusion testing and ensure samples follow appropriate testing streams relating to clinical condition.
# 7	Outcome Propose resolutions for anomalous blood group antigen typing.